News and Insights
The Numerof 2017 US Health Insurance Outlook
As our Numerof 2017 US Health Insurance Outlook infographic illustrates, this year’s story for health insurance will be about dramatically changing roles and relationships – not to mention political and legislative uncertainty. You’ll engage in new and different ways with providers, consumers, employers, regulators, medical device makers and pharmaceutical manufacturers.
Competition will intensify, with mega-mergers and new entrants (including delivery organizations) playing a key role, despite anti-trust challenges. As deductibles and copays increase, more consumers will become healthcare shoppers seeking transparency and competitive prices. Consumer participation in public and private exchanges will also elevate their role as the industry’s direct customer. Meanwhile, employers seeking better outcomes at lower cost will engage in more direct contracting for bundled services in areas such as orthopedics, oncology and cardiac care, or even for all care on a PMPM basis.
For hospital systems and IDNs, new alliance, network and support service combinations will change the face of consolidation. There will also be greater openness to new payment models, risk assumption and alliances with payers and employers. Increasing physician employment and growing access will put more pressure on network adequacy.
Tensions with pharmaceutical manufacturers over high priced drugs will continue, creating openings for new formulary and pricing approaches, as well as biosimilars. Nevertheless, opportunities for collaboration in areas such as data sharing and risk-based contracting will grow for pharmaceutical and medical device manufacturers alike.
Given this outlook, what’s next? We recommend these key action steps:
- Collaborate with providers to improve outcomes, reduce cost and increase value
- Identify providers that can assume accountability and risk
- Develop analytic and influence capabilities required for success in risk-based models
- Demonstrate value tangibly to plan sponsors and members, with a focus on total cost of care
- Engage with consumers differently to reduce membership churn and gain share in new markets
At Numerof & Associates, we support health insurance companies in achieving these key action steps for success in today’s evolving healthcare landscape. From competitive strategy and alliance development to implementation of new payment and network models, we have solutions. Read more about our perspectives and solutions for healthcare insurance and see our case studies.