The healthcare industry is constantly evolving around both external market factors and evolving patient needs. At J.D. Power, we look at industry trends through the eyes of the consumer. What are the macro factors that influence their healthcare experiences and expectations? We see four mega trends influencing health insurance in the medium-term future:
- Value-Based Care
- AI and Digital Self-Service
- Increasing Medicare Advantage Enrollment
- Supporting Social Determinants of Health
How should health plan leaders be responding to these trends to ensure a positive member experience?
Value-Based Care
While different healthcare consumer segments will be impacted differently by each of these trends, nearly all sectors of the healthcare economy feel some level of pressure to improve patient outcomes while reducing costs, a central tenant of Value-Based Care. In a 2022 American Academy of Family Physicians Survey, 49%1 of physician practices said they are participating in some form of value-based payment, and 18% are developing the capabilities to do so. These trends are expected to continue as payors shift more incentives to providers to take on some level of risk tied to performance, and as consumers seek more cost-effective healthcare options.
Member Experience Focus: With a core focus of value-based care being improving patient outcomes, healthcare leaders need to have a clear idea of what an improved patient outcome means to them and what it means to the patient. To ensure these are aligned or identify changes that need to be made, organizations should continuously monitor whether patients are seeing and are satisfied with the results of value-based care.
AI & Digital Self-Service
There is an increasing appetite to leverage digital technologies to grow membership and increase member retention. Since the pandemic began in 2020, more and more consumers, including those 65 years of age and over, have expressed and demonstrated an openness to using digital technologies. Patients became more aware that they could take care of their health needs remotely and realized that in-office or “brick and mortar” health is not always necessary, especially for routine care. As a result, telemedicine, virtual appointments, wearables, and mobile health apps all saw a “boom” in usage during and after the height of the COVID-19 pandemic. According to the AMA, physicians now receive 57%2 more portal messages than they did prior to the pandemic. In addition, over 80% of physicians agree or strongly agree that telehealth improves a patient’s access to care, and our research shows a growing majority of consumers now say they prefer telehealth over in-person visits for a wide range of routine care.
Member Experience Focus: An important note, however, is that patients have indicated that they are more open to using digital channels as long as they are easy to use and drive to the right outcomes as perceived by the patient. While expressed demand for self-service is increasing, our research shows that digital engagement for certain segments has remained stagnant or declined more recently. For example, just 24% of Medicare Advantage plan members indicated they used telemedicine in 2022, down from 35% in 2021. Maintaining and increasing digital engagement relies on healthcare leaders understanding what a good digital interaction is for their customers and providing the experience that meets their needs.
Increasing Medicare Advantage Enrollment
Approximately 50%3 of all eligible Medicare beneficiaries are currently enrolled in private Medicare Advantage Plans. For comparison, in 2007 only 19% of eligible Medicare beneficiaries were enrolled in Medicare Advantage. What’s driving these increases? These enrollments are believed to be attributable to consumer interest in lowering healthcare costs, the extra benefits that an MA plan offers, such as vision, hearing, and dental services, and more and more health plans offering needed support around social determinants of health (see more below) for underserved populations.
Member Experience Focus: With an increased number of enrollees, MA plan leaders not only have a broader group of members to provide with a satisfactory experience, they also have a broader group of members at risk. With members able to switch to a provider that they feel meets their unique needs, it’s critical for leaders to listen to their members’ expectations and ensure their services align.
Supporting Social Determinants of Health
With the recognition that nonclinical factors, such as the member’s access to transportation, healthy food, a social network, and other variables impact population health, more and more health plans are seeking creative ways to support patients in need. Recent examples of this include:
- BlueCross BlueShield of Illinois introduced ICD-10 Codes4 to track and address social determinants of health. This allows a member’s care team to be aware of and document a member’s social needs.
- Kaiser Permanente launched a program titled “Thrive Local”5 which allows members to connect with critical community resources, such as food, medical equipment, and transportation. The tool provides real-time status updates on referrals, so Kaiser providers can track whether members and patients receive the support they need.
- Aetna provides analytic services6 to employers with Aetna plans, assigning a social risk score to each member of the plan. Based on this score, interventions can be made to address disparities.
Member Experience Focus: We anticipate a rise in attention placed on Social Determinants of Health, as increasing evidence supports the need and impact to underserved communities. For example, in a 2020 survey, Kaiser Permanente discovered that 63% of Northern Californians have at least one unmet social need. At-risk populations report a low incidence of their health plans coordinating care, leaving ample opportunities for healthcare plans to participate in care coordination. To better understand these opportunities and the needs of their own populations and communities, health plan leaders should be connecting with their members to understand what levels of unmet needs may exist for them. Identifying support opportunities that exist will help define member experience strategies and can be used to improve both the overall member experience and patient health.
Key Takeaway
The biggest takeaway for healthcare leaders that want to be best positioned to respond to evolving trends is to know your members. This means understanding their expectations and needs at the segment level. This focus will better enable you to deliver value that is individualized for the member and their unique health and support needs and to differentiate your products and services.
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1Value-Based Care Statistics: Equipping Physicians for Value-Based Care https://www.agilonhealth.com/news/blog/equipping-physicians-for-vbc/#:~:text=In%20addition%2C%20the%202022%20American,to%20adopt%20this%20payment%20model
2What’s adding to doctor burnout? Check your patient portal inbox https://www.ama-assn.org/practice-management/digital/what-s-adding-doctor-burnout-check-your-patient-portal-inbox
3Half of All Eligible Medicare Beneficiaries Are Now Enrolled in Private Medicare Advantage Plans https://www.kff.org/policy-watch/half-of-all-eligible-medicare-beneficiaries-are-now-enrolled-in-private-medicare-advantage-plans/
4ICD-10 Z Codes for SDoH https://www.bcbsil.com/docs/provider/il/clinical/health-equity/ICD-10_Z_codes_flier.pdf
5Making lives better through Thrive Local https://lookinside.kaiserpermanente.org/making-lives-better-through-thrive-local/
6Investing in health equity https://www.aetna.com/employers-organizations/resources/social-determinants-of-health/putting-analytics-to-work.html
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