The healthcare industry has experienced more changes in the last few years than it has in the last few decades, and it’s not slowing down. The demand for change is growing, and slowly but surely progress is being made. Health plans are implementing consumer-driven changes. Alternative healthcare payment models are becoming more popular. Digital health companies are making it easier to find care. Even the government is creating rules and regulations for change. 

For your health plan to compete with the emerging entrants offering what people demand, attract potential new members, and keep up with the changing healthcare landscape, here are the healthcare changes you need to watch and adopt.‍

Digital self-service and telehealth are here to stay.

COVID-19 accelerated the usage of telehealth and other digital health services. Now that patients, payers, and providers have experienced the ease of digital health, there’s no turning back. Even before COVID-19, one survey found that in 2018 57% of respondents prefer digital self-care options. So what does this mean for your health plan? 

The demand for telehealth is here to stay, so consider expanding your coverage for it. Digital health is going to continue to grow and become more useful, especially as consumers demand digital tools to help them with their healthcare experiences. To improve your plan offerings, consider implementing digital self-service tools that members actually want to use. One way to easily integrate digital capabilities into your offerings is through platforms that make it easy to search and compare providers in-network.

And if you think your health plan can afford to wait on implementing these changes (or simply put them off completely) think again. The same 2018 study found that plans who offer digital capabilities outperform competitors in overall satisfaction and retention by nearly 5%. Plus, 27% of respondents reported leaving their payer because their new one had better or more self-service options. Do you want to lose 27% of your membership? I doubt it.

Consumers want help navigating the healthcare system.

Even with recent innovations transforming healthcare, one thing still remains: the system is confusing. In fact, the healthcare system can be so overwhelming to navigate that many consumers are willing to pay for patient advocacy services to help them find the right care. In our survey with Nelson Associates, 100% of respondents expressed a willingness to pay for patient advocacy services. These services included:

• Bill negotiation.
• Surgery facility location service.
• Prescription shopper service.
• Medical record transfer service.
• Healthcare provider match/scheduling service.

More and more people are realizing that patient advocacy services are an affordable way to improve healthcare experiences. Whether through healthcare navigators or digital tools that allow consumers to easily navigate their own health, health plans have an opportunity to use patient advocacy to stand out from competitors and increase member satisfaction.

Value-based care and direct primary care are catching on.

If you’re unfamiliar with either of these concepts, check out this blog to learn about value-based care and this blog to learn about direct primary care. This change is coming from both providers and patients, which is why it has real potential to stick. The pandemic forced a lot of patients to put off care, which meant lost revenue for providers. Especially providers who operate on a fee-for-service model. With direct primary care, providers get paid on a subscription basis. It doesn’t matter if a patient goes one month without ever going to that provider and then the next month goes five times; the provider is paid the same. Plus, many experts have reported that value-based care providers had greater financial stability during the pandemic. It seems that Jenny Aghamalian, Vice President, Public Affairs and Strategy at Sedera, made a great prediction for 2021 when she said in our roundtable discussion:

“Membership-based medicine is really starting to take root. Whether it’s direct primary care, virtual primary care, or medical cost-sharing, I believe that belonging to a medical practice or a community that supports your holistic health — rather than the less than desirable fee-for-service status quo — will continue to take root and flourish.”

Final thoughts.

There are many more changes happening in healthcare besides the three listed in this blog, but we listed these because they are:

• Already here.
• Gaining momentum.
• Pretty simple for you to add to your health plan.

There are changes you can make this year to make digital self-service a reality for your members. There are value-based care models you can adopt. If you’re a self-insured employer, there are VBC/DPC providers you can work with. Third-party patient advