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Analysis

Health Plans Must Overcome Uncertainty, Get Ahead of Trends for 2018

By Gregory A. Freeman  
   January 03, 2018

Health plans face challenges such as an influx of people into Medicare and more pressure to participate in risk-based contracts. The uncertainty that complicated health plan strategies in 2017 will continue this year and could accelerate.

Health plans are facing a different landscape this year than they have known in years past, and they will have to act quickly to get ahead of the forces that could determine success or failure. The loss of the individual insurance mandate penalty is only one factor complicating their business strategies, but it makes addressing the other factors even more urgent.

Uncertainty over what their business world will look like in the near future continues to be the overriding concern.

The loss of the individual mandate will be the most difficult issue for insurers in 2018, says Tom Bizzaro, vice president for health policy and industry relations at First Databank, which provides pharmaceutical data to health plans and providers. It remains to be seen how much the loss will affect enrollment, and any action on healthcare law by Congress could greatly affect the trajectory of health plans, Bizzaro says.

"They can deal with any situation if they know what the rules and regulations are going to be. I am hopeful that even without the individual mandate, citizens will realize the importance of having medical insurance," he says. "I am also hopeful that Congress will act to stabilize the market. I think as with any industry there will be winners and losers in 2018. The insurers that can be the most flexible and reactive to changes in the marketplace will be the most successful."

Health plans shouldn't expect any relief from the uncertainty that plagued them in 2017, says Joe Paduda, principal of Health Strategy Associates, a consulting firm specializing in managed care for workers' compensation and group health.

"The healthcare delivery sector is undergoing massive disruption, with neighborhood hospitals, payer-owned providers, provider-owned payers, and provider consolidation blowing up entrenched business models," he says. "Marry that disruption with the requirement that insurers have to market, operate, and partner differently in each geographic area, and insurers' massive challenges are daunting indeed."

Gregory A. Freeman is a contributing writer for HealthLeaders.


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