Best Practices amidst Merger Talks
1 like144 views
The document analyzes the member websites of Aetna and Humana to identify best practices in features such as plan details, claims, personal health records, and wellness programs. It finds that while both sites provide effective capabilities, Humana excels in areas like responsive design, plan information positioning, and its incentivized wellness program. The document concludes that a merger between the companies could combine their respective strengths to create an improved digital experience for members with more transparency, convenience, and tools to support health and wellness.
Best Practices amidst Merger Talks
- 1. Best Practices amidst Merger Talks A Review of the Aetna and Humana Member Websites
- 2. 1 ABOUT CORPORATE INSIGHT Corporate Insight (CI) provides competitive intelligence and user experience research to the nation's leading finance and insurance institutions. For 20 years, CI has tracked new developments across industries through our syndicated Monitor research and consulting services. Now, Corporate Insight is turning our proven methodology to examine the digital member experience of leading group health insurance firms. There are no assumptions in our work – we use live accounts with industry leaders to benchmark their effectiveness across all major channels and give our clients unparalleled competitive intelligence. PRESS COVERAGE CONNECT WITH CI
- 3. 2 INSIDE… ABOUT CORPORATE INSIGHT .........................................................................1 INTRODUCTION ...........................................................................................3 RESEARCH METHODOLOGY............................................................................3 BEST PRACTICES ..........................................................................................4 Multi-Device Compatibility ............................................................4 Plan and Coverage Details..............................................................5 Personal Health Record..................................................................8 Claims...........................................................................................10 The Wellness Trifecta: Health Assessment, Goal-Setting, and Rewards Program.........................................................................13 Help Resources: Communication Center, Live Chat, FAQs ...........15 CONCLUSION ............................................................................................18 CONNECT WITH CORPORATE INSIGHT............................................................19
- 4. 3 INTRODUCTION Amidst an uptick in industry mergers and consolidations, Aetna and Humana struck a deal that would combine Humana’s Medicare Advantage business with Aetna’s commercial portfolio, providing health insurance to over 29.4 million individuals and creating the largest Medicare Advantage insurer in the U.S. Although the proposed merger is not expected to close until 2016, both firms have expressed that with this combination, they will commit to create innovative, technology-driven products as well as online services and solutions that promote high-quality health, and greater transparency and convenience for consumers. For members, the merger could result in an improved digital experience, combining Aetna’s strength in medical history resources and claims details with Humana’s strength in responsive web design, plan/coverage details and its HumanaVitality program. RESEARCH METHODOLOGY In this one-off study, we imagine an optimized member experience resulting from the combination of best practices from Aetna and Humana. While we are not predicting that all of these services will be offered by either insurer at any point in the near future, the possibility of an improved digital experience for both Aetna and Humana members does exist. Given the recent merger, this study highlights the best practices of the private member websites of Aetna and Humana, offering detailed analysis of the most notable site features - including website design and navigation, plan information positioning, account management capabilities and educational tools and resources.
- 5. 4 BEST PRACTICES This white paper identifies the following best practices for member resources on the private websites of Aetna and Humana. The resources listed are not solely offered by the highlighted firm, but represent the best features available from the Aetna and Humana member sites. Multi-Device Compatibility Digital technologies represent a vital avenue through which firms showcase plans, educate consumers and integrate members. Members use tablets and mobile devices in place of traditional desktop computers to learn about healthcare and wellness initiatives, check and pay claims, locating healthcare providers and more. As an attractive and cost-friendly method of delivering tools for health-related activities, more health insurers should go responsive in order to target the tech savvy population that demands the speed and convenience they have come to expect from the banking, property and casualty insurance, and retirement industries. Model: Humana Humana provides a fully responsive private website, employing expandable sections, swiping capabilities, an omnipresent main menu and other functionalities. Members receive a unique and noteworthy online experience through seamless navigation and user-friendly displays when traversing through plan coverage and claims details, health and well-being educational content, the HumanaVitality health rewards program and a health care provider location tool. Aetna members would significantly benefit from this upgrade in site navigation through more intuitive access to online resources as well as an overall improved aesthetic look to the site.
