5 health insurance stories that defined 2015
Wellness programs gain popularity, face scrutiny
Wellness programs continued to gain popularity in 2015, but the programs faced increasing concerns about their effectiveness and privacy implications.
Wellness vendors and third parties may not be covered under HIPAA's privacy law, which means employee privacy could be at even greater risk depending on how outside vendors handle that personal health information.
For example, many women have concerns over the fact that their pregnancy status may somehow get back to their employer, and others worried that detailed health data for individuals could create a caste system, with the healthy reaping the benefits of substantially lower insurance rates than those with measurable illness or genetic conditions.
But in just one year, Aetna proved that employee wellness programs could show a positive return on investment when it saved more than $600,000 with a personalized program that targeted employees at high risk for metabolic syndrome.
In addition, a court's ruling in favor of New Jersey-based Honeywell means employees can be required to partake in biometric screenings or face financial penalties. Some are calling for health insurers and employers to design programs that are more about rewarding personal responsibility and less about penalizing individuals.
Payers and providers increasingly collaborate to improve care
Another topic that grabbed readers' attention in 2015 was with the payer-provider relationship and how it has evolved to adapt to an era of value-based care. This year, insurers faced a regulatory environment that required them to make critical decisions--particularly when it comes to merging with and acquiring providers.
Still, as more and more health systems entered the Medicare Advantage marketplace, the lines between payer and provider began to blur. Payers are starting to understand the importance of establishing relationships with providers that will reward them for managing patients' chronic conditions.
Additionally, it appears more payers and providers are moving to a collaborative future, since payers can provide a wealth of information to providers, making a key contribution to improved healthcare quality and lower costs.