One of the nation’s largest self-insured employers predicts bad times ahead for U.S. health insurers unless they make radical changes in how they do business.
As consumers take on more financial responsibility for their healthcare, they will demand more flexible products, better service, more accountability from health insurers and providers, and greater clarity in information on costs and quality of care, says a new report by a study group for IBM Inc., Armonk, N.Y.
Increasing U.S. healthcare expenditures, rising medical errors and an expected sharp drop in employer-paid health care insurance are some of the pressures driving changes in the industry, IBM notes in its report, “Healthcare 2015 and U.S. Health Plans: New Roles, New Competencies.”
These developments will stimulate consumers to make better health and wealth decisions, the report predicts. “Such changing market dynamics will in turn create new opportunities and daunting pressures for health insurers,” says Dan Pelino, general manager of IBM’s Global Healthcare & Life Sciences Industry unit and a contributor to the report.
If health plans are going to provide successful new delivery models, they must first recognize that health care purchasing is becoming akin to a retail atmosphere, he says. “Those that fail to do so will face rapid marginalization,” Pelino warns.
Health plans will be asked to deliver more individualized experiences for consumers while being increasingly valued by healthcare providers as helpful business partners, the report predicts. Chances for collaboration include opportunities to anticipate care needs, provide and compensate high-value care, streamline administrative functions, and to move consumers to adopt healthier life styles.
To meet changing market and consumer preferences, health insurers would have to transform their leadership, culture, competencies, business models, organizational structures, sourcing strategies, processes and information technology, according to the report.
It predicts a number of other changes in health care in the years leading up to 2015:
A shift from employer-based to government-based and individually purchased coverage, caused by a push for universal coverage; a general decline of employer-paid insurance and an aging population.
Rising individual responsibility for health care decisions. Health care and financial planning will become increasingly linked to each other as consumers take future health needs into account in their financial planning.
Increasingly complex healthcare models, emphasizing prevention, chronic-condition management and better care coordination.
“Many health plans are well-suited to help shape and lead this transformation, given their financial resources, knowledge of the local markets and key relationships with providers, members and employers,” the report concludes. “These resources and relationships can help align incentives and facilitate change in other stakeholders. For example, health plans can help providers successfully transition to a value-based reimbursement environment and can help members change behaviors, in part through rewards for healthier lifestyles.”
IBM self-insures the health care of more than 350,000 employees and their dependants.