Communicating Plan Changes Clearly and Preserving Trust

The 32BJ Health Fund introduced a new and innovative network design in April 2019. For the first time in its history, it differentiated amongst health systems in the New York City metro area. While most health systems would be preferred and keep the same low copays, others that charged significantly more for care would become non-preferred and have significantly higher copays for planned care. While most participants were already using preferred hospitals, the goal of the new design is to steer even more participants to use preferred hospitals when they need hospital-based care.

Before implementing the changes, the 32BJ Health Fund developed a communications plan to inform plan participants of the changes, help participants find preferred hospitals for care, ensure they knew how to get help if they needed it, ensure they knew why the change was happening and maintain the favorable view most participants had of their health plans and their trust in the Health Fund.

The Fund created a communications plan that focused on timing, testing and transparency to ensure that members knew what plan changes were coming and when the changes would happen, understood why the changes were being implemented and retained their trust in the Fund.

The goal was to communicate early and often with members through a variety of formats and languages, including 2-3 pieces of mail per month to participants in the three months leading up to the change; additional mailers to people who previously used non-preferred hospitals and those it knew were in its maternity program and would give birth in the coming months; a robust field plan for Health Fund staff and union staff to bring information to union members’ worksites and regular union meetings; updates to highlight the change on the website; and a series of emails in the weeks leading up to the change.

The mail program included a mix of federally-mandated mailers to describe service changes and a series of accessible and compelling pieces that were easy to read and clearly outlined the changes in simple language. The centerpiece of the campaign was a glossy 8-page brochure that presented the most compelling arguments (outlined below) and offered a pull out card with specific questions that participants could take to their doctor if they had in-patient or outpatient care planned and wanted to make sure they’d be treated at a preferred hospital with the low copay.

All materials were produced in English and Spanish, the two languages spoken by the majority of plan participants.  Communicating in their preferred language was key, to make sure that there were no language barriers to understanding the information.

After the changes in the plan on April 1, the Health Fund has continued to communicate with members via email and post, including two recent mailers reminding all participants of the changes. The Health Fund also sends an explanatory letter to all participants who use a non-preferred hospital for planned care to explain why they paid a high copay and what their options are for receiving care at a lower cost to them.

Getting the Message Right

Before and after the plan change, the Health Fund used focus groups and polling to hone their message to participants. Focus groups and polling included union members as well as their spouses since non-member spouses are also decision makers in a family’s health care decisions.

Ahead of the changes, the Health Fund conducted focus groups to determine what messages might be the most compelling to union members and their spouses.  They found that the most successful message in promoting the change is the one that provides the most context and detail.

The top testing message explained the Health Fund has been providing generous benefits for a $100 hospital admission copay for the last five years, but skyrocketing NYC hospital costs were making it untenable. Hospitals are overcharging, with a one Non-Preferred Health System having an average price of $83,000 for a hip replacement compared to the average price of $58,000 for the same procedure at Preferred Hospitals in NYC. To keep the copay at $100 for preferred hospitals, it was necessary to discourage members from going to hospitals that overcharge.

Telling people why the change was happening was the most compelling argument. By sharing the cost differentials between preferred and non-preferred hospitals, members realized why the change was necessary.

Testing the message also made it clear that the medium was also important. The Health Fund needed a simple way to explain the issues, in plain, clear prose and in multiple languages. It was also important to urge participants to determine what the changes meant for them before they were faced with a big bill. Health Fund materials instructed people to talk to their doctors to find out where their doctors were affiliated and included a wallet card so people could ask questions when they went to the doctor or called their doctor’s office.

As the Health Fund rolled out its explanation of plan changes, they used these key messaging components:

  • The change itself: copays for planned visits at non-preferred hospitals going up significantly
  • Why the Health Fund is making the change: non-preferred hospitals charge significantly more (including specific examples)
  • How participants could avoid these charges: use preferred hospitals
  • How participants could get more information and help: links for information online, sample questions for their doctors, phone numbers and office hours for participants to talk to the Health Funds member services representatives for guidance

Four months after the change, the Health Fund commissioned a poll of 600 participants who had used hospital services in the previous 12 months to gauge their reaction to the changes. The results showed that participants had a good understanding of the change but there was still room for improvement in both their knowledge and perception of the change.

The polling found that after the plan change, the Health Fund remains in great standing among members and their spouses. The majority view the health care benefits, the quality of healthcare facilities available, the number of facilities or doctor’s offices near them, and the quality of doctors available in the network “very favorably”. 32BJ Benefit Funds enjoys a great deal of trust. Nearly 9 in 10 trust 32BJ Benefit Funds to recommend benefit programs, though non-preferred users are less likely to have the same level of intensity in their trust.

There remained some more challenging areas.

Further effort is needed to raise awareness of the change to hospital admissions. Only a third of members are familiar with any change for hospital admissions. When the change in copays is described further, fewer than a third are “very familiar” with this change. When the changes in copays to both inpatient and outpatient admissions are described, the overwhelming majority understand the change. There is opposition to the change, but there is also recognition that some hospitals are paid more for the same services. Similar to research the Health Fund undertook in 2018, the majority “strongly oppose” the change to the copay structure. Even still, members and their spouses are aware that some hospitals are paid more for the same services, indicating that communications on the cost to the fund resonates.

While the polling provided valuable insight on what worked well in our messaging and what challenges remain, perhaps the most important data point is how participants’ behaviors have changed. In the six months following the plan change, the Health Fund saw movement in the right direction as more participants moved to preferred hospitals for planned hospital visits.

The Health Fund is continuing to build on the lessons learned from the early stages of the plan change and will continue to educate members and spouses on why the changes were made and how they can still get the best-quality care with low or no copays.

Our key takeaway is that when participants truly understand the reasons for the plan changes, they are more likely to have a favorable opinion of them and to make choices based on what is best for them and their families.