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Insurers constantly caution seniors that their Medicare Advantage perks such as hearing aids, dental payments and even gym memberships will fizzle if Democrats get their way and cut government subsidies for them. However, tens of billions of Medicare dollars funneled through insurers also pay for extras that never reach beneficiaries: multimillion-dollar salaries; executive retreats in Hawaii, Scotland and Cancun; and massive expenditures on marketing to lure more customers to the privately administered Advantage plans.

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The Medicare Advantage Piece of the Healthcare Debate

Retail pharmacies in the U.S. filled 3.65 billion prescriptions in 2008, and another 238 million prescriptions were filled by direct mail. Each Rx was issued by a physician — which explains why the pharmaceutical industry in the U.S. spends heavily on marketing efforts aimed at doctors, including customer relationship management programs. All large pharmaceutical companies in the U.S. have robust CRM programs aimed at the physician community, and many of the hundreds of other drug producers also employ some type of CRM program directed at doctors.

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Pharma’s New Prescription for CRM

What U.S. business wouldn’t want a customer base of 37.5 million prospects? In 2008, hospitals in the U.S. registered that many admissions — a number that equals 12 percent of the U.S. population. Yet the hospitals in the U.S. have largely underutilized the customer relationship management tools that could exploit the data in that customer base to create significant increases in business volume and more profitable operations. In a sluggish economy, hospitals could use a shot in the arm to attract more clients.

Rx for Hospitals: A Big Dose of CRM

CRM has lagged in the health insurance industry, but a major transformation is imminent. “There’s been a reluctance to make comprehensive investments in technology compared with other sectors,” said Gartner analyst Joanne Galimi. “Generally, the firms in the sector have been very tactical, only investing in specific areas — basically reacting to pain points. Some of the resistance stems from the complexity of installing lots of modules and because it’s very costly.” Mergers within the industry, beneficial in gaining market share, have added to the problem.

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Health Insurance CRM, Part 2: The BPO Catalyst

The health insurance industry, especially in the U.S., has a long way to go before it achieves a high level of performance in the use of customer relationship management tools. However, pressure is coming from market forces — including new government healthcare reform policies — that will compel improvements in health insurance CRM, whether insurance companies want it or not. A new wrinkle in health insurance that is just now emerging as a major factor — and one that will be more important in the future — is Consumer Directed Healthcare.

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Health Insurance CRM, Part 1: Shifting Into Catch-Up Mode