As our Numerof 2023 US Health Insurance Outlook infographic illustrates, this year’s story for health insurance will be about dramatically changing roles and relationships. Payers will engage in new and different ways with providers, consumers, employers, regulators, medical device makers and pharmaceutical manufacturers. All this will come in the context of continued political and regulatory uncertainty, amidst the aftershocks of Covid-19.

Competition will intensify, with new entrants (including delivery organizations) and new insurance products coming to market. New market entrants will use technology to minimize friction between the consumer and the payer and/or care delivery, redefining the healthcare delivery process as they do so. As deductibles and copays increase, and as regulation forces more transparency, more consumers will become healthcare shoppers. Engaging them will be more critical than ever. 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.

Among hospital systems and IDNs, consolidation will continue to create challenges in holding down rates. Moving providers toward new payment models and risk assumption will require active engagement by payers. Increasing physician employment and growing access will put more pressure on network adequacy. Growing recognition of the need to address social determinants and health disparities brings more focus to these areas.

Tensions with pharmaceutical manufacturers over high priced drugs will continue, creating openings for new formulary and pricing approaches. Nevertheless, opportunities for collaboration in areas such as data sharing and risk-based contracting will grow for pharmaceutical and medical device manufacturers alike. Payers, who generally exited the pandemic in a cash-rich position, will use these resources to fund new collaborations and to accelerate M&A activity across industry verticals – acquiring care delivery, PBMs, and tools to improve consumer engagement.

Given this outlook, what’s next? We recommend these key action steps:

• Actively engage 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.

Need critical insights across the healthcare sector? Check out our 2023 outlook infographics for healthcare delivery, medical devices and diagnostics, and pharmaceuticals.