News and Insights
The Numerof 2024 US Health Insurance Outlook
As our Numerof 2024 U.S. Health Insurance Outlook infographic illustrates, the story for health insurance continues to be about dramatically changing roles and relationships. Payers will continue to 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 significant political and regulatory uncertainty, influenced by the Inflation Reduction Act (IRA) and 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, consumers will increasingly make decisions as price-conscious 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 and improving quality of care outcomes. Moving providers toward new payment models and risk assumption will require active engagement by payers. Physician employment will continue and growing access will put more pressure on network adequacy. Recognition of the need to address social determinants and health disparities continues to bring 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. National 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 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, including evaluation of the utility of AI.
- 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.