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1    Consumerism in healthcare is experiencing high expectations for consumer choice. The driver for greater healthcare consumerism has been the escalating costs of healthcare as employers are asking employees to share in this cost resulting in changing consumer behavior. With this changing behavior comes the requirements of information to make informed decisions. Health information technology through the use of claims data, electronic medical records in transparency and quality data to enable consumers to have access to provider data regarding the cost and quality of care. Plan benefit designs have increased patient responsibility for this through co-pays, deductibles and health risk assessment (HRA) obligations. In exchange, consumers want more choice in both plan selection and providers along with convenience to services with a clear understanding of their payment responsibility (Appold, 2015). Historically the purchasing power oF healthcare/plans was driven by employers, now plans and providers must win over consumers one at a time (Appold, 2014). The impact of consumerism on healthcare providers in regards to information technology, claims management, and member services includes patient access to lab results, downloadable discharge instructions and health records without having to make an office visit to get the information. They want to schedule appointments online or have virtual visits (telemedicine) at a time that is convenient for them, as well as the convenience of personal information automatically populating forms rather than completing paperwork at every visit. A greater emphasis on convenience by consumers is evident

 

2       Consumerism impacts the healthcare system through the creation of consumer behavior. The consumers become prepared; they function more, and they are informed thus make informed health decisions (National Academy Press, 2012). The consumers are free to use technology enhancing them to connect to the healthcare providers, government and healthcare plans.  Consumerism in conjunction with internet information supply makes information technology an important aspect in healthcare paradigm. Additionally, consumerism impacts the kind of jobs in the field of healthcare due to a probable decline in health professionals in some areas. Health organizations need to ensure that they meet demands of the consumers. They must involve the marketers, nurses, physicians, information technology experts in the strategic decision on IT.  The tools promote healthcare consumer space through cost transparency, the introduction of competitive shopping experiences.  Electronic medical records systems revolutionalized health information and patient access to healthcare. Fully functional EHR system reduces the preventable errors in treating patients. Personal health records play a vital role in healthcare coordination. The Tech-savvy consumers (patients) prefer receiving medical result electronically and can make follow-up questions to their providers.  Information Technology in the healthcare improves the safety of the patients, health care quality, efficiency and data collection (Tham E, et al. 2011). I.T assists in restraining the rise in medical costs.

 

3       The key to effective employer – sponsored sales is to provide the purchasing group the right amount and type of information. The literature reviews indicate that this fine process is similar to other industrial purchasing but it does have some unique to healthcare aspects. As healthcare shifts from a revenue-generating provider dominating system to a cost conscious payer dominated system the employer is playing an increasingly major role in the selection of healthcare providers (Lindenmouth, 1990). Understanding value from the consumer’s perspective items such as cost control, quality, and freedom of choice for both employees and employers, better information for decision-making (data transparency) as well as simplification of processes i.e. claims processing. Foundation to this process on the health plan process side lead generation, prospecting, rating and underwriting and finally the quote. Identifying the stages in the healthcare buying process as well as the players is foundation to strategy development and effective marketing for health plans. He for the sales marketer is understanding the purchasing group charged with selecting the health care plan these usually include the facilitator, proposal prepare, key influencer within the group and the individual was signing authority. The first stage is the information gathering stage where vendors are evaluated on specific attributes and their ability to deliver followed by the vendor review stage where the employer engages a needs assessment which includes provider quality, ability to deliver, years in service where some vendors are eliminated at this stage. Final selection stage details all proposals eligible for review, benchmarking from outside organizations that have adopted similar solutions are considered. After vendor selection and ongoing relationship with the buyer is expected as a salesperson is designated to facilitate an ongoing relationship with the client (Choong, 2010).

 

4       The employee-sponsored sales process encompasses the component elements of providing health insurance coverage to employers for their employees. The steps involved include lead generation and initial contact followed by rating and underwriting and quote development. Products are designed for the employer and plans offered to the employees. Finally, employees select the appropriate plans for their needs and enrollment processes are undertaken (Kongstvedt, 2007). This is typically accomplished as a new or renewal function and the level of service involvement will usually depend on whether the employer is fully insured by the MCO or self-funded thus requiring only administrative services. Accreditation of managed care organizations has become a barometer of value and quality by which employers and consumers can compare health plans to their needs. Nearly every major health plan consumer as well as many state, local, and federal governments require some form of accreditation or quality reporting mechanism to be in place before they will consider entering into a relationship with the MCO. Among these, the National Committee for Quality Assurance (NCQA) provides perhaps the most comprehensive quality and value assessment of health care plans through its Health Plan Employer Data and Information Set (HEDIS). HEDIS provides comprehensive comparative tools for employers and other consumers to evaluate health plans against each other to assess quality.  Brino (2014) explains that health plans accredited by the NCQA cover approximately 136 million American health care consumers. However, the NCQA itself recognizes that its current system of accreditation requires refinement. The NCQA’s focus is largely on health plan quality and consumer satisfaction.  To meet the demands of an evolving health care environment, NCQA health plan accreditation standards for 2016 will include assessments of access, information accuracy, and awareness of rights to appeal.  This includes an evaluation of access to specialty care to ensure that sufficient in-network providers are available to provide specialty services for patients without unreasonable delays in delivery. Also included is a measurement of the reliability and accuracy of directories of in-network providers as well as the delivery of accurate and timely information to consumers regarding coverage and right to appeal coverage decisions (NCQA, n.d.).

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