"For example, many network contracts prevent health plans from adding copay differentials for different providers or allowing for network carveouts. "
Don't think this is the best strategy from a member experience perspective. Healthcare is already confusing and copay differentials can add another layer of complexity to healthcare navigation.
You bring up a good point - however, there are some interesting approaches where you would give members a guaranteed copay price BEFORE they visit a doctor (via an app) and the member would be guaranteed to not pay more than that amount. This can actually create more piece of mind for the member.
I am skittish about putting more burden on the member. I had an HMO plan once and got grief for a year from my wife because of the gating process to see specialists. Switched to PPO the following year. Plan design has to start with member experience at the forefront. Innovation to ensure financial sustainability is critical but should not come at the expense of member experience.
One friction point that I have experienced as a healthcare consumer is doing the research and finding the best provider. What do you think of a concierge service where a member is incentivized ($10 Amazon gift card ;)) to have a call with a patient navigator before going to a provider location. As part of that call, the navigator can triage the issue and guide the member to the best quality, low cost provider in their area with a link to the provider's info. This will solve the research headache at a stressful time in the patient's journey.
The member still has access to the broader network and can go wherever they want for the same copay but they might be more likely to take the recommendation.
"For example, many network contracts prevent health plans from adding copay differentials for different providers or allowing for network carveouts. "
Don't think this is the best strategy from a member experience perspective. Healthcare is already confusing and copay differentials can add another layer of complexity to healthcare navigation.
You bring up a good point - however, there are some interesting approaches where you would give members a guaranteed copay price BEFORE they visit a doctor (via an app) and the member would be guaranteed to not pay more than that amount. This can actually create more piece of mind for the member.
I am skittish about putting more burden on the member. I had an HMO plan once and got grief for a year from my wife because of the gating process to see specialists. Switched to PPO the following year. Plan design has to start with member experience at the forefront. Innovation to ensure financial sustainability is critical but should not come at the expense of member experience.
One friction point that I have experienced as a healthcare consumer is doing the research and finding the best provider. What do you think of a concierge service where a member is incentivized ($10 Amazon gift card ;)) to have a call with a patient navigator before going to a provider location. As part of that call, the navigator can triage the issue and guide the member to the best quality, low cost provider in their area with a link to the provider's info. This will solve the research headache at a stressful time in the patient's journey.
The member still has access to the broader network and can go wherever they want for the same copay but they might be more likely to take the recommendation.
Great post!