Authored by: Pat Goetz
Laughter is often the best medicine, which might explain why a recent South Park video about the challenges of the American healthcare system resonated with so many viewers.
The video poked fun at the system, highlighting problems with surprise medical bills, long wait times, and prior authorization hurdles. As viewers silently nodded their heads, the video went viral, capturing over two million views to date.
The episode was also a topic of discussion at a recent health insurance conference, as AHIP’s Jeanette Thornton noted: “Have you seen South Park? They really don’t like us,” according to an article published in the Health Payer Specialist.
A study found that 55% of healthcare consumers are not fully satisfied with their insurance. While many of the challenges highlighted in the video aren’t easy to fix, payers can still take action to improve healthcare member engagement and win back trust.
Denials, appeals, and pre-authorization challenges
During the South Park episode, the characters are led into a dark, dingy basement to request coverage, which is quickly denied.
However, in real life, the denial process isn’t nearly as personalized as portrayed in the episode. Many payers use technology to deny large batches of claims at scale without ever opening a medical file.
A recent article highlighted how this process works, with technology identifying mismatches between acceptable tests and procedures based on specific ailments. One doctor interviewed for the article said, “We literally click and submit. It takes all of 10 seconds to do 50 at a time.”
Trends toward using these technologies might explain why claims denial rates are up and member satisfaction is down.
While not all payers use these tools, adopting fair and clear appeals and grievances processes is important. Processes around prior authorizations also have improvement opportunities, which could help further ease member frustrations.
Additionally, it’s helpful to look at expanding networks. Providers are in short supply, particularly specialists. Expanding networks gives members more options and decreases their need to go out of network to reduce wait times in receiving care.
Improving cost transparency and communication
A recent study found that only 17% of U.S. adults know the cost of care before receiving services. This lack of cost transparency and surprise medical bills fuel member frustration. Increased transparency from payers could help reduce this challenge.
While it’s true that processes exist for members to learn the cost of care, they aren’t straightforward and often involve members going back and forth between payer and provider.
Also, even with technological advancements, healthcare still relies heavily on outdated processes such as using fax machines and traditional mail. Whenever payers can evaluate and improve processes around coverage and costs to create faster online experiences, they enhance transparency and member satisfaction.
Building partnerships between payers and providers
During the South Park episode, characters were stuck in the back-and-forth process described above. The video underscored the frustration, pain, and dissatisfaction that come along with the process. The key to solving this challenge and many of the others described in the video is closer collaboration with providers.
The healthcare system is large and involves many players, but as Thornton notes, payers are struggling with a public image challenge. In some ways, they are taking the brunt of the fall for challenges throughout the entire system.
Collaborating more closely with providers to better understand and fix the impacted areas, such as surprise medical bills and sluggish pre-authorization processes, can help improve health plan member engagement and earn back members’ trust.
Do you need support improving your appeals and grievances processes? We can help you improve member experiences and use technology to scale your efforts.