September 17, 2015 | Rosemarie Day

What Exchanges Can and Should Learn from Amazon.com

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I was recently talking to a colleague who’s done some work for Amazon.com, and we were remarking on Amazon’s phenomenal success as a consumer marketplace.  The biggest reason for that success is that they always put the customer first.   According to my colleague, that’s the lens they use at the corporate level, whenever they are making a decision about what to invest in or take a position on.

That simple clarity of customer first is exactly what health insurance exchanges need to embrace, whether public or private exchanges.  And it turns out that this is easier said than done.  Let’s take a look at what tools customers want and where things stand with exchanges.

WHAT TOOLS DO CUSTOMERS WANT?

Amazon.com (and consumer websites, like Travelocity) have set a high bar.  They have informed customer perspectives in other areas, like exchanges.  A recent survey of employers, when asked what their employees want to see in an exchange, shows this:

  1. A great shopping experience – ease of use (think Amazon!)
  2. Tools that aid in plan selection – allows consumers to find the plan that best meets their needs (e.g. enabling decision support based on a consumer’s answers to a series of questions)
  3. Ability to keep current physician (if they have one) – this need can be met with an easy tool to see the physicians in a health plan’s network
  4. Mobile device compatibility – many employees only have access to internet through a phone
  5. Education tools – to help customers understand the difference between premiums, deductibles, etc.
  6. Wellness program discounts or awards (again, a simple tool could help here).

In public exchanges, customers want many of the same things.  They have a stronger need to be able to find affordable plans (since they don’t have an employer subsidy).  They also don’t want to be overwhelmed by choice [refer to our previous Health Affairs article and Pacific Business Group on Health’s research for more information].

But we should look beyond what consumers see in exchanges today, and think about what they’d like to see in the future, based on an Amazon.com standard.  Some examples of great on-line purchasing features include:

  • Receive your product very quickly – can exchanges find a way to mimic this?
  • Returns are easy – can exchanges make switching health plans easy (for at least a limited period of time) if people made a mistake when they purchased?
  • Product suggestions based on your purchase patterns and/or “people like you bought this”- this would be helpful for first time buyers and renewers on the exchange.

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WHAT EXCHANGES NEED TO DO

Anyone who is running a health insurance exchange needs to walk in their customers’ shoes.  They need to go through the shopping experience from beginning to end.  This will help exchange leaders to see how the website tools and the products being sold should be designed in a “customer first” way.

Public Exchanges

Public exchanges have had a difficult time “putting the customer first” with website tools.  While they have invested heavily in technology, a lot of what they have built is helping people to determine their eligibility for insurance subsidies.  This is certainly important for the majority of public exchange consumers, but perfecting the systems to support these arcane rules has deflected resources and attention from implementing other consumer facing tools and state-of-the-art website features.  In addition, public exchanges serve many masters in the public sector and it’s difficult for them to “put the customer first” given the competing (and often political) demands.

And yet, to boost enrollment and retain existing customers, “putting the customer first” is exactly what public exchanges need to do.  With federal funds for exchanges on the wane, it will become even harder for public exchanges to “put customers first” through technology improvements.  To mitigate this, public exchanges should:

  • Turn to the private sector and leverage the investments that are being made there, rather than trying to “reinvent the wheel.”
  • Share tools with their sister exchanges that have been able to innovate.  Foundations could help to foster this sharing of ideas amongst public exchanges.  One way to spearhead this would be to sponsor a contest amongst the public exchanges to reward those with the best “customer first” website features.

And no matter what, the leaders of state and federal exchanges should continually listen to their call center representatives and hold focus groups with their customers on how to improve the shopping experience.

Private Exchanges

Compared to public exchanges, private exchanges have the best shot at truly putting the customer first.  They have the freedom and flexibility to design their approach.  But have they succeeded?  The recent improvements in exchange technology alone have been significant, fueled by a good deal of private investment over the past few years.  In addition, private exchanges are often sponsored by the organizations that already understand employers (benefits consultancies such as Aon, Mercer, and Towers Watson and brokers.)  But what they really have to understand is how to make an on-line solution truly work for the end-user, the consumer who is actually selecting the health plan.  It’s the individual employee who’s the customer in an exchange, not the human resources staff.  And that’s what Amazon has mastered and some exchanges are still learning.  Given the very competitive marketplace for private exchanges, we strongly urge them to compete more in this area of putting the customer first.  Consumers expect no less!