Member Engagement, Payer Spending Lead Top 10 Stories of 2017

By Thomas Beaton

December 11, 2017 - The 2017 news cycle was a constant flurry of political and financial developments for payers. From the turbulent efforts to repeal and replace the ACA in the House and Senate to challenges with member engagement, population health, and cost cutting, payers have continued to navigate a healthcare market that seems to change constantly.

Payers prepared for these changes throughout 2017 by leveraging data to make more informed decisions when designing health plan benefits and providing financially solvent health plans under the ACA.

With the year almost over, creating financially successful health plans that are cost-effective is a pressing concern for payers, as indicated by the viewing habits of HealthPayerIntelligence.com readers.

In 2018, small and mid-size payers will not only be tasked with providing health plans that benefit their organizations financially, but also delivering plans that have the quality to compete with offerings from the nation’s largest payers.

Payers may set themselves apart in the market by offering competitive small business health plans, using specialized analytics to address social health determinant care costs, or providing desirable wellness benefits to beneficiaries, but payers must ultimately find a tactic that gives them the most developed insights for pursuing their enterprise goals.

Here are the top stories of 2017 in descending order of popularity.

10. Payer Pricing, Partnership Strategies for Population Health

Population health, a leading value-based care trend, can help payers lower spending on high cost chronic conditions.

Payers can assist in the success of population health programs by restructuring pricing for chronic condition treatments and medications, participating in value-based insurance design, and using data analytics to identify high-risk patients within beneficiary populations.

9. How Payer Philanthropy Can Address the Social Determinants of Health

In interviews with HealthPayerIntelligence.com, community outreach experts from Humana, Aetna, and UnitedHealthcare discuss the strategies for addressing negative social determinants of health that contribute to high payer spending.

Strategic philanthropic investments in community leadership organizations help improve beneficiary health behaviors while enriching the community.

8. How Pharmacy Benefit Managers Lower Prescription Drug Prices

Pharmacy benefit managers (PBMs) use various tactics to negotiate drug prices for payers such as leveraging long-standing relationships with manufacturers, the promotion of cheaper generic/alternative medications, and development of programs that help payers improve members’ medication adherence.

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

Consumer-directed health plans are highly marketable because their high-deductible, low premium financing design are cost-friendly to consumers.

Payers offering consumer-directed health plans should make sure that younger, healthier beneficiaries with good financial behaviors are enrolling in the plans. Enrolling unhealthier, financially irresponsible beneficiaries is not ideal as these individuals could quickly run through deductible amounts.

6. Payer Collaboration Can Address the Social Determinants of Health

Research from AHIP identified strategies for payers looking to address social health determinants that exacerbate healthcare costs. Case studies found that proactive involvement with community and wellness organizations can help lower the rate of conditions that influence negative outcomes.

5. 80% of Payers Investing in Member Engagement, Satisfaction

To support current enrollment and develop optimized new enrollment procedures, 80 percent of health plans in a Change Healthcare survey said they are investing in member engagement and consumer satisfaction improvements.

By providing customer support tools, preferred member communications, and hiring member engagement professionals, payers are hoping to improve member confidence in health plan shopping while standing out from the market.

4. The Benefits of Accountable Care Organizations

The number of accountable care organizations (ACO) is growing in the modern healthcare landscape, and gives payers an opportunity to save on costs and move from fee-for-service to pay-for-performance. What are the benefits of these arrangements, and how can payers profit from them while improving patient outcomes?

3. The Progress and Challenges of the Affordable Care Act

A review of the sweeping healthcare legislation from 2010 reveals that it has been a double-edged sword for payers.

Policies like the individual mandate and cost-sharing subsidies help payers fund the cost of care for high-risk beneficiaries, but consumers sometimes have trouble paying for coverage. The ACA has significantly impacted the health payer industry, leading payer organizations to thoroughly address these challenges.

2. Top 10 Most Expensive Chronic Diseases for Payers

Healthcare spending is a $3.3 trillion problem for payers, which is largely driven by the expenses of treating chronic diseases.

Reviewing publicly available information from the CDC helps illustrate to payer organizations what their healthcare dollars are most likely to treat. These costs have lead healthcare leaders like the AMA to ask payers to establish chronic disease management funds and programs.

1. Top 5 Largest Payers in the United States

The most profitable, financially stable payers in the US continue to set a standard for other payer organizations. Combined, these payers serve more 160 million beneficiaries and earned over $410 billion in revenue from the previous year, according to quarterly and yearly financial reports.

Payers can position themselves for success in the next year, as healthcare costs continue to climb, and policy debates at the federal level continue to influence the payer market and the healthcare industry as a whole.

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