- 6. 5 Plan and Coverage Details Viewing plan and coverage details is integral to the member’s online user experience. The plan information display centrally hosts all pertinent information for those insured, including plan type, plan name, provider network, member name, member ID, and group ID. Coverage details should be directly displayed on the member site and include in-network and out-of- network rates, provider rates, copayments, deductibles and limits for medical services. Offering an abundant selection of online plan information and coverage details is always encouraged, as members expect transparency. However, it is essential for firms to properly organize this content using tables and distinguishable sectional borders. Firms should consider using expandable sections to maximize page real estate. Model: Humana Humana’s member site offers noteworthy plan and coverage information accessible directly from the homepage and from an aptly named tab on the main menu. The site provides all pertinent plan Expandable main menu and sections via a menu icon and disclosure controls Swiping capabilities featured on all horizontally scrolling menus Main Navigation Menu – Mobile View Mobile Member Site Homepage – Coverage & Claims Intrapage Tab
- 7. 6 information that a member would find on their ID card as well as health benefit plan coverage details within expandable tables. Members can also modify the amounts displayed with a calendar filter capability. While Aetna’s site offers access to just as much plan and coverage information and has a similar expandable tabs that organize Medical, Dental and Pharmacy benefits, members would benefit more from the Humana model which promotes coverage and benefits information directly on the homepage. Medical Coverage & Benefits Page (Top) Comprehensive coverage details including limitations and exclusions Members can modify the date displaying the information Lightbox with member’s DOB, relationship to subscriber, and mailing address
- 8. 7 Medical Coverage & Benefits Page (Bottom) A separate Deductibles & Maximums page includes progress meters and tables that display the remaining amount of individual participating/non-participating deductibles and participating/non- participating out-of-pocket limits as well as how much has been applied toward annual deductibles, out- of-pocket maximums, and lifetime maximums. Medical Deductibles & Maximums Page (Top) Expandable table with in- network and out-of-network details for services provided at a hospital emergency room
- 9. 8 Medical Deductibles & Maximums Page (Bottom) Personal Health Record Patients and healthcare providers need as much personal health data as possible to make informed decisions. Patient health information is typically scattered among all of the providers, specialists, and facilities they have ever visited. Carriers should develop informational platforms in order for members and providers to store and view the patient’s health data. Through these platforms, doctors are well informed of their patients’ health and can give the best care, while members should be offered actionable plans to improve their health figures and maintain a healthy lifestyle. Specifically, personal health records on member websites collect and store up-to-date health data such as lab results, medications, conditions and more in a single and well-organized platform or section of the private site. Model: Aetna The Aetna Personal Health Record (PHR) is a secure online platform accessible from the main member website. The Personal Health Record allows Aetna members to view and organize personal health data, and provides resources based on the data that help improve their care and health.
- 10. 9 The PHR auto-populates health data from claims received from doctors, hospitals and pharmacies, as well as from any online health assessment the member has completed on the site. Members can also manually add medical information. The platform features a Vitals & Trackers section that illustrates these key health measures over time in either a graph or table. The PHR uses a proprietary software system called the Active Health Care Engine to identify ways in which the member’s health care might be improved, where the engine matches information in the PHR against a set of clinical best practices derived from medical literature. If the Personal Health Record finds a potential health risk, the member as well as their provider may receive an alert and/or task. Alerts and tasks are received via email or when first logged in to the PHR and inform the member about when to take tests and screenings as well as potential dangers, such as drug interactions. Members can directly share Vitals & Trackers as well as other health data with their doctors, and they can filter and sort data to print. Humana members would greatly benefit from having a Personal Health Record like Aetna’s since currently they can only access a downloadable report that takes into account the member’s answers to their health assessment, not data from more exact sources such as medical records and claims. Personal Health Record Platform – Health Summary Page (Truncated) Health history separated into categories Access to related educational resources, tools, and health programs.
- 11. 10 Claims Medical claims are as important for members as they are for providers and insurers. They serve as a way for members to keep track of and manage their medical visits and view a breakdown of costs. For providers, it serves as a way to record and charge for the services provided, and for insurers as a way to monitor the health and financial data of providers and members. Claims should be organized in tables with date of service, claim number, provider/facility, status, and payment amounts. The best firms offer sorting options on table columns, advanced search by date and claim type, download capabilities and a detailed overview of each individual claim. Term definitions, FAQs, explanation of benefits, and customer service contact options are all essential items that benefit the member. Online claim submission and online pay are two value-added capabilities that firms in the healthcare insurance industry have been slow to adopt. Model: Aetna and Humana Both Aetna and Humana offer noteworthy claims sections on their member sites that are accessible from the homepage and from a dedicated main menu tab. Both firms have a claims summary page with a table of common claims data with download and search capabilities. Individually however, Humana’s members would benefit from Aetna’s capabilities such as its sortable table functionalities and its online claim payment, powered by Citi’s Money² for Health platform, since Humana’s site does not offer either. Similarly, Aetna members would benefit from having a claims summary page like Humana’s, which is well designed and includes a pie chart of the member’s YTD coverage charges and a PDF claim form. Aetna Member Site Claims Summary Page (Truncated) Online chat help feature.
- 12. 11 Humana Member Site Claims Summary Page (Truncated) The combination of both firms’ resources would be most ideal with both firms offering a comprehensive breakdown page for each claim, listing all charges, what their plan covers, and what part they are responsible for. These pages should include additional plan details like date paid and processed, provider and member services contact information, and PDF versions of the claim’s Explanation of Term definition flyout.
- 13. 12 Benefits (EOB). Currently neither firm offers the option to submit a claim electronically – something that is uncommon among most other health care insurance firms. Humana Member Site Claim Details Page (Truncated) Lightbox with a simplified view of how claims are processed.
