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


    Priority #1: Affordability and convenience

    Plans must have an urgent focus on creating more affordable and convenient care, says Walsh. “Helping consumers navigate and find the best care—that includes both quality and cost—is today’s work,” she says. “Health plans and care systems that are able to deliver high quality care in a more affordable way will be the consumer’s choice. The challenges of individual premium increases in marketplaces across the country underscore the fact that access to healthcare and coverage isn’t enough—it must be affordable.” 

    HealthPartners, for example, is continuing to move to value-based payments, packaged pricing and total cost of care approaches that are based on health outcomes and quality of care. “Reforming the way care is paid for supports greater transparency,” says Walsh. “Plans will need to provide members with cost and quality data to make more informed decisions about the best use of the healthcare dollar.”

    Successful plans will also bring care directly to consumers. HealthPartners’ virtuwell, a 24/7 online clinic, and [email protected] clinics (similar to primary care clinics but located at a work site) are examples of first-generation efforts. More than 250,000 consumers use virtuwell.com and there are more than 20 [email protected] clinics.“Services will also continue to move from in-person and telephonic to mobile and in the community,” Walsh says.

    Hospital-at-home programs that enable patients to receive hospital-level care in the comfort of their homes, such as the Johns Hopkins Hospital at Home (HaH) care model, are another example of the shift to remote care. Compared to similar hospitalized patients, HaH patients have better clinical outcomes: lower rates of mortality, better satisfaction, less caregiver stress, and cost savings of 19% to 30%, according to Johns Hopkins.

    It’s also critical to provide patients with resources so that they can find convenient care options. For example, Clover has an in-house customer experience team that explains plan benefits to members, connects them with local providers, and resolves issues. “Insurance can be confusing and intimidating, especially to Medicare beneficiaries, so we encourage our team to spend as much time on the phone with members as it takes to resolve their issue and make them feel comfortable and cared for,” Keenan says.

    Next: Transparency



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