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Payers Driving Value by Promoting Connected Care Models

Payers that look to market health plans for the next generation of tech-savvy healthcare customers should consider creating connected models of care.

Payers look to market health plans to future consumer bases

Source: Thinkstock

By Thomas Beaton

- As payers vie to remain competitive in commercial insurance markets, they must be able to effectively manage consumer costs while providing beneficiaries the best possible healthcare experience now and in the future.

Rising healthcare costs are challenging payers to create health plans that have low-premiums and provide comprehensive healthcare benefits. At the same time, payers also must find innovative ways to make health plans and coverage options more consumer-friendly, with services that help the latter manage care and costs.

Creating a health plan that improves consumer experience while maximizing healthcare cost-effectiveness may soon be a reality suggests David Biel, the US Leader for Health Plans consulting at Deloitte.

Younger consumers from new adult generations will soon become health plan holders, and more individuals with a higher healthcare IQ will age into Medicare and encourage the use of value-based care models. Ultimately, health plans must simplify care coordination for a new group of Millennial and Gen Z beneficiaries that frequently rely on technology to streamline their shopping experiences through smart devices and applications.

“How does a health plan bring all the parties together for the consumer in order to help them navigate the whole system? A health plan is going to differentiate itself and capture a consumer’s heart and mind by getting them connected to their providers, pharmacy, and other services,” Biel said.

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David Biel, US Leader, Health Plans Consulting at Deloitte Source: Xtelligent Media

Developing point-of-sale interfaces that allow new health plan consumers to navigate without a representative is key, as indicated by the rise of on-demand services accessible through personal devices.

“Gen Z and the millennials are creating a culture of must-have innovation. They would prefer not to talk to a human than talk to a device who can navigate the pathway to get the product in your hands as quickly as possible,” Biel added.

Based on current industry estimates, roughly 26 million people are about to enter Medicare and these individuals are heavily connected and use smart devices in their daily lives.

As a result, payers offering health plans must have consumer options ready to offer future tech-savvy beneficiaries, with a chance to age in public payer programs, the option to manage health plans/insurance with connected tech. 

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“The opportunity to leverage more next gen technologies and capabilities that are connected — in the home, to devices, to your car — is going to be unprecedented,” Biel said.

These beneficiaries represent a segment of the patient population vulnerable to chronic conditions, which opens the possibility of connected home health care as a market segment opportunity for payers to jump on early.

“The healthcare system has the opportunity to evolve the two aspects together — to try to leverage the next gen technologies with this new set of beneficiaries to find new and better ways to coordinate care through connected devices and next-gen technologies to try to move the care model and change the care model and drive it more in the home, not in the hospital,” Biel added.

Providing concierge-services and connected health plan management is an ambitious way to make health plans more consumer-friendly, but ultimately new consumers want healthcare coverage that maximizes their return on healthcare services.

Health plans that offer the use of technology (e.g., telemedicine through mobile technology) to manage chronic conditions can help beneficiaries participate in preventative care that helps lower their need for more expensive healthcare utilization.

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“The technologies that are going to help the chronic condition patient monitor their conditions in the home where the prevention aspect will really play a role in managing the costs,” said Biel.

This opens the door for value-based care models to thrive, where collaboration between payers, providers, and other healthcare stakeholders determine payment and reimbursement based on quality of care.

“At the end of the day, the value-based care model is centered on having the single team across all those entities whose goal is to keep the patient as healthy as possible, manage their risk, and try to manage the medical costs,” Biel added.

As payers look to manage care costs and create better customer experiences for their beneficiaries, health plans have the opportunity to encourage value-based contracts with providers and simultaneously provide innovative user experiences for beneficiaries.

Biel believes that the transformation health plan consumer based on future will require scaled up collaboration between payers, providers, and others in the value-based ecosystem.

“It’s going to be about collaboration between plans, providers, drug companies, PBMs, coming together and creating solutions that meet these consumer demands. That is where scale and strategy will be required to succeed.”


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