Health Plans Focus on Consumer Education, Tax Reform Could Spur Changes

Gregory A. Freeman, September 6, 2017

WEX Health uses data analytics to help employers and consumers better understand how they are spending their healthcare dollars.

"Employers can see how employees are spending the money in their health savings accounts or flexible spending accounts, to help reimbursement arrangements," Byrd explains.

"With consumers, we are giving them more actionable prompts, such as alerting them that they've reached the point with the HSA when they can invest, explaining why they should do that and how it helps them save for retirement. Employers and those who service them in the health plan industry are focused on that because the trend is inexorable, with more and more employers moving to higher deductibles and more consumer engagement."

Paying for Value
To help be proactive in actually addressing the cost of care, health plans are focusing their efforts on paying for performance or outcomes versus volume, says Theresa Stenger, an employee benefits consultant with Trion Group.

"The market is shifting from fee-for-service models with the goal of having provider contracts that incent adherence and improved overall health of attributed members," she says.

"This is not just limited to the medical care provided by a doctor or facility. More and more medical carriers and pharmacy benefit managers are entering into value-based contracting for the prescription drug spend, where contract value is dictated by specific measures like lower hospital admission rates. "

Carriers are also looking for creative ways to address emerging cost drivers like increased behavioral health spend by leveraging telemedicine to deliver a cost effective solution that also helps address the overall lack of access issue, Stenger says.

"In addition, Medical carriers have to always be vigilant in understanding and identifying potential wastage or fraud to help eliminate or reduce the exposure for their entire book of business," she says.

Gregory A. Freeman

Gregory A. Freeman is a contributing writer.

Facebook icon
LinkedIn icon
Twitter icon