To Remain Competitive, Health Plans Must Support Value-Based Care

I recently participated in an AHIP webinar, "Growth and Innovation with a Consumer-First Future," with HealthEdge customer Sal Gentile, CEO and Co-Founder of Friday Health Plans, along with UST HealthProof's CEO Kevin Adams and HealthProof President Raj Sundar. We discussed current challenges health plans face while competing to grow their business in today's rapidly changing healthcare industry.

There are increasing market pressures for more health plans to move away from traditional fee-for-service models and adopt value-based care. However, an audience poll revealed that 34% of health plan employees say their ability to support value-based models is the top challenge inhibiting growth and efficiency. This correlates with the relatively slow growth of value-based arrangements between health plans and providers.

Value-based contracts and benefit plans can range from simple incentives to risk sharing, including full capitation. That's why it is critical for health plans to have the supporting technology that can drive the business with whatever model fits.

"I don't think it's any surprise in this industry that change is a constant thing in our business. And what's amazing is the degree of change never seems to let up," said Kevin Adams. "If you implement the right capabilities, whether that be people or systems, you can adapt to that change very easily."

Legacy systems with minimal business flexibility, convoluted configuration, custom code, and manual processes hinder a plan's ability to shift to any form of value-based care and realize subsequent growth opportunities. Health plans need a system with the flexibility to configure all types of plans and can quickly respond to changing regulations with minimum disruption.

With value-based care, the exchange of information with providers is also critical for success. Health plans require technology that can provide comprehensive, actionable data and analytics about the patient's health to their providers.

Actionable insights are not only valuable for providers in value-based arrangements, but they can also help health plans continue to innovate and offer new benefit plans and designs.

"We're a very metric-driven organization," said Sal Gentile. "It guides us in two ways. It helps us determine whether or not we're meeting our objectives and hitting our results, and it also drives the new learnings that will dictate what we're going to invest in next, what we have to fix, and where we want to go."

To support growth and efficiency, health plans need a core administrative processing system that supports value-based models and new partnerships.

Case Study
Friday Health Plans: Building for Growth, Efficiency and a Consumer First Future

Friday Health Plans turned to UST HealthProof and HealthEdge for a core administration processing system to grow their business to an agile, next-generation, modern organization that can keep up with shifting consumer demands. Download the one-page case study to learn more. 

case study image value based care

About the Author

Harry Merkin

Harry Merkin, VP, Marketing

Harry has worked with both payers and providers through many dynamic changes in healthcare for a number of years. He is currently responsible for Marketing at HealthEdge, including product marketing, demand generation and thought leadership. He previously had similar responsibilities at Evariant and NaviNet and has collaborated with many transformative entities across the healthcare landscape. Harry has helped introduce and promote innovative enterprise software solutions that enable payers to improve their competitive effectiveness, as well as perform valuable communications between payers and providers, and allow providers to effectively collaborate with patients and consumers as well as with each other. He is a frequent speaker at industry conferences and forums and contributor to the ‘Edge Report, the HealthEdge blog.

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