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ACA, Member Engagement Challenges Led Top 10 Stories of 2018

The Affordable Care Act and the challenges of proactive member engagement led our top 10 stories of 2018.

Affordable Care Act, member engagement, and chronic disease

Source: Thinkstock

By Jennifer Bresnick

- It’s fair to say that the health payer community had a lot to process in 2018. 

Mergers, partnerships, and new entries into the field rocked the traditional industry setup, while federal efforts to chip away at the Affordable Care Act continued to create an environment of uncertainty and financial risk.

Meanwhile, the ongoing transition to value-based care – and its associated pressure to improve member engagement and control costs – continued to spur innovation in plan design and a heavier reliance on data analytics to guide their next steps.

Throughout this tumultuous year, readers turned to for information and insights on the current and future state of their industry. 

Our top 10 stories of 2018 reflected the critical importance of keeping pace with changes to the ACA and the challenges of developing proactive, effective member engagement programs to reduce the financial and clinical impacts of chronic disease.

In reverse order, here are the ten most popular articles from the past twelve months.

10. 80% of Payers Aim to Address Social Determinants of Health

The social determinants of health took center stage in 2018 as payers ratcheted up their efforts to reach members in their homes and communities before they end up in the ED or the inpatient setting. 

According to a February 2018 survey by Change Healthcare, 80 percent of payers squared up to the challenge of improving the social determinants of health by pouring millions of dollars into community-based programming, better data collection, and member outreach programs.

Payers are concurrently expanding their risk-based reimbursement initiatives, making it doubly important to engage both providers and beneficiaries in more proactive, socioeconomically sensitive care.

9. CVS, Aetna Merger May Face Antitrust, Consumer Protection Issues

The mega-merger between CVS and Aetna captured the industry’s attention in 2018, as policy pundits predicted massive changes to the consumer landscape and data analytics experts thrilled at the prospect of unprecedented opportunities to target individuals and their behaviors.

While the $69 billion takeover did close at the end of November, readers flocked to this March 2018 article highlighting the concerns of the American Antitrust Institute that the deal would limit choice and potentially run afoul of consumer protection laws.

The Institute noted that in conjunction with the proposed merger between Cigna and Express Scripts, the CVS-Aetna deal would represent a “fundamental restructuring” of healthcare, creating a monopoly situation.

8. Top 10 Healthcare Spending Categories in the United States

High costs for medical care and prescription drugs dominated headlines in 2018, putting payers and providers on the back foot in the face of consumer anger and federal warnings to reduce spending.

This breakdown of the highest-cost categories of care, based on data from CMS, and the CDC, illustrates just how severe the spending problem can be.  Prices continue to inch inexorably upward, meaning this late 2017 benchmark article will soon be sadly out of date.

7. Early Health Insurance Premium Proposals Indicate Hikes for 2019

Payers started to publish their proposed 2019 premium rates during the summer of 2018, giving observers a glimpse into what to expect in the near future.  While many payers asked for relatively conservative increases, companies in several states requested double-digit hikes for their members.

In Maryland and Virginia, some individual plans are slated for steep increases in monthly premiums, with a few options almost doubling in cost for members.

The increases are the result of continued uncertainty around the ACA and the growing availability of non-ACA compliant plans that are expected to bring changes to enrollment patterns and risk pools.

6. How Payers Can Improve HEDIS Quality Measure Performance

The increasing focus on consumer choice and patient-centered care in 2018 has left many payers wondering how they can best show off their quality and value to choosy beneficiaries.

High HEDIS scores offer payers the opportunity to showcase better outcomes and beneficial spending techniques to potential consumers and other industry stakeholders.

In this resource article, breaks down the meaning of HEDIS scores and suggests several methods for improvement on these key metrics.

5. What are the Pros and Cons of Consumer-Directed Health Plans?

High-deductible health plans have become a favorite for payers looking to shift costs to consumers and, theoretically, promote more responsible spending. 

The combination of a high deductible with one of the tax-advantaged variations of the personal health savings account creates what’s known as a consumer-directed health plan, in which the member has significant responsibilities for his or her own spending.

These plans seem attractive to payers, but may not always be the best option for consumers.  Here, we break down the benefits and drawbacks of consumer-directed health plans and offer insights into how to make these options work to everyone’s advantage.

4. Affordable Care Act Changes May Bring a Rocky 2018 for Payers

In January of 2018, the payer industry was still puzzling over the potential impact of repealing the ACA’s individual mandate, the expansion of flimsy association health plans, and the Trump Administration’s ongoing actions to destabilize the insurance marketplace. predicted that these actions would create frustration and insecurity in the market in the year to come, and it’s no particular joy to have been correct. 

Uncertainty will still be the industry’s watchword as we enter 2019, which does no favors for consumers or for businesses. 

3. How the Affordable Care Act Changed the Face of Health Insurance

Although this piece was published in 2016, its enduring popularity shows that the health payer industry is still coming to grips with the changes wrought by the landmark Affordable Care Act.

Premiums and deductibles haven’t stopped increasing over the past two years, and many payers haven’t yet cracked the secret of creating a stable, consumer-friendly operating plan in the face of radical change.

While much has changed in the intervening years, some things – like a growing reliance on value-based reimbursement and the need to balance price hikes with better benefits for members – are likely to continue for the foreseeable future.

2. Top 5 Largest Health Insurance Payers in the United States

The “big five” companies that dominate the health insurance landscape are raking in billions in net revenues, even as they jockey for position in an industry that is rendering traditional approaches to coverage obsolete.

UnitedHealth Group, Anthem, Aetna, Humana, and Cigna have huge power in local and national markets, leaving competitors to woo customers on the strength of innovative member experiences and data-driven personalization.

That isn’t to say that these companies aren’t doing everything in their power to create more memorable interactions and overhaul their historically lackluster customer service, even if it means buying up other companies – or letting themselves be bought. 

They have a crucially important head start with their unbelievably massive consumer datasets, and are bringing their influence to bear on proactive population health management and more impactful engagement strategies.

1. Top 10 Most Expensive Chronic Diseases for Healthcare Payers

The most popular article of 2018 reflected the ongoing importance of chronic disease management – and the enormous spending that comes from the increasing incidence of long-term conditions.

The top 10 most expensive chronic diseases for payers include diabetes, cardiovascular disease, and Alzheimer’s, all of which affect tens of millions of individuals and cost billions of dollars a year.

Getting ahead of the development of preventable conditions will be the biggest challenge for payers heading in 2019, especially as regulatory changes create new pressures to balance risk pools and improve the overall health of members.

This breakdown of the most costly diseases facing the American public gives payers a good idea of where to focus their population health management and member engagement strategies as we move into a brand new year.


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