Payers and Consumers: The Path Ahead

Steve Krupa, CEOJanuary 10, 2020
The 'Edge Report

Healthcare payers have a long history of thinking of themselves as fiduciary entities.  This self-image is changing by necessity, as consumers become increasingly savvy in evaluating and selecting the services impacting their lives.  Recent surveys, including one by Survata and commissioned by HealthEdge, show that consumers of all age groups want improved communication with their health insurer through multiple channels, particularly when it comes to understanding their benefits.  They also prioritize understanding their financial responsibility by “what do I owe?” both before and after encounters with providers.  Millennials, more than any other age cohort, want incentives for healthy behaviors from their health insurer. Health insurers who modernize their systems to effectively serve their customers will differentiate themselves as consumers increasingly make decisions influenced by online reviews and word of mouth versus brand loyalty.

Social Determinants of Health: Outcomes and Factors

Another area where health insurers can proactively influence health outcomes while lowering overall costs is in the consideration and proactive addressing of non-medical factors that impact their customers, known as social determinants of health (SDoH).  Factors such as isolation, access to transportation, healthy food, and stable housing have been proven to have a direct impact on the health of individuals and families.  Health insurers who partner with providers and community resources to screen for these factors and connect at-risk consumers to key resources have demonstrated they can bend the healthcare cost curve and improve lives in a tangible, measurable way.  Innovative programs funded and driven by health insurers such as UCare and Humana, for example, have resulted in healthier outcomes.  More attention to these factors involves high touch, on-the-ground outreach and strong community partnerships.  2020 will see some of these pilot programs become standard, while health insurers who have been watching from the sidelines will begin to act and get involved.

Cost Per Transaction

Along with thinking of consumers as customers, health insurers have an imperative to lower administrative costs, specifically for the myriad of transactions they manage internally.  Automating processes that have been handled manually, sharing information in real-time with customer service representatives, and providing information directly to customers electronically have been proven to lower costs and improve customer satisfaction.  In addition, resources saved can be reallocated to innovation, further enhancing health insurers’ competitive position.  Those organizations that focus on transforming to consumer-facing, hyper-responsive and digital enablement will be most successful in 2020.

Readiness for Change

Companies have formed new partnerships in many areas of healthcare, most notably in the health insurance market.  These entities, whether formed by established organizations coming together, the result of acquisitions and consolidation, or from new start-up endeavors, have disrupted more traditional models.  Each of these represents new forms of competition for the established health insurer, forcing organizations to act in response to new threats.  The path forward will feature new collaborations with providers, enhanced relationships with employers, and innovative offerings directly serving consumer needs. 

No matter which path they choose, health insurers must have the flexibility to move quickly, while reconfiguring their products and businesses based on the changing dynamics around them.  The same applies to health insurers with government programs, as regulations are subject to change based on legislation, policy changes and/or legal disputes.  Health insurers who adapt rapidly with confidence and agility will emerge the winners.

Where does your organization fall on the change curve? How do you plan to adapt in 2020? Let me know.

About the Author

Steve Krupa is the CEO of HealthEdge

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