In my previous posts, I looked at five macro-themes as well as five implications for hospitals. In this post, I want to focus on health plans and I’ve enlisted a co-author – Priyal Patel, Director of Health Plan CX at Perficient.
These predictions for health plans are in light of the five themes I see for 2021:
- Telehealth as a competitive advantage,
- New insurance markets,
- More self-service digital triage tools,
- Mega-mergers of vertically integrated health delivery models, and
- Multi-dimensional, socially-driven contract tracing.
In PART THREE, we turn to five specific predictions for Health Plans for 2021:
11. Health Plans Pivot
The burning platform has been lit – there is going to be a major overhaul of plans in the marketplace. Regulatory changes are going to create solvency issues for plans around the country.
As was the case back in 2009 when the Affordable Care Act rolled out, smaller plans will find themselves with more complex competition. These competitors are unlikely to come in the form of new entrants. Rather, entrants who have more political influence may be able to shape their positions more favorably.
OUR PREDICTION: Health plans will need to pivot quickly to better align their business models, operating realities, and member expectations, shedding costs quickly and doubling down on digital transformation efforts at scale.
12. Government Intervenes
The Biden administration will address a number of healthcare initiatives and issue new mandates. As price transparency is a level for plans to exert change on hospitals, government rate setting will influence the private markets.
The Biden plan allows for individual marketplace insurance purchasing, but it caps the ratio of income to insurance. Drug prices will come under more scrutiny and the purchasing power of the U.S. Government, both directly and indirectly through Medicare and Medicaid, will become the tool making change.
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OUR PREDICTION: Health plans will be able to offer fewer choices to more people and more Americans will get health insurance directly, avoiding their employer altogether. This will create new online shopping dynamics, previously only seen in Medicare Supplement Plans.
13. Mega Mergers, Part 2
Because of the first two predictions, the market of insurance providers will necessarily contract. Claiming the need for more efficiency, health plans will continue to roll up smaller, regionally-focused players.
Plans will need to create competitive-cooperatives, working to share costs (administration, lobbying, technology) while serving different markets. The Blue Cross Blue Shield of Illinois, Montana, New Mexico, Oklahoma & Texas (HCSC for short) is a great example of this model.
OUR PREDICTION: Health plans will be able to absorb the additional individual, smaller-market, higher-volume enrollment by creating and streamlining common processes across distance. These collaborations will further create defensible moats.
14. Self-Service Accelerates
To better manage the cost dynamics of these “retail” members, health plans will have to accelerate their direct-to-consumer efforts. Call center functions now need to be digitized at scale.
Even if you have a clear roadmap to self-service maturity right now, you may already be behind. The majority of our plan clients are contending with how to implement a streamlined shopping experience and automate enrollments, payments, claims processing, communications, etc.
OUR PREDICTION: Self-service hits warp speed, with consumer expectations for full digital experiences with health plans reaching maturity.
15. Buying Innovates
With all the above changes, health plans have their hands full for 2021. Many health plans have centers of innovation where ideas are cultivated and tested. That will all change in a market of impatient growth
This year, innovation will shift to outside organizations. Health plans will be looking for consumer engagement tools that will improve member experience and lower costs.
Health plans will be looking to acquire tools that make their members healthier, both as a cost mitigation approach as well as to create stickiness for their members.
OUR PREDICTION: Health plans will need to create a technology portfolio strategy to rationalize their point solutions, enterprise platforms, and innovative products in a coherent and useful way.
With an increasing marketplace for members, driven by lower costs, increased competition, a growing need for self-service, and market-led innovation, 2021 will prove to be a transformative year in health plans.
PART FOUR, we’ll talk Virtual Health.