Speed to Market with New Business Models Drives Competitive Advantage

Health plans must add or expand new business models quickly to take advantage of opportunities, drive competitive advantage, and retain membership. All health plans, no matter the size, continually address their business plans by expanding into new geographical markets, creating new products, marketing to new customers, or simply retaining membership by building satisfaction and loyalty. But to do it successfully, they must be able to answer the following questions before they launch:

  • What benefit offerings will resonate with the market?
  • How can the retention rate for existing business be improved?
  • Will the group/member setup be completed on-time with high quality for processing?
  • Does the provider community properly support improved health and low cost to the members?

In the years I’ve spent working directly with our customers, I’ve learned a lot about what they are worried about, what challenges they’re facing, and what keeps them up at night. While working with large regional health plans, here are some of the scenarios I’ve witnessed:

A regional Northeast health plan with Commercial, Self-Funded, Medicare Advantage, and Medicaid lines of business, added new provider contract and payment models, and implemented value-based payments, to align with the provider network. By doing this, they increased customer satisfaction and overall health in the community, as well as improved stakeholder engagement among members, employers, providers, and hospitals.

A Mid-West organization with Commercial, Individual, Medicare Advantage, and Medicaid lines of business, focused on speed-to-market and decreased time to create and launch a new benefit plan. As a result, they increased member satisfaction by simplifying account setup and enrollment and reducing errors.

Several customers have had to respond to providers and consumers embracing new care by offering patients a hybrid of telehealth and physical visits and enhanced mental health resources. With multiple options to deliver and receive quality, convenient care, it’s important that health plans design benefit plans that address consumers’ needs. 

When all is said and done, I’ve come to realize that maintaining flexibility and the ability to respond quickly and correctly the first time not only enhances a payer’s competitive position but, in many cases, can save a regional plan. It has become binary. Have the ability and succeed, or not build the capability and fail. Happily, I’ve seen many chose to succeed.

About the Author

David Nesbitt

David Nesbitt, Vice President, Sales Operations

David is a senior executive responsible for sales operations across the HealthEdge solution suite. In his current role, he supports all HealthEdge sales activities including partner relationships. David has more than 25 years of healthcare payer experience and brings a broad background spanning software development, product management, professional services delivery and sales. He has been with HealthEdge for more than 13 years. During this time, David has served as Product Manager designing HealthRules Payor functionality as well as Senior Director of Business Services managing the business consultants and education services in Professional Services. Prior to his tenure at HealthEdge, David held product management and delivery roles at NaviNet and Verisk Analytics. His early healthcare experience was in the role of software development at Healthsource/CIGNA. 

McLaren Health Plan Captures New Business in a Competitive Landscape

To learn more about McLaren's success after implementing HealthRules, read the case study

Case Study

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