Four priorities your health plan must embrace to thrive in the future

Health plans of the future will focus on consumers: designing products, care and services to support improved health. 

Walsh

“Health plans of the future will make it easy for consumers to understand their coverage, and also how to access the best care for their condition. This includes convenience, quality and costs,” says Andrea Walsh, executive vice president and chief marketing officer, HealthPartners. Successful plans “will understand consumer values and preferences using engagement and data analytics. And they’ll use that to support better health and care, both individually and in communities.”

Five to 10 years ago, plans fundamentally focused on two stakeholders-employers and provider networks, says Patrick James, MD, chief clinical officer of health plans and policy and medical affairs at Quest Diagnostics. “Over the last several years, the member has become a key part of the stakeholder triad. Several plans have even designated the equivalent of a ‘chief consumer officer charged with understanding the consumer, as well as keeping an eye on the larger marketplace and competitors,” James says.

James

Successful plans of the future will also better adapt to shifting healthcare policies. Based on the new administration and Trump’s stated priorities, reduced regulations will likely be a big focus over the next few years, with less utilization review and fewer reporting requirements, according to says Ron Geraty, MD, chief executive officer of AxisPoint Health.

Plans “will answer to market forces rather than government mandate, leading to lower costs,” Geraty says. They will also encourage greater provider alignment by easing and simplifying reporting requirements, he says.

“Health plans of the future will partner with care systems. In doing so, they will redesign more affordable care and advance payment reform. Changes to the underlying business model in healthcare will be another central focus for the future. Care and coverage will become much more integrated. And community health will emerge with increased importance,” Walsh adds. 

To thrive, plans will also need to take a proactive role in managing member outcomes and provide consumers with the resources they need to improve their health, says Clover Health Chief Operating Officer Wilson Keenan. “Health plans must show their value to consumers and providers.”

Here’s more on the above changes, and four priorities your plan must embrace to thrive in the future.

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