PAINS

   Low enrollment
   Broker management issues
   Low customer retention
   Inaccurate reporting
   Quoting and underwriting delays
   Marketing campaign issues
   Competitor tracking
   Low productivity
   Increasing claims costs
   Increased expenses
   Billing issues
   Profit losses
   Merger difficulties
   Multiple offices and branches
   Internal communications
   Excessive paperwork
   Decrease in service quality
   Other

PAIN DESCRIPTION:

The problem of low enrollment has a loopy effect: clients are not attracted to HMOs with low enrollment. Numerous studies have found that the presence of HMOs in the healthcare marketplace reduces costs throughout the healthcare system.

Further supporting this conclusion is new research that shows premiums for employer-sponsored insurance are lower in areas with high HMO enrollment. Specifically, total employer insurance costs are 8-10 percent less in areas where HMO market share is above 45 percent, compared with areas where HMO enrollment is below 25 percent.

Several factors contributed to this positive impact on holding down premium costs: HMO premiums are often lower than non-HMO premiums; high HMO enrollment areas have experienced much slower recent growth in premiums than other areas; and substantial HMO market presence exerted a "spillover" effect that helped to restrain non-HMO premiums. The researchers noted that the spillover effect of competitive pressure was evident in areas with an HMO market share above 25 percent.

Often Health Plans have low enrollment if they were not able to attract potential clients, market successfully, or keep a finger on the pulse of their sales process.

PAIN ANALYSIS:

The dream of most Health Plans is to enroll companies with 100+ employees, who are all healthy, young, and do not have chronic conditions. Not all HMOs/PPOs are happy with Medicare, Medicaid, or federal enrollees.

For example, General Accounting Office (GAO) found that the number one reason HMOs drop federal enrollees is because of low enrollment. "Plan enrollment is one of the most critical components of a plan's overall profitability," GAO said in their report.

Low enrollment also increased HMO managers' concerns that their companies were taking on too much financial risk. HMOs worried that costs would outweigh premiums. For example, the premature birth of triplets to an enrollee in a small HMO could be enough to throw its profitability off, GAO said.

Your success is directly linked to the number of subscribers you gain. Low enrollment is the leading cause of financial instability for HMOs. The two most successful ways of increasing enrollment are closing more quotes and increasing renewals. What is the reason you lose so many renewals? Why does that competitor always beat you on quotes?

Closing Quotes

Imagine having the ability to streamline the process of census and application processing, underwriting, and plan design, giving your reps all the information to build relationships, actively following up, prioritizing major quotes, and automating the follow-up of small quotes.

Renewals

Relationships take time and effort. Automating customized, unique contacts that drive response back to your reps ensures satisfaction throughout the policy term. Automatically educating subscribers in preventive care and new services allows you to deepen the loyalty to your plan. Being able to deal with issues like speed of response, quality of care, and accuracy in network referrals, all on one call, is only possible with the right tools.

How do you deal with low enrollment problem in your organization? Is your marketing reaching your target audience? Do you track sales process steps? How well do you know your prospects? How many quotes do you lose due to a minor mistake?

ADVICE:

Wouldn't it be great if you had one automated system that would help you to answer all of the above questions?

According to the HMOZ CRM Report, properly implemented CRM software can help significantly increase enrollment (16 to 48 percent for Health Plans with less than 1,000,000 members, and 8-12 percent for Plans with more than 1 million members) and even select more desirable types of enrollees. If you had one system, designed only for Health Plans, that manages all your prospects, sold groups, brokers and agents, specialists and providers; quotes, renewals, and plans; marketing campaigns and expenses; powerful reports; opportunities; competitors; and your sales and marketing library, you would be empowered with the advantage to do the same job required to enroll a new group in less time and instantly access crucial information for faster closure.

Most of HMOZ respondents reported a decrease in data entry, increase in service quality, and control over the sales process. Direct sales became more predictable and communication with brokers and agents improved significantly.

One Demo is better than a thousand words, and one Solution Audit is better than a thousand demos. We encourage you to follow our CRM proverb and take advantage of this opportunity.

Click on one of the three links below to continue your HMOZ research.