The Emerging Shift to “Value” for Health Plans

All citizens of Florida deserve the security of universal health care that guarantees access based on needs rather than income.

It is a fundamental human right and an important measure of social justice. The government should play the central role of regulating, financing, and providing health care. Everyone faces the possibility of poor health.

The risk should be shared broadly to ensure fair treatment and equitable rates, and everyone should share responsibility for contributing to the system through progressive financing.

The cost of health care is rising. Over the past years its expenditure have risen faster than the cost increases reported in other sectors of the economy. As a matter of fact, the free market doesn’t work for the health care system.

Movement already began on the long journey from traditional “fee for service” healthcare to a model that emphasizes value and quality. It’s been underway for a little while now, but we expect to see real acceleration over the next 12-24 months.

Astute observers of our health system have predicted this shift for some time, but the “market” is often slow to adapt to unfamiliar change.

Health reform and many related initiatives have converged to help fully activate this new model.

The NY Times reported on how new payment approaches are beginning to positively impact provider and patient experience (see “Health Insurers Are Trying New Payment Models, Study Shows” from July 9, 2014).

We see reports such as these as the first waves of the seismic shift that will transform healthcare in this country. We also see the opportunity and responsibility for health plans to contribute to greater patient-provider collaboration as they continue to evolve and gear up for a more consumer-centric market.

A number of trends are materializing that illustrate this ever-increasing role for consumers in next-generation health plan models.

We’re seeing a rise in healthcare consumerism, marked growth in the individual market, and increased participation in HSA-eligible high deductible health plans.

In their September 2012 report “Transforming Healthcare: From Volume to Value,” KPMG cites numerous trends that signal this developing reality.

Health plan executives surveyed for the report predicted significant changes in the health plan market over the following five years, with growth predicted for CDHPs (78% said so), Individual (76%), Medicaid (76%) and Medicare Advantage (71%). Most felt that group health insurance would decline in that time frame.

We’re already seeing these predictions beginning to play out.

AHIP also released a survey noting there are now over 17 million active HSA-eligible insurance plan members, which is up almost 12% from 2013. Enrollment has increased an average of 15% per year since 2011. Still relatively small numbers, but market conditions favor further expansion.

This evolving megatrend of “Volume to Value” will redefine the health insurance market.

It will move the industry from risk manager and claims adjudicator to collaborative partner and outcomes driver. The health plan of tomorrow can be a true catalyst for healthcare change.

To realize this potential, health plans must become more consumer-centric in their strategies, tactics, messages, tonality and service offerings. They need to deliver meaningful solutions to providers and members and help drive collaboration between these two constituent groups.

They can be truly instrumental in helping to solve an array of significant problems and open up opportunities for greater reimbursement and better outcomes.

In the past, health plans have been supportive of their members with health improvement initiatives around chronic disease or preventative testing or by providing relevant health-related information.

But today, health plans are increasingly connecting with providers and members through portals, which have significant untapped potential for increased interface.

Think of the many areas of patient-provider collaboration that can be enhanced with the right sort of technology interface for intervention, interaction, information sharing and other purposes.

A dynamic, user-friendly and valued portal and related mobile apps can be essential in addressing areas such as:

• Gaps in care – helping to better intervene in the area of chronic disease
• Risk reduction – support for those with at risk for disease or complications
• Wellness and prevention – addressing potential health concerns + relevant testing
• HEDIS scores and STAR ratings – for increased reimbursement
• Big Data- make it personal, relevant and actionable

Health plans stand ready to lead the way with smart solutions to many of our healthcare challenges.

By focusing on member experience and delivering value through user-friendly technology, they can fundamentally enhance how members access the health system and address their own health concerns.

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