In the industry’s era of uncertainty stemming from Washington, D.C. and what the future has in store for healthcare is at the top of everyone’s mind. But, the truth is that no one really knows, and any prediction saying otherwise are merely guesses. This was the general consensus at this years’ 2017 TAHP Managed Care Conference.

Despite this uncertainty, we can focus our attention on what is more certain; what health plans can do today to build strategies for the future. According PwC Health’s report, The health insurer of the future: Consumers’ advocate, providers’ parter, there are three primary areas where health insurers can make choices now to be positioned for a more prosperous future:

  • shift towards value-based care
  • consumer-focused initiatives
  • the advancement of technology

A third of consumers reported that they don’t think health insurance is worth what it costs – yet the US spends one out of every five dollars on healthcare, according to the report. Interestingly, 68% of consumers reported that they rarely or never have used consumer-centric tools offered by their health insurers. There is a tremendous opportunity to empower consumers by offering simplified plan designs, price transparency solutions, and self-service solutions.

Of course, it’s easier said than done! Health plans often convey that have expended a considerable amount of resources to develop/enhance consumer oriented tools, and they often found the projects to be much bigger than anticipated. Identifying areas of inefficiency pertaining to claims administration, premium billing/collection, and enrollment will be critical factor for success in the coming years.

Taking a brief look at consumer shopping, among the executives surveyed in the PwC report, only 50% said they were implementing web-enabled platforms to streamline the plan shopping experience for consumers, another 25% said they were planning on offering one in the next 5 years, and the last 25% said they were not implementing in the next 5 years, or they were unsure. With so much uncertainty in the industry, investments in streamlining the plan shopping experience to empower consumers and create a more efficient process will pay dividends in the future.

Medicaid expansion is another strong area of interest. Medicaid expansion has been adopted by 32 states so far, with 7 states receiving approval for 1115 waivers. Five states (Indiana, Kentucky, Arkansas, Iowa, and Massachusetts) currently have their 1115 waivers pending before CMS and more are expected. Each state is proposing their own requirements, such as 1% premium surcharges for tobacco users, minimum work requirements, and sliding scale premiums just to name a few.

According to Charles Smith, Executive Commissioner of Texas HHS, he and his team have been in close contact with CMS and the Trump administration, and will ultimately do what is best for the people of Texas. For states like Texas, it is uncertain if they will choose to expand Medicaid to cover those in need of access to care. However, we have observed industry experts who have communicated and agreed that the road to the future will continue to be rocky before giving way to smoother road.

The views and opinions expressed by the authors on this blog website and those providing comments are theirs alone, and do not reflect the opinions of Softheon, Inc. or any employee thereof.

Hamoon Hadavand

Hamoon Hadavand

Senior National Account Executive at Softheon
Hamoon is an industry expert in the healthcare payer market. He is responsible for Softheon’s strategic payer partnerships, strengthening existing client relationships, and identifying new market opportunities. Over his career, he has held several senior sales and business development positions within information technology and healthcare.
Hamoon Hadavand

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