6 issues confronting health plans right now

"From Payor to Healthcare Partner," a paper published by KPMG earlier this week, discusses pandemic-driven trends and issues facing health plans.

Here are six takeaways:

1. Increased use of elective procedures among members: While 2020 saw a steep decline in elective procedures due to the pandemic, healthcare service rates are expected to increase up to 10 percent through 2021. 

2. Enrollment shifts due to unemployment and aging baby boomers: More than 14 million people lost employer-sponsored health coverage in 2020, prompting more individuals to purchase coverage through the ACA exchange. This negatively impacted commercial health plans, especially as more baby boomers enrolled in Medicare Advantage plans.

3. More scrutiny of government insurance products: As health plans expand into federal marketplace exchanges and government plans like Medicare, they will need to prepare for additional oversight and regulatory reviews and audits from CMS and the states, the paper said.

4. Reevaluation of telehealth programs: Since telehealth is here to stay, payers will need to work with federal and state governments on regulations that ensure widespread access to telehealth as well as fair payment and reimbursement rates, according to the paper.

5. Greater demand for wellness services and health equity: The pandemic sparked a surge in mental healthcare needs. It also highlighted payers' needs to create benefits that address social determinants in order to advance health equity. These include economic stability, neighborhood environments, education, food and community factors. 

6. Payers become consumer-centric healthcare partners: A continued focus on value-based care, as well as shifting care from inpatient settings to less costly outpatient settings, is essential, the paper said.

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