Medical plan costs continue to increase at double-digit rates. Reasons for these increases include: increasing negotiating power of hospitals and physicians, increasing patient demand for services, lessening of tight managed care controls, increasing hospital costs, increasing medical technology costs, increasing price and utilization of prescription drugs, rich plan designs, government cost-shifting, and medical malpractice costs.

How can you sell effectively in such conditions? How can you convey to your prospects that the value of your Health Plan’s products outweighs their cost?


Health costs impact Health Plans future premiums. Claims costs are rising at a high pace and you have to raise premiums quite high, which results in the membership loss.

What is driving the claims costs?

  • An aging America – There are more people over age 50 than school age, and a 55-year-old has higher average medical bills than a 16-year-old.
  • Births – The younger population, especially those in the childbearing years, also contributes to the claims costs. You probably pay for at least one birth per day with nearly 25 percent of the babies delivered by C-section.
  • Cost Shifting – Federal programs such as Medicare and Medicaid limit benefits in order to balance budgets. These budgetary limits do not accurately reflect the costs of treating public patients. As a result, doctors and hospitals make up the difference in revenue by shifting charges to those who are capable of paying with private insurance.
  • Mandated Benefits – Every time the government regulates certain benefits, such as mental health, maternity stays, fertility coverage, preventive care, or chiropractic, the costs of those benefits are passed on to everyone regardless of who uses them. These benefits are important, but are creating a perceived big-brother health care system with much higher utilization.
  • Technology – New technology and drug treatments are increasingly expensive. Open heart surgery and organ transplants are almost routine. And where an average x-ray may cost $80, the same MRI costs $1,200. The potential overuse of technology is being encouraged by multi-hundred-million-dollar medical facilities that need to make a return on their investment.
  • Malpractice and Overtreatment – According to the American Medical News, a study by physicians of the AMA more than 8 of 10 physicians admit to practicing defensive medicine to avoid malpractice suits by ordering additional and sometimes unnecessary tests.
  • Anti-Organizations legislation – There is a growing concern that doctors cannot act responsibly if given financial incentives to be cost-effective. This, litigation-driven belief is putting nails into the coffins of Organizations plans.

With healthcare payors processing approximately four billion claims a year, many organizations are finding it a major challenge to process and pay high volumes of claims in an accurate and timely manner. Prompt payment legislation has placed additional pressure on payors to turn around claims quickly, and healthcare costs increasing at an estimated annual rate of 15 to 20 percent have made it financially difficult to reimburse high claims costs.


If your Organizations has to raise premiums, Sales and Marketing reps have to assure prospects and customers their dollar will be spent for better value plans than those of your competitors. Educating a large number of clients in an organized manner is not an easy task. That is when HMOZ campaign management tools become handy.

With QIEM HMOZ, you can identify and target the most profitable prospects, create custom campaigns for unique target groups, automate standard campaign activities and communications, manage and track all aspects of campaigns in one place, analyze campaign ROI and increase marketing efficiency, shorten the sales cycle, and increase customer retention.

Successfully launched marketing campaigns may cover the damage done to your Organizations by increasing claims costs.


Marketing Campaign Automation is a necessity for Health Plans. You need to target a large group of people in the most effective way and analyze your performance after all.

QIEM HMOZ allows you to track campaign responses effectively: view response data real-time to analyze the impact of campaigns in progress, assess campaign metrics such as response ratio and associated sales revenue, add or edit campaign info or responses from within account or contact records, and roll information captured at the individual opportunity level into management view.

Utilize QIEM HMOZ Campaign Reporting: analyze the effectiveness of marketing efforts (ROI) and increase efficiency, examine campaign responses, associated revenue, and product detail, evaluate potential vs. actual returns for each lead source, region, or media type, view campaign data via reports, and guide marketing strategy.

One Demo is better than a thousand words, and one Solution Audit is better than a thousand demos. We encourage you to follow our CRM proverb and take advantage of this opportunity.