Hayes, Inc. at AHIP: Health Plan Transformation

Posted by The Evidence Blog on June 16, 2015

“Disruption” was the theme of the 2015 AHIP Institute. As such, the session, “How Health Plans Will Transform in the Next Five Years” forecasted the challenges and opportunities that are bound to surface. Between industry survey data and potential strategies that could be leveraged in the coming years, attendees learned about how to best prepare for what’s next in the health insurance industry.

What does the future hold? The panelists agreed that the critical attributes of next-generation health plans are benefit customization and customer-focused payment models. Health plans will need to find internal structures that are both agile and flexible. Recognizing that consumers (versus brokers) are the new audience, service and payment models will be crucial to success. Internally, payers will need to make a paradigm shift to accommodate a new customer base that makes purchasing decisions in a vastly different way than health plans are accustomed to currently.

Over the coming years, collaborative relationships with providers will become mandatory to remaining competitive in the industry. With a common mission to reduce costs and drive outcomes, payers will become increasingly involved in the point-of-care protocols and decisions providers make on a day-to-day basis. Transparency will become another crucial factor, both internally with customers and externally with providers. With members as the new consumer, full disclosure about costs and terms of service will be necessary. Members will look to purchase insurance in the same manner they purchase all other commodities—value for price. Providers will require full disclosure regarding the members they are treating in order to evaluate risk. Panelists also cited differentiation as a factor plans need to consider. Health plans will have to find ways to set themselves apart from the pack. By starting with a clear vision, health plans can find small ways to offer unique services that will generate convenience, reduce cost, or increase value.

Lastly, as with all industries, remaining current with technology trends in healthcare is an integral piece of the puzzle moving into the future. By gathering and analyzing data retrieved from electronic medical records, payers will be able to generate more refined coverage policies resulting in better, more cost-effective care. The processing of claims has to be improved via technology as well. A number of plans still process manually, which is both labor intensive and expensive, thus increasing the cost to the consumer.

Topics: Hayes Blog

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