While 2017 will certainly be filled with an array of unpredictable scenarios, there are seven trends that we can count on increasing in significance this year. These seven trends include:
No surprise here! Market disruption resulting from change in political leadership is likely to be the number one issue, requiring health insurers to map out various what-if scenarios and prepare both their PR and structural responses to each. While doing this, insurers also need to implement measures to increase their operational agility and adapt a ready-for-anything, responsive approach.
Additionally, health plans can work to better shape and control disruption by participating in the political debates and ensuring that if bold action is taken, the replacement for the Affordable Care Act is an option that leverages their specialized industry insights and considerations. The complexity of health care requires education—it requires that health insurers work to inform the political debates in order to minimize disruption to its consumers, business models and plan design.
There’s been a major shift already in the language plans use when discussing premiums, deductibles and cost-sharing details in their marketing and member communications, as it is no longer simply about communicating what something costs—but helping members evaluate whether they can actually afford and plan for the cost. As the role of managing the cost of healthcare continues to be placed in the hands of the consumer, affordability will continue to emerge as a focal point of marketing messaging and market differentiation.
The shift from traditional fee-for-service medicine to value-based reimbursement will continue. Fueling this change is in part CMS’s Medicare Access and CHIP Reauthorization Act (MACRA), which replaces the way clinicians get paid under the Medicare Part B Physician Fee schedule, requiring that clinicians demonstrate the value of the services they provide via measurable, year after year results. While the MACRA received marginal visibility last year, it is expected to become a focal point of 2017. What does this mean for health plans? Plans will need to collaborate with clinicians to help them develop new ways in which they can begin to better define and assess value. They also may need to adapt their networking criteria accordingly.
Additionally, health plans should themselves adapt to a value-driven market by considering how they can diversify their products, services and business models. They should work to better communicate what they do, how they do it and why it makes a difference across their pre-sale marketing, ensuring that cost is always communicated in alignment with value and demonstrating that value in their product materials via inclusion of personalized content and decision support tools.
Liquid consumer expectations will move plans to find ways to collaborate with providers in order to leverage the patient data at clinicians’ fingertips and deliver more personalized health engagement that can compete with best-in-class customer experiences across industries. Health plans will also need to accelerate their integration of digital media into marketing and member communications in order to take advantage of the big data and analytics that can be garnered and used to create dynamic customer behavioral profiles and predictive marketing models, and in turn, support targeting and personalization initiatives.
Health plans need to make themselves and their processes easier to do business with for consumers and potential partners. This includes making EOBs and claims easier to access and understand, as well as integrating internet self-service capabilities that can more accurately and helpfully address member inquiries. 2017 will be about reducing the confusion and complexity member experience when selecting, receiving and paying for provider care. Insurers working to do so are investing heavily in innovative new technologies and flexible IT infrastructure support services.
6. Information Technology
2017 will be about building the data and information technology to support a retail like health plan shopping experience. In raising the cost of premium and deductibles, consumers in turn have become more sensitive of health care costs, but now require the price comparison technology that can enable them to be more intelligent shoppers. While slick price transparency mobile apps are abundant, the underlying data to support a healthcare price comparison app is severely lacking. There are no reliable sources of pricing data on healthcare services like retail pharmacies, prescription drug manufacturers, hospitals, outpatient clinics, physician offices etc. Because of this, data structures must first be created in order to support a true comparison shopping experience. Health plans should consider collaborating with database design specialists to help guide the development of these structures and the procurement of required data.
7. Process Automation
With emerging technologies, such as Blockchain, showcasing its potential to transform 20+ business process, from provider contracting to payment tracking, customer service delivery, product underwriting and more, automation will continue to transform not just health insurance processes, but overall business models. The complexity of basic health insurance processes will be reduced in 2017 through increased integration of process automation technologies.
This year, the challenge of affordability will remain a signature issue, while government regulation and innovation will continue to make profound impacts on the industry. Yet, despite the backdrop of unpredictability, great opportunity exists for the health plans willing to make investments in the empowered health care consumer and the processes, technologies and communications required to support them and their power to choose.
To explore the breakthrough technologies and processes Cierant is helping leading insurers employ to triumph these trends, please call 203-731-3555 or email firstname.lastname@example.org.