Health care continues to change. The Affordable Care Act may be repealed, or at least certainly changed, and its replacement is uncertain. Employers are seeking value and innovation - but getting nothing but cookie-cutter solutions from the payers. Insurers seem stuck in a time warp and appear tone deaf to both the employer and the consumer.
While health plans should be flexible to respond to this volatile market and an ever-changing world, their outdated, legacy systems often are a roadblock to any form of flexibility. They are utilizing dated, homegrown tools that limit their agility. A "we know best" mindset chokes any type of innovation. Limited to a "one size fits all" model - their claims payment, benefit design and care management tools seem impersonal to the consumer and lack transparency for the employer.
To make matters worse, many insurers are racing to raise rates in this era of uncertainty while struggling to provide any new tools to meet market demands. This is bad news for the employer who is trying to take care of their workforce and provide a healthcare benefit. Worried about their own bottom line - the thought of bringing something new to the market is beyond the health plan's reach.
While these incumbents wring their hands, a new entrant has emerged - the Health Solutions Company. These new firms are not afraid to bring disruptive thinking to the market. Far more agile than legacy insurers, they are hyper-focused on two primary goals:
- Reducing overall costs for the employer and
- Providing a high-value experience for the employee (covered member).
The clarity of their business model affords investment in new claims management tools, innovative data technologies and care management solutions that offer concierge-level support for the employee. More importantly, they are creating a seamless experience for the employer and their employees. Simple things - like a single number to call on your insurance card for help. A searchable digital version of a benefit plan on your phone, and 24/7 access to a clinician. And the early-adopter employers are having great results.
Today, there is a palpable shift in the market away from the traditional insurer as employers realize they now have options and choice if they work with these new innovators.
And Here's Why
Next to payroll, health care is typically the second largest line-item cost on any company's monthly income statement. CFO's and HR professionals have spent the last several years changing out their health insurer partner every other year or so -- and have found most of the promises made are hollow. Cost transparency, innovative plan designs and support for their employees are just a long line of broken promises. They are now taking the bold move to evaluate their healthcare options with the same detail as any other cost - and the pre-packaged bundle of noise from the carrier is no longer appetizing.
As more employers chose to say no to the status quo and are willing to look to these new firms in the space - I expect we will see more and more disruption. Employers are seeking solutions and answers - it's time for substantive value.
The only certainty in today’s health care industry is change— just blink your eyes and you can fall behind. Keeping up with change is admirable, but it isn’t enough. In the future, these health solutions firms will offer information, insight and transactional capabilities through a variety of user experiences. Data will not be limited to portals and printed reports - but every employee will have full access to services and support in their pocket via their phone - 24 hours a day, 7 days a week. Care management will become very personal and meaningful both to patients and their families.
I'm excited about the future and the disruption these new innovators bring. It's time to put "care" back in healthcare. And deliver real value for the employer and their employees.