Tech, consumer behavior driving health care changes

The way in which the health insurance industry operates on a continual basis has changed a lot over the past several years, and more changes are in the offing as health care reform remains a big issue in Washington. As a consequence, insurers are trying to become a little more agile when it comes to how they operate, make determinations about premiums and so on. That, in turn, could help to make the industry as a whole more appealing to consumers, even as costs continue to climb.

For instance, more than 4 in 5 major health insurance companies now look at social determinants of health as a means of evaluating populations of potential policyholders, and using that information to determine ways to reduce costs for certain people, rather than raise rates for others, according to a new survey from Change Healthcare. In addition, 96.6 percent of the 2,000 respondents said they didn't think high-deductible plans led consumers to undertake less risky behavior.

“Health care organizations are transitioning from negative to positive incentives to influence consumer behavior much faster than most would expect,” said David Gallegos, senior vice president of consulting services at Change Healthcare. “Payers are also taking aggressive steps to advance value-based care and crack the code to successful consumer engagement.”

Nearly half of respondents also said that while they have a significant interest in more tech investment, they may not pursue them as heavily as they otherwise might like, thanks to concerns about security and patient privacy. Nonetheless, nearly two-thirds also said they are looking at greater data integration to keep their own administrative costs down.

Telemedicine may have a big future for consumers.

Other changes in focus
Meanwhile, a separate survey from Damo Consulting found that many health insurers are now devoting more resources toward developing technological options that will boost value for them, in line with findings in the Change Healthcare survey. This includes a shift toward spending on analytics as well as AI development to more quickly and easily unlock insights into broad trends in patient health and use of care options.

In fact, 60.5 percent of respondents said they were investing more heavily in these value-based care areas, compared with nearly 58 percent who said they are working on care management, the survey found. Meanwhile, spending on cybersecurity is being scaled back somewhat, with just 40 percent of companies saying they will make such investments.

This comes as more than half of respondents believe the industry will see growth between 10 percent and 30 percent in the year ahead, while more than a quarter believe it will grow by more than 30 percent.

The potential rise of telemedicine
In addition, it's likely that health insurers may choose to boost patients' access to medical professionals without significantly driving up costs by expanding their telemedicine offerings, according to a survey from Sage Growth Partners. While more than half of all respondents have already broadly adopted telemedicine as at least a part of patient care, 44 percent have not. Another 20 percent say they are looking into such an effort at this time.

Nonetheless, 86 percent of those polled said this is either a “medium” or “high” priority for their companies going forward, the survey found. Indeed, nearly 3 in 4 say they believe their budgets for telemedicine will grow at least somewhat in 2018, including about 1 in 7 companies that believe they will see those budgets grow by more than 25 percent.

Health insurers are likely in a position to do more to encourage consumers to care for themselves in ways that will allow them to keep costs down – both for themselves and insurance companies. Any avenues they can pursue to follow through on that opportunity will likely result in significant positives for health care going forward.