Stepping Up the Game of Health Plan

Tim Matthews, Medicare Sales Director at PacificSource Health Plans, leverages his leadership skills and deep-rooted industry expertise to lead his team comprising sales and support individuals in Oregon, Washington, Idaho, and Montana. Extensive knowledge of industry trends and challenges and 14 years of experience in Medicare sales have aided him in establishing PacificSource as a reputed organization in the industry. Matthews’s thought leadership helps PacificSource deliver on its commitment to providing members with a wide range of health plans at affordable rates. 

In an interview with the Insurance CIO Outlook magazine, Matthews sheds light on some of the current challenges prevailing in health insurance sales and how companies can convert them into profitable opportunities.

What, according to you, are the latest trends in insurance sales?

One of the major trends in insurance sales is the value-based payment model, where primary care providers are assessed and rewarded for managing patients more holistically. Healthcare organizations are significantly investing in the model to improve patient outcomes and stay relevant in the market. 

Nonetheless, healthcare providers need to balance the risk and reward of leveraging such models. One of the fundamental ways for them to mitigate this risk is to follow an integrated team approach, which involves ensuring there are dedicated specialists for managing behavioral, social, and chronic conditions, and professionals to manage pharmacy and the primary care unit. By utilizing data analytics when designing support systems for value-based care, providers can provide efficient healthcare services in a cost-effective manner. This holistic approach proves to be beneficial for healthcare organizations in reducing hospital admission and readmission rates, reducing ER visits, and ultimately improving patient satisfaction. 

What are the projects you are working on and the technological and process elements you have leveraged to make your project successful?

We have been working to deliver an omnichannel enrolment platform for our members and broker partners to enrolltheir clients through any medium of their choice, be it face-to-face, digital, or telephonic.  

Although traditionally, elderly patients preferred to meet with our broker partners in-person to discuss Medicare via a home visit, the pandemic-induced regulations demanded a safe and compliant way for engagement. 

“Rather than competing on a price basis, we endeavor to set the benchmark for customer service. This makes us a go-to partner for our members, healthcare providers, and broker partners.”

Consequently, we started improving our omnichannel platform by working closely with the IT team that leverages agile methodology to allow members to sign upin non-traditional ways. Today, our members can enroll electronically via DocuSign, digitally through the website, telephonically or in traditional ways such as paper, mail, or fax. The choice is theirs.

What steers you ahead of the market competition?

We are a regional carrier, competing against national behemoths. As we are a non-profit organization, every dollar we spend counts, and we must make sure that we are thoughtful about our investments. Rather than competing on a price basis, we endeavor to set the benchmark for customer service. This makes us a go-to partner for our members, healthcare providers, and broker partners. 

Our top priorities have always been to take a member-centric approach and serve as a high-touch organization as we operate locally (Pacific Northwest). We are easy to do business with due in large part to our ability to answer most of the member calls within 30 seconds by employing knowledgeable, local professionals without the use of a phone tree.  

Additionally, we stay compliant with the regulations institutedby the Centers for Medicare & Medicaid Services (CMS) to ensure the industry is working thoughtfully and appropriately with patients, especially the senior population.

How do you envision the evolution of the health insurance space in the next 12 to 18 months? 

From a technological standpoint, one of the latest trends gaining traction is the digitalization of the patient experience with their health care provider—the digital front door.As members expect speed and personalization of services, we must ensure that we are using technologies that are familiar to them. By utilizing such technologies that optimize the patient journey at every touchpoint and deliver an end-to-end digital experience, the digital front door helps members interact with the healthcare providers face-to-face, or via phone, email, and chat, as preferred. 

What is your sage advice to budding professionals in the industry? 

Become comfortable with the uncomfortable, acknowledging the fact that the marketplace is ever-evolving. Understanding how the technology works and using it smartly could help boost productivity. Customer experience is paramount and should never be compromised. Attitude and effort are in your control, and if you can control those, success follows undoubtedly.