4 trends affecting insurers this year

February 11, 2014 | By Dina Overland

The healthcare industry is evolving in the post-reform market, bringing in new competitors, compelling innovative incentives and refocusing priorities--all with an eye toward providing better care at a lower cost, according to a blog post in the journal Health Affairs.

In the post, Susan DeVore, CEO of Premier healthcare alliance, outlines eight trends that will affect insurers and providers this year. Here's a sampling, rounded out with some examples from our own recent FierceHealthPayer news coverage:

1. Chronic care

As insurers and providers continue to partner in new accountable care organizations (ACOs), the shared savings programs will likely increasingly focus on consumers with chronic conditions. "Since each chronic condition increases costs by a factor of three, managing this population is the sweet spot for the ACO, and the deepest pool from which to pull savings," DeVore wrote.

That means implementing more patient-centered medical homes that aim to manage chronic conditions with specific care pathways that address behavioral health needs, decrease hospital admissions and emergency room visits.

ACOs and medical homes will also increasingly make use personal health coaches who motivate patients on a one-on-one basis and help coordinate care with all players. Exemplifying this trend is Health Care Services Corp.'s own medical home model where nurse care managers help consumers with chronic conditions while coordinating and monitoring patients' progress, as FierceHealthPayer recently reported.

2. Employer-based wellness incentives

Wellness programs are quickly becoming one of the hottest trends throughout employer-based health coverage. In fact, a survey last year found that 52 percent of large employers are offering financial motivation alongside their wellness programs.

That's because employers' attempts at offsetting the continual rise of private insurance costs is now dovetailing with a reform law provision allowing employers to boost the dollar value of wellness incentives to 30 percent of total coverage.

Some of the wellness incentives include tools such as free pedometers or subscriptions to wellness websites and incentives like gift cards or extra paid days off.

3. Private insurance exchanges

The number of private health insurance exchanges will likely rise this year as more companies consider private exchanges as a way for their employees to buy health insurance using a defined contribution.

For example, IBM and Time Warner have both decided to move some retirees to private exchanges where they can shop for individual coverage using a health retirement account.

"Our expectation is that private exchanges will continue to grow in popularity in 2014, as they give employees an opportunity to customize coverage and provide a predictable amount of spend for the employer," DeVore wrote.

4. Data sharing

The key to unlocking the true potential of electronic data is sharing the information in a way that everyone can read and understand. One way would be creating an open source tool that allows developers to design new applications to use the data so that providers and insurers can actually leverage the information. "It's sort of the iPhone approach to health care technology--Apple owns the operating system, but anyone can design an app that leverages it to deliver programs and services that the user truly values," DeVore said.

To help create a smooth transition to such a data sharing platform, some insurers are already making their systems more transparent and available to other industry players. Aetna, for example, has a forward thinking approach to sharing its information, granting its provider partners with a high level of access to its claims data.

To learn more:
- read the Health Affairs article