Although payors have been minimally disrupted by the pandemic, sky-high profits mean that their medical loss ratios (MLRs) failed to reach minimum standards set by the ACA. Payors can invest these profits into new clinical- and quality-driven capabilities and offer their enrollees personalized experiences that align with the larger shift toward consumerism in healthcare. This paper goes into detail on the six trends to watch in 2021, as well as on how payors can capitalize on these trends to become “healthcare partners” with their enrollees in the emerging post-pandemic healthcare ecosystem.
Trends include the following:
- Increased member utilization of elective procedures: By helping members navigate a an increasingly complex healthcare environment. payors will increase member loyalty and potentially help stabilize the volatility in utilization experienced over the past year.
- Enrollment shifts due to unemployment and aging Baby Boomers: There are a number of opportunities for payors to grow enrollment by providing education and outreach regarding current on-exchange, Medicaid and Medicare product offerings, as well as how to transition between products as life circumstances warrant.
- Greater scrutiny of government insurance products: Payors should ensure that evolving policies align with proposed and anticipated regulations; that supporting documentation of procedures and processes are up to date; and that methods of assessing new regulations, updating policies and informing stakeholders are in place.
- Reevaluation of telehealth programs: Since virtual health services are likely here to stay, payors should work closely with federal and state governments on regulations that ensure both widespread access to telehealth and appropriate levels of payment and reimbursement.
- Greater demand for wellness services and health equity: As healthcare partners, payors have numerous tools at their disposal to help members stay healthy and to drive health equity through, for example, social determinants of health (SDOH) initiatives.
- Payors become consumer-centric healthcare partners: With a healthcare partner model, measures of quality and value must shift from transactional value to health outcomes, member satisfaction, retention rates, and reduction in appeals.