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Shop-by-Doctor: The Health Plan Shopper’s Secret Weapon During Enrollment

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HMO or PPO? Copay vs. coinsurance? What’s the cost-sharing structure for out-of-network specialist visits, mental health services, and home health care? Shopping for a health insurance plan is a notoriously painful process — whether you’re seeking individual coverage, choosing between plans offered by your employer, or examining your Medicare Advantage options, it’s often difficult to identify the plan that best matches your specific requirements. With COVID relief initiatives reopening the ACA exchanges through Aug. 15 and subsidy eligibility expanding through 2022, more individuals than ever before will likely be faced with navigating the complexities of purchasing a health plan.

Like modern shopping experiences in other industries, the bulk of health plan selection now occurs online, via digital health insurance exchanges of both the public and private variety. For these digital platforms, used by consumers, seniors, brokers, and businesses alike, it’s critical to deliver intuitive, data-driven user experiences that provide full transparency into the rates, cost-sharing, subsidy estimates, and other features of all available health plans. However, a robust plan library, side-by-side plan comparison, and a modern quoting interface are insufficient to meet the needs of today’s users.

Shop-By-Doctor: provider-centric plan selection

To many consumers, there is no more significant determinant than whether a plan offers in-network coverage of their preferred providers, hospitals, and facilities. This has become even more important in recent years, as out-of-pocket maximums have increased and high-deductible plans have gained prevalence. To avoid the potentially high cost of out-of-network care, most consumers begin their plan shopping process with one question: “Which plans cover my family’s doctors and our local hospitals?”

Multi-carrier digital platforms have made answering this question far simpler than when paper SBCs and carrier-specific portals ruled the plan selection and enrollment landscape. Today, many multi-carrier exchanges and state-based marketplaces have integrated shop-by-doc functionality — the ability to filter available plans to show only the options that cover users’ preferred doctors and providers — into the plan shopping process.

Offering shop-by-doc has material benefits. Consumers avoid out-of-network fees and purchase a plan based on what’s actually important to them. Vericred, currently powering shop-by-doc functionality on several leading private marketplaces and state-based exchanges, has found that about 70% of consumers shopping for health plans will add their providers as a search criterion. For health insurance platforms, shop-by-doc is no longer an optional feature — it’s an essential component of a modern, integrated, fully-digital plan shopping experience.

Integrating shop-by-doc functionality into the shopping experience

Despite shop-by-doc’s obvious benefits, there remain some holdouts among consumer and broker-facing platforms. Adding this functionality was, traditionally, a near-impossible endeavor. The industry lacked a centralized, standardized source of provider-network data from which platforms could power provider-centric plan shopping features. Acquiring this information, in a usable format, from hundreds of health insurance carriers was beyond their operational and resource constraints.

But that technical barrier no longer exists. Vericred has transformed shop-by-doc into a simple addition to any existing platform, by building APIs that enable platforms with quoting functionality to integrate shop-by-doc into their system, without acquiring and maintaining the underlying provider-network data. These APIs are a bridge to better user experiences, and, ultimately, better-informed health and financial decisions and a smoother enrollment process for all.

If you’re interested in delivering shop-by-doc functionality to your platform’s users, reach out to learn how Vericred’s data solutions enable tech companies to build robust decision support experiences.