Health Plans: The Battle for Gateways and Goal Lines

September 21, 2020  |  Paula Serios, Joel English


In a national research study fielded in July of this year, BVK found that when it comes to health plans, provider panel size, premiums and benefit levels are all vitally important to consumers. This is a common theme across most health plan studies. While these considerations are somewhat obvious and intuitive, determining how each impacts the selection process is a bit more complex. It demands looking beyond these necessary and desirable features and exploring values and behaviors that provide the collective means for differentiation, member growth, and retention.

These additional considerations are needed to address deeply rooted category perceptions as well as the influence of personal experiences with health plans; specifically, the medical management and cost functions. Insurance is a means for us to gain affordable access to the doctors, hospitals, medications, and healing tools we require to keep us healthy. Though this is a category imperative, the reality is that a sizable number of members have been frustrated by their health plans. They perceive those plans as keeping them from needed care. What does this tell us? That panel size, cost, and benefit criteria are best viewed as a means to an end—health plan selection and retention. To make plans more attractive to both current and potential members, plans must devote greater attention to broad-based benefits that address their concerns and align with their individual aspiration.

In BVK’s experience working with health plans and exchanges across the country, we have learned that provider panel size, premium costs, and benefit levels are what we call “gateway” criteria: criteria that, if not met, will preclude a health plan from consideration. But for many, these are not the only criteria that they want to consider when selecting or continuing with a health plan.

There are two principal reasons why these are “gateway” criteria rather than “goal line” qualities capable of creating separation and closing the sale:

So, gateway criteria alone do not provide the means for a defensible, long term competitive advantage. This is the reason Walmart stepped away from their long-standing and highly focused “low price always” positioning. It became a feature they couldn’t absolutely defend and left them with little else upon which to compete for business. Walmart’s current campaign focuses on a multi-faceted appeal based on intangibles such as their employees, the shopping experience, and a “Buy American” focus in order to provide dimension and broaden the appeal of their brand. Do they still talk about low prices? Of course. Do they end the conversation there? Absolutely not.

BVK’s national research study explores a series of qualities related to underlying motivations, trust, and consumer centricity that emerge as “goal line” qualities. If present in combination with competitive gateway features, these qualities can provide a valuable means for differentiation and get people across the goal line. Simply put, they can get people to select or retain your plan.

Many of the features, behaviors, and qualities studied relate directly to disconnects with insurance companies related to size and profit orientation. Factors such as not-for-profit status, provider sponsorship, and locality play a pivotal role as they appear to foster assumptions about motivation, patient centricity, and accountability that offer differentiation from larger, for-profit insurers. With other national research studies showing a loss of confidence in government and large corporations, plan features related to trust and accountability carry a lot of weight.

We would welcome the opportunity to talk with you to further explore our findings and your specifics. Or you could join us for one of our upcoming webinars where we will discuss our national research and its applications. You can also reach out to [email protected] with questions or comments.


is a Senior Vice President, BVK Health


Joel English is a Managing Partner, BVK Health

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