Health plans are increasingly seeking ways to cement partnerships with the providers in their networks, helping to provide tools that will allow them to survive and thrive in the move toward value-based care. At the top of that list is leveraging the enormous amount of data that payers have available and putting it to use to make it easier for providers to do business with them.
In 2017, that continued expansion of the power of data, a patient-first mentality and a focus on innovation will most impact health plans. We asked two industry experts for their perspectives on these current trends and others:
Karen Love, COO, Community Health Choice:
“What I think health plans will be doing in 2017 is figuring out which of the strategies we began pursuing under the ACA are likely to remain regardless of what the replacement looks like. For example, the movement toward more individuals making decisions about what their health insurance is going to be and with whom is a trend that will be there regardless of what happens with the ACA. What we were doing to be more consumer-responsive, to better understand subsets of our members and what their needs are, are strategies we will continue to pursue.
“We are implementing a customer relationship management (CRM) system that enables our employees to have a holistic view of that customer. What we get now about our members from healthcare.gov is pretty bare bones. What do they understand about their membership? What is their health literacy level? What language do they speak? If I’m going to create a better member experience with us, I have to learn more about them and build that into my process of onboarding members.
“One of the other big trends is figuring out how much data to share with which providers and in what format. We have to do a better job of feeding actionable information to our providers about members. Collaboration with providers, meeting the needs of their patients and giving them actionable data is something more insurance companies are working on.
“This year, we are going to be working with some of our large provider groups trying to create shadow data systems, that will say, ‘here’s what it might have looked like if you had been capitated for this group of patients,’ or ‘here’s what it would have looked like if had we paid you a bundled payment for these services.’ They need to feel confident that the value of that bundle is substantiated by their own experience. We have tremendous analytics capabilities. What kind of reporting can we give providers that would help them move in the direction of value? In the coming year, it’s going to be important to be nimble and flexible and able to respond to rapid changes in the market you serve.”
Shawn Larsen, Director of Quality Improvement, Health Optimization, Bright Health Plan:
“The rise of the consumer is a critical trend for health plans in 2017. In any market, serving to the consumer is the key to change. But in healthcare the consumer remains the most important and most overlooked player. With wage stagnation and an aging population, it’s more important than ever to keep the consumer at the center of plan design and deliver what consumers want, need and deserve: quality, individualized care at an affordable price. The need to keep care affordable leads to another key trend for 2017: payment innovation. In an effort to control the cost of care and deliver better outcomes, payers and providers are entering into more risk-sharing agreements and bundled payment arrangements.
“Continuing to put the consumer first as the market transforms out of necessity and as a result of any regulatory changes will be both the biggest challenge and opportunity for health systems. In times of change and uncertainty our reflex is to default either to negativity or to what we know – to look for certainty. However, doing so will mean retreating to a system that did not put consumers at the center. Remaining committed to the guiding light of transformation, the consumer, will be difficult, but will engender the most change and bring about the most opportunity for payers, providers and, of course, the consumer. This becomes much easier to do when incentives align, which is why Bright is so excited about our care partnership model. It puts the provider and the payer on same team to deliver the best health care experience.”
The bottom line for health plans, agree Love and Larsen, will be balancing the need for certainty in a turbulent time with the commitment to transformation. What’s more, health plans have a responsibility to help their network of providers prepare themselves for that transformation, no matter what their level of readiness.