- 14. 13 The Wellness Trifecta: Health Assessment, Goal-Setting, and Rewards Program An effective wellness program encourages clients to make healthy lifestyle improvements through incentives and rewards. By providing resources like health assessments, goal-setting, and rewards programs, firms can effectively motivate their members to live healthier lives. Effective health assessments can take into account fitness habits, demographic data, eating and lifestyle habits, and mental and physical health to give members a personalized lifestyles impact appraisal. Health assessment results can offer actionable goals and activity recommendations to make healthier choices and reduce chances of illnesses. By supplementing these resources with a rewards program, members will be encouraged to make healthier decisions. Model: Humana Humana’s HumanaVitality on the member site features all three wellness resources – health assessment, personalized goal-setting, and rewards – in one noteworthy program that gives members an opportunity to set goals, earn Vitality Points, and learn the value of making healthy choices. HumanaVitality is integrated into the member site and is promoted throughout, with its dedicated tab on the homepage. Members are first encouraged to take the Humana Health Assessment (HHA), a brief online questionnaire about their medical history and current lifestyle. The HHA provides a Vitality Age – a measure of how one’s body has aged based on their lifestyle. Members can share progress and status to social media channels. Humana Member Site Homepage Top – Humana Vitality Tab (Truncated)
- 15. 14 Humana Member Site Homepage Bottom – Humana Vitality Tab (Truncated) Following the assessment, members receive personalized recommendations to establish goals and gain Vitality Points by completing activities such as jogging, getting a flu shot, and using educational resources. The site offers a variety of resources and capabilities where members can input and track their progress and activities. Humana Vitality also allows members to sync fitness devices – such as pedometers and heart rate monitors – to their account and earn Vitality Points for their workouts. Humana Member Site – Earn Rewards Section Top (Truncated)
- 16. 15 Humana Member Site – Earn Rewards Section Bottom (Truncated) With more Vitality Points, members earn higher statuses (Bronze, Silver, Gold and Platinum), which can be converted into Vitality Bucks. Vitality Bucks can be spent at the online Humana Vitality Mall, on items such as movie tickets, hotel stays, digital cameras and health equipment. While Aetna’s site offers a comprehensive health assessment and personalized goal-setting platform, members would greatly benefit from an incentivized program such as HumanaVatality, where they earn points to spend of rewards for their hard work to achieve healthier lives. Help Resources: Communication Center, Live Chat, FAQs Effective online assistance is an important component of any member site, allowing members to take full advantage of plan services and online resources. A unified help center, FAQs section, online chat and message center are beneficial to members on the private site, providing them with resources to help themselves. These types of offerings can often circumvent the need to call customer service, saving contract holders both time and the hassle of interacting with call centers. Model: Humana Both firms offer excellent help resources on their member sites. Aetna and Humana both offer dedicated help centers accessible from the universal footer that house site FAQs as well as links to an online chat capability, a list of program-specific contact numbers and to communication centers, where members can send the firm secure messages.
- 17. 16 Humana Member Site Member Support Page and Chat (Truncated) Humana includes links on the member site footer to a video tutorial, hundreds of topic-specific FAQs, a comprehensive glossary, and links to member guidelines and forms. Secure email message platform.
- 18. 17 Humana Member Site Member Support Page (Truncated)
- 19. 18 CONCLUSION Progress in the healthcare insurance environment requires keen understanding of the healthcare system, technological ingenuity, and strong ties to consumers. While all three characteristics are difficult to attain, firms struggle most with the latter two. Understanding the needs and wants of the consumer is a good place to start. When firms partner and consolidate they are able to take advantage of one another’s capabilities and can traverse these challenges. Together, the consolidated organizations should create innovative, technology-driven products and services that fit the needs of a health-conscious population. Through their solutions, insurers should stimulate quality care at lower costs, greater transparency, and more convenience for their members. An established consumer experience will prompt more informed decisions and healthier members. As a result, firm consolidation will probably have an advantage in health care strategies, because each frim, respectively possess expertise in plan development and established industry relationships, allowing them, to design a consumer-focused healthcare experience. These factors, combined with greater transparency, are pushing healthcare to become more of a consumer good. In this case, members of Aetna will have much to gain in terms of online capabilities from those being offered by Humana. While both firms provide effective and notable online capabilities, compared to Aetna, Humana offers improved services with categories like web design and navigation, plan and coverage details, help resources and most notably, a wellness program. Once the merger is complete, members of the newly combined firm could benefit from Aetna and Humana’s strengths pertaining to transparency, through Aetna’s personal medical history information and Humana’s plan/coverage details. Similarly, a consolidated online claims platform could be highly improved by using Aetna’s detail of information displayed and the online payment capability with Humana’s structural and visual design. Humana’s health and wellness platform is unmatched as it offers a comprehensive health assessment, personalized goal-setting, a rewards program and a corresponding mobile app. As healthcare exchanges and new competitors offer customers more choices and innovative health solutions, insurers need to distinguish themselves by providing customer experiences that instill loyalty and trust. Members will abandon companies that do not deliver leading plans and services on their own terms.
- 20. 19 CONNECT WITH CORPORATE INSIGHT CONTACT US Craig Sherter Director of Business Development Monitor Services (646) 929-5149 CSherter@corporateinsight.com HEALTHCARE MONITOR www.corporateinsight.com/healthcaremonitor CONNECT WITH CI