Editor’s Note: Independent review services improve member and provider relations. BHM’s proven data collection and processing puts claims documentation to work. CLICK HERE for our white paper on the leveraging the value of Peer Reviews for organizational improvements.
The U.S. election looks to push a teetering ACA in any direction. The coming open enrollment periods will also influence the 2017 reactions from Health Plans and Providers. Healthcare Trends
Gregory Scott, US Health Plans leader and vice chairman of Deloitte LLP (profile), shares his perspective on trends impacting health plans as they respond to the rise of consumerism and the proliferation of the value-based care model. Healthcare Trends
Get serious about analytics.
Get collaborative in value-based care.
Get closer to your customers.
Get better in government business.
Get strategic about Innovation.
Today, too many health plans classify analytics as a technology and data issue for the CIO to address, or entrust analytics to individual business units to manage in their silo. Analytics demands an enterprise strategy with CEO sponsorship and focus.
Health 
plans need to do more than negotiate and administer value-oriented contracts with providers.
The best-positioned health plans are those who understand their members, define desired customer experience, and implement initiatives to realize those aspirations.
Many health plans have invested heavily in Medicare, Medicaid, the dual eligibles, and other government programs. For many of those plans, these investments are reaping the dividends of higher Star ratings, new State contracts, increased member growth and retention, improved economies of scale, and/or the avoided costs of compliance problems.
Health plans need an Innovation playbook with offensive, defensive, and collaborative plays.
Scott continues, “Health plans are seeing increased pressure to demonstrate value. In response, plans will need to develop strategies to align with providers under new payment arrangements (such as accountable care or value-based care), even as old business models persist. In the traditional power struggle between providers and payers, providers are gaining leverage. Regaining balance will require greater collaborations and partnerships—between providers and plans and between plans and nontraditional players like niche technology companies.
Health plans that understand consumers’ wants and needs, and are able to activate the right behaviors in the right consumers at the right time, will prevail and grow in the redefined, consumer-centric healthcare marketplace.
Integration along the value chain also presents opportunities for growth. Collaboration between health plans and providers to drive value-based care and better health outcomes offers tremendous opportunities to expand and increase market share.
Health plans pursuing innovation should adopt a more encompassing definition of “product” to include provider networks, different financial arrangements, and consumer engagement models. They should also consider consumer-focused strategies to drive engagement (in shopping for health plans, selecting providers, taking care of their own health) and improve the customer experience—all of which can help increase health plans’ value.”
Full Deloitte Article Healthcare Trends
Independent review services improve member and provider relations. BHM’s proven data collection and processing puts claims documentation to work. CLICK HERE for our white paper on the leveraging the value of Peer Reviews for organizational improvements. Healthcare Trends