6 ways payers can compete in a consumer-driven marketplace

As consumers continue to make more informed decisions about their health, insurers will need to find ways to adapt their models to demonstrate their value.

Dr. Patrick James, chief clinical officer of health plans and policy, medical affairs at Quest Diagnostics, told Becker's Hospital Review that he expects consumerism to spawn a variety of new plans and a greater diversity of coverage options for consumers. Seeing an opportunity to disrupt the health insurance industry, new entrants are already developing new models that deliver on convenience and cater to distinct segments of the population.

Here are six ways for payers to stay ahead.

1. Find new ways to engage consumers. In a recent survey from PwC, 97 percent of health insurer executives said building consumer trust will be important to their consumer strategy in the next five years. To build trust, Dr. James says health plans are taking advantage of advances in technology to develop new transparency tools. They are also finding ways to improve member satisfaction by enhancing service offerings, minimizing delays and reducing denials.

2. Partner with providers. Health plans are collaborating more closely with providers to develop new value-based care and risk-sharing models. According to Dr. James, Quest Diagnostics is seeing a great amount of interest in its healthcare analytics platform Data Diagnostics coming from payers seeking to help physicians meet new quality performance requirements and verify risk coding is accurate.

3. Focus on your critical skillset. In his conversations with health plan medical directors, Dr. James finds that they are looking for trusted partners to help manage capabilities such as claims adjudication so that they can focus their time on activities geared toward maintaining their employer base and keeping customers satisfied.

4. Upgrade your technology. Health plans with an eye to the future are upgrading their technology to make sure data is conversant and available across the organization, says Dr. James. Centene, for example, views its IT capabilities as a competitive differentiator, and has invested more than $400 million over the last five years to adapt its legacy claims systems and take advantage of newly-available real-time analytics.

5. Identify new ways to assess risk. Dr. James says both new health insurers entering the market and existing players that want to be more competitive are identifying new ways to assess risk. In the past, legacy health plans could pass a lot of risk on to employers, but now that they have more skin in the game they must be more proactive in helping members make decisions to mitigate risk.

6. Look to other industries. Keeping an eye on innovators across industries will not only help health plans anticipate what's coming, it will provide them with ideas they can adapt to their own models. Dr. James advises executives to seek ways to enhance their information systems and improve transparency – two critical areas of opportunity for the health plan of the future.

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