Accelerated by the Covid-19 pandemic, healthcare innovation has skyrocketed over the last few years to meet the evolving demands of Americans who are eager for personalized, accessible, and quality healthcare. While this innovation brings a lot of benefits, including addressing consumer demand, it also exacerbated existing challenges, such as the continued rising costs of healthcare, and hastened the move toward value-based care models. While these changes can be difficult to keep up with, health plans must recognize them and adapt accordingly to improve outcomes for members and drive business growth.
Health plans are in a unique time of change and have the opportunity to be seen as partners for success with employers and providers. Here are a few key healthcare trends that health plans should watch in the coming months:
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Salem Shunnarah Salem Shunnarah leads the Health Plans & Systems segment at Virgin Pulse. He helps develop value-based products, software, and services for the health plan and health system markets. By aligning market need and demand with the company’s solutions, the Health Plans & Systems team assists customers with their strategic and financial goals to […]
Embrace the power of personalization
Consumers have become accustomed to convenient digital tools in all areas of life, including shopping, ordering food and groceries, and banking, among many others. With an abundance of curated social media content, playlists, shopping lists, and more at their fingertips, consumers expect this type of personalization in healthcare too.
Data shows that 88% of consumers prioritize personalization as much as or more than they did a few years ago, so it is imperative for health plans to offer their members personalized support that addresses their individual health risks, wellbeing priorities, and health goals. To successfully engage and activate these members, health plans can harness the power of data and predictive analytics to gain valuable insights into what offerings will resonate with certain populations and create personalized experiences that meet their unique needs – perhaps even before they know they’ll need it. Doing so will not only meet consumer expectations, but will drive better outcomes and create more brand stickiness.
Prepare for rising healthcare costs
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
The financial fallout of Covid-19 is leading health organizations to experience increased costs of resources, salaries, and supplies. On top of this, they also need to manage more costly patient care and a sicker overall population due to delayed screenings and diagnoses. To prevent revenue loss, excess costs, and falling quality performance, health plans need to build a strategy for how they will manage these costs in both the short- and long-term.
Technology is an effective way to support members’ health and wellbeing journeys. Digital platforms that deliver personalized, accessible, and timely health information can encourage members to get back on track with regular checkups and appointments and lead healthier lives. Plans can also maximize use of telehealth and other virtual and remote tools to shift care to a lower-cost setting. Taking a proactive approach will help health plans get ahead of and manage high-cost events, as well as avoid expenses related to member attrition and acquisition.
Understand populations to drive health equity
Health equity may be difficult to achieve, but it is an incredibly important movement for health plans to embrace. CMS recently announced its approach for advancing health equity along with a challenge to healthcare leaders to make similar commitments. To do this, health plan executives must fully understand their members and what they need to achieve their personal health and wellbeing goals.
Consumer and social determinants of health (SDOH) data should be analyzed and incorporated into any successful health equity strategy – a one-size-fits all approach will fall flat. SDOH data allows health plans to better understand their members and communities beyond surface-level insights, helping to establish solutions that help them overcome barriers to health. For example, some individuals may need transportation or scheduling support to get to medical appointments while others may need guidance around nutrition and exercise or prevention programs and screenings. Once these programs are established, health plans must also invest in strategies to educate members, and drive engagement and adoption.
Move beyond enrollment to activation and engagement
Starting something new is hard, and health and wellbeing practices like better nutrition and exercise plans are no exception. Research shows that 80% of people will abandon a new habit in the first 30 days. Health plans need to be strategic about how they promote these initiatives. It is not enough to just offer a health and wellbeing program or service, health plans should go one step further to educate members and help them understand the next best action for achieving their goals, driving engagement.
This requires health plan leaders to adopt a data-and-science-based approach. Once they understand what resonates most with members through data analysis, they can make communication strategies personal and relevant, encouraging members to take the next best step, and connecting them with resources they both need and are likely to utilize. Understanding how to drive sustained engagement and what supports long-term behavior change is critical to achieving this success.
Consider the evolving definition of value
As the healthcare system evolves, so does the notion of value and what it means in terms of value-based contracts. From 2021 to 2025, value-based contracts are projected to grow to cover 22% of insured lives in the U.S. – nearly 65 million people.
Health plans can help providers deliver value to patients while also supporting the move to value-based care. This includes working with providers to support patients with telehealth and other digital health tools. It also involves meeting the unique needs of members to drive actions such as completing a missed cancer screening or attending a prenatal care appointment. To contribute to value-based care success, health plans can enable healthy actions and long-term behavior by simplifying how individuals navigate their benefits and interactions with the larger healthcare system. Better navigation leads to more engaged consumers who adhere to preventive care recommendations, adopt healthier habits, get control of their chronic conditions, and decrease overall risk.
To successfully drive better health outcomes and business growth, health plans need to pay attention to trends within the industry and address them. Innovations in digital health are pushing the healthcare industry to evolve at a rapid pace. By embracing these advancements and adapting them to address and solve member needs, health plans can deliver personalized healthcare experiences that drive value and improve member satisfaction and health outcomes.
Photo: rudall30, Getty Images
Salem Shunnarah leads the Health Plans & Systems segment at Virgin Pulse. He helps develop value-based products, software, and services for the health plan and health system markets. By aligning market need and demand with the company’s solutions, the Health Plans & Systems team assists customers with their strategic and financial goals to drive meaningful activation and engagement via health and wellbeing programs.
Salem brings more than 25 years of experience in healthcare, benefits, and human resources, with leadership roles in Fortune 50 consulting and payer organizations including Elevance Health (formerly Anthem) and Aon Hewitt. His experience affords him a deep understanding of the objectives of health plans, employers, and consultants, enabling him to achieve meaningful results. He is driven by his desire to align with customers’ goals to achieve better outcomes while improving the overall healthcare experience.
