What’s in Store for Healthcare in 2016?

Posted by Anand Natampalli & Daniel Schulte

Digitization. Engagement. Consumerism.

For the past several years, these buzzwords have had significant, if varied, meaning for both payers and providers. These terms carry the weight of the many advances and challenges healthcare professionals face every day as the industry continues its long, inexorable shift to a care model based on value and the continued migration of the patient/consumer toward the center of the healthcare ecosystem.

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Our prognostications for what 2016 holds for our payer and provider partners are rooted in industry wide need to optimize the customer or member experience to make brands more competitive – reducing monthly cost per member, improving satisfaction and loyalty to payers and providers, and leveraging technologies to increase self-service capability. Addressing these objectives includes tackling the challenges of meeting increasing workforce demands, leveraging data to offer consumers a better experience, and implementing technology to improve outcomes and lower costs far beyond the four walls of a hospital or physician’s practice.


The Primacy of Data Continues Unabated
Payers used to leverage analytics to look for ways to reduce operational costs. In 2016 and beyond, the focus will be on creating highly targeted products, channels and service offerings that keep patients healthier. For example, payers will use highly personalized behavioral data to make wellness recommendations for members. This targeted approach of wellness is possible with analytics resulting in higher adoption rates compared to a traditional outreach.

Customers’ Leverage is a Game-Changer
Members purchasing health insurance on the exchanges will be faced with a choice each year, and those choices will be right in front of them for comparison. A poor customer experience this year will increase the likelihood of finding a new payer next year. Based on 2014-2015 data, 38% of members changed their health plans in state exchanges within one year. With price points remaining comparable, customers will continue to look to service and experience as key differentiators when choosing a health plan.

Continued Front Office/Back Office Integration
Lowering administrative costs and enhancing efficiencies will be a priority for most health plans this year, as they seek to challenge new competitors, penetrate new markets, and assess strategies for creating an optimized customer experience. Realizing these goals will require health plans to rethink their business models—most notably, bridging the gaps and uncovering integration opportunities between front office and back office processes.

Nurse Support Increases
As a tactic for improving customer experiences (as well as their health) more health plans will invest in consultative support by highly qualified healthcare professionals, such as nurses. HGS’s 1,500 registered nurses are supported by a health information line and nurse triage, level-of-care assessments, and wellness solutions. These professionals will enhance the customer experience by providing answers to routine customer queries, perform care assessments, and offer healthcare advice and information.


Engagement & Activation Becomes More Seamless
Technologies that enhance and improve patient engagement and activation will be critical to healthcare moving forward. Through population health management we are learning more about how to create wellness strategies and to stratify patient populations based on their conditions and adjust for nuances in age, race, diagnostic groups, and the like.

A critical aspect of engaging patients is delivering a unified, seamless experience across the channels or devices of their choice, be it via smartphone, laptop, landline, email, or online chat. This is a very different experience than many members have had with providers in the past, but it represents the level of convenience and service consumers have come to expect in markets ruled by the consumer experience across the economy.

Telehealth Grows

Three elements are required for telehealth to become part of the mainstream of healthcare:

  • It needs to hold healthcare costs down.
  • Providers must be reimbursed for the time spent on telehealth.
  • Patients must be comfortable with a remote visit instead of an in-person visit.

The first and second requirements are being taken care of by the Centers for Medicare and Medicaid Services (CMS) and its use of a code that pays providers to deliver remote care management services to patients with two or more chronic conditions. The goal is to help those patients get better and stay well.

As for the third requirement, teleconferencing applications are making consumers comfortable communicating electronically. The ability to visit a physician via a smartphone, tablet, kiosk, or other technology creates convenience. For many, 10 minutes via video conference versus long waits in waiting rooms for a 10-minute visit will become the preferred method of interaction for many simple healthcare encounters.

While not all of these predictions are particularly revolutionary, they do point to an industry that has ably faced the winds of change and is eagerly seeking to build on recent successes.

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