Changing markets and the entrance of non-traditional players into the health insurance market are pressuring payers to transform their models.
Health plans are in the early stages of shifting their focus, using multi-dimensional data to improve wellness and care, according to a study recently released by the Deloitte Center for Health Solutions.
Information technology will play a significant role in enabling the transformation, the Deloitte report suggests, as health plans aim to better manage population health risk, while at the same time, personalizing interactions with consumers.
Many plans may have a long way to go, the report contends. Health plans must learn “how to engage and influence consumers toward better health through a high-touch experience with digital devices,” researchers note. “Data and data interoperability will be the secret sauce in improving wellness and care for members, but consumers will own their data and will need to see and harvest the value in sharing it with health plans.”
Transformation resulting from value-based care has been slow, although it’s been picking up momentum recently, says David Biel, principal at Deloitte Consulting.
“Two main elements are driving the transformation. One is a deeper focus on the consumer,” Biel says. “There’s a bigger focus on affordability, which is ultimately a focus on the consumer, who is impacted by cost. Also, the digital technology revolution has finally caught up to the healthcare industry—machine learning, cognitive capabilities, all the wearables are all accessible to the typical healthcare plan.”
New entrants into the field are likely to accelerate change among health plans, Biel contends. “Walgreens, Walmart and other companies are taking a deeper dive into healthcare, and they’re bringing a different value proposition to the consumer.
“Consumers on average are not happy with the cost and access overall,” Biel says. “I get frustrated, as an individual consumer taking care of others, it can be difficult at best. Consumers have been crying for better access for a long time; what will change the game is the disruptive players. The retail giants and other companies see the healthcare market as an opportunity to extend their footprint and change their brand, and capture a market that has greater margin potential.”
Biel sees three fundamental roles that will drive value within the health industry.
An emphasis on well-being and care delivery. To successfully “navigate the new role of being a steward to members’ well-being and care, health plans will need to be closely aligned with care delivery teams,” the report states. “This could open up new opportunities to manage health.”
Care enablement. As business models shift for health plans, they’ll “develop a new take on the traditional role of ‘financier,” as their business models shift to look beyond adjudicating and paying claims.”
Data and platform. A shift will occur here as well, report writers say. “Health plans will begin to move beyond using data to support compliance and reporting functions to become data conveners, science and insight engines, and data and platform infrastructure builders,” they contend. “Digital technologies will be focused on reducing care costs and achieving better outcomes. “Using the wealth of data they possess, they will develop new revenue streams based on consumer insights, monetization of data, population health initiatives, and customized offerings.”
“Traditional (health plans) are paying attention; they’re asking themselves how will I compete and what does that look like,” Biel concludes. “They’re placing a bet that, as we have more information and transparency involved, they can get more analytical and can use digital technologies to become more predictive.”