In a surprising turn, smaller health plans are taking some of the same approaches to health IT strategies and investments as larger plans, a survey by Medecision shows.
Because of the small size (between 200,000 and 900,000 covered lives) of the some of the responding health plans, Medecision expected them to be in survival mode and focused on cost cutting, operational efficiencies, and core technology platforms, according to Ellen Donahue-Dalton, vice president of marketing at the Wayne, PA-based healthcare management solutions company that sponsored the research study.
What the researchers found instead is that the smaller payers weren't so much in a cost containment mode as "we thought they would be. They were sort of broader in their preparation," says Donahue-Dalton.
That means the smaller plans are just as focused as the big guys on provider connectivity, data, and system interoperability, and consumer engagement.
The survey involved C-suite executives from nine health plans and used an online "bulletin board" focus group, which is a virtual group that can interact with the moderator as well as participants. The responses were collected over three weeks in April 2012 and included one-on-one follow up sessions.
Medecision identified four strategic initiatives common to the responding health plans:
Cost containment
Reducing these overhead expenses through automation and analytics was of particular interest.
Provider communications
Participants pointed to the need for enhanced collaboration with providers, such as providing guidance and education on healthcare reform, sharing data and analytics, and bringing them into risk/reward sharing programs.
Accountable Care Organizations
Health plans recognize that they may need to lead the way in developing new care delivery models, and/or providing the tools and support for health systems and hospitals to pursue the affordable care organization model.
Market share/member retention
Health plans are figuring out the best ways to position themselves in the market given the potential effects of the presidential and congressional elections. Donahue-Dalton says they are looking at using automation to grow membership, connect care, and reduce costs.
That means making sure their care management, disease management, and utilization management is "really robust" so they can scale membership—add commercial or government membership—without needing to increase staffing such as nurses or care managers.
"They really want their core systems to do more for less," she explained.
According to the survey, over the next three to five years health plans will focus on these investments areas:
Consumer Engagement
Donahue-Dalton says there will be an emphasis on building personal relationships between an individual and a service provider, with a focus on the individual. "It's not about the health plan. It's about that individual's health, their chronic disease, their caregivers, and how they search for a doctor or hospital. It's personal."
Noting that consumers are comfortable in the online retail world where there is a great deal of price and relationship transparency, consumers are expecting that same level of engagement with their health plans, Donahue-Dalton says.
They want to be able to select a plan, get a cost quote, and have their claims paid correctly and quickly. But they also want their health plans to help them watch their health, remind them about needed tests, and subsidize their weight loss programs and gym memberships.
And, they want all of this in a streamlined process. "It's a huge challenge," says Donahue-Dalton. "Health plans are going to have to take that leap into meeting members where they are."
According to the survey, payers are focusing their consumer engagement initiatives primarily in these areas: enhanced web portals, health insurance exchanges, and member incentives, including wellness programs and education.
Health information exchanges and deployment of interoperability
Participants indicated the need for two-way communication between payers and providers, especially in terms of being able to push data to electronic medical records. As healthcare transforms itself into a more consumer-centric industry, Donahue-Dalton says health plan relationships with providers will be "core assets."
Data aggregation/analytics
Health plans are looking at ways to invest in data warehousing and analytics to use member data more effectively. Analytics will play a critical role in consumer engagement and health plans are looking not only at how to present the data they collect but also exploring what data they need to have to better serve their members and providers.
Survey participants mentioned adding supplemental data from the Centers for Medicare & Medicaid Services, pharmacies, and labs.
I see a lot of survey information that engages the major players and their plans. What this survey helps us understand is that the big ideas of healthcare transformation such as affordable care organizations, the shift to the individual market, and the role of analytics—are permeating throughout the health plan industry.
That's important as we look down the road at how healthcare reform legislation may change depending on the outcome of the elections.
Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
