The “consumerization” of health insurance has greatly disaggregated the buyers of this market once dominated by a traditional B2B sales model. Gone are the days of the lone wolf sales agent calling on customers or brokers and winning deals. To capture share of the rapidly expanding Private Healthcare Exchange requires a different approach – a teaming model with reps possessing new and different skills, and a new and different sales support model. Good caddies provide their golfer with critical information to improve their shot accuracy. The new sales support role acts like a good caddy – providing analytics, insights, and program coordination to help health insurance Sales Reps increase their wins on the Exchanges.

The rise of Private Healthcare Exchanges:

Private Healthcare Exchanges are driving a fundamental shift in the Health Insurance marketplace. An Exchange is an online market place where health insurance products are supplied by selected vendors. These Exchanges can be single-carrier, or multi-carrier, and in either case provide employees the ability to choose a health plan which best suits their needs. This relatively new go-to-market model for health insurers has been met with favorable response from consumers based on the rapid growth: 3 million members enrolled via Private Exchanges in 2014, 6 million in 2015, and a forecast of 12 million in 2016! However, this “consumerization” of group health plans creates an interesting challenge for the current B2B sales model deployed by most health insurance companies.

Prior to the Exchange, the Health Insurance Sales Rep (“Rep”) would build relationships with various C-suite stakeholders at the company (or broker) and demonstrate their plans were cost-effective while providing the required level of coverage. The group would sign up and all of the eligible members within the group would enroll (unless they were on their spouses’ plans). In today’s market, after signing the group, the rep must shift to a B2C-like campaign to enroll as many members of the group via the Healthcare Exchange.

Sales Role Evolution to “Health Consultant”:

As the Health Insurance industry evolves, so must those who sell its wares. Being a scratch golfer is great, but it won’t cut it in today’s market realities. You’ll notice these are not easy skills to develop or maintain. The bar has been raised and competition has heightened: this is the PGA Tour! The new responsibilities of the “evolved” Health Consultant are as follows:

  • Develop high-quality partnerships with targeted customers by demonstrating high levels of industry and marketplace knowledge.
  • Maintain a deep understanding of health care reform and its implications on customers in order to guide them through the changes and uncertainty.
  • Understand customers’ health care financials and underwriting policies, and know how to create health plans which meet their financial and coverage needs.
  • Guide customers with a long-term perspective on how to best balance costs and maximize overall group health (for example, bundling ancillary health insurance products into Wellness Programs, or developing a business case for self-funded vs. fully-insured options).
  • Use analytical capabilities to develop solutions which increase “account stickiness” and profitability by promoting risk and non-risk ancillary products; oftentimes by demonstrating long-term cost-savings by increased group health.

If that’s not enough, here are a few more specific activities the evolved Health Consultant must take on to ensure success with exchanges:

  • Stay close to employers, brokers and consultants to understand their needs and anticipate market trends.
  • Identify those likely to migrate to exchanges, and develop retention strategies.
  • Capture voice of customer and use these insights to inform product development, pricing and marketing strategy.
  • Plan and execute B2C campaigns in order to reach individuals directly (with the permission of the employer, of course!)


(Exhibit 1: Job Evolution Continuum for Health Insurance Sales)


(Exhibit 2: Future Seller Competency Compared to Current Competencies)

Can the Health Consultant do all of this alone?

Answer: No.

Enter, the new Sales Support Role, an “Exchange Specialist”:

The job of the new health insurance sales person, or “Health Consultant” has indeed evolved substantially, and more than ever they need support. The “Exchange Specialist” is the answer. This role is paired with the Health Consultant to provide reports, analytics and insights on the Exchanges. They provide plan details required for listing on various exchanges, work closely with the Health Consultant to forecast Exchange targets (number of cases), and develop B2C strategies to maximize enrollment. The Exchange Specialist also coordinates and executes B2C marketing campaigns in order to increase pull-through.

Specific activities to ensure success in exchanges:

  • Develop custom campaigns targeting large/national employer populations
  • Support the annual renewal process by coordinating outbound calls to private exchange enrollees
  • Develop and launch a “Customer Success” web portal providing decision support and education before, during and after the enrollment process.
  • Provide general operational, administrative and training support to Exchange partners.

“Cautiously Embrace” Change:

As the U.S. Health Insurance industry continues to evolve, we can be certain traditional sales models will no longer be as effective as they once were. Companies who are able to “cautiously embrace” change and invest in evolved roles such as the “Health Consultant” and the “Exchange Specialist” will prepare their organizations for success. To be sure, this is not easy. While we can’t guarantee a “hole-in-one,” Alexander Group has worked with several carriers to help them with this transformation, and we can demonstrate how the proper Sales and Sales Support Roles will take a few strokes off your game.

Learn more about Alexander Group’s Health Insurance practice.

Original author: Chris Gosline


Insight type: Article

Industry: Health Insurance

Role: C-Suite, Sales and Marketing Leadership

Topic: Sales Productivity, Talent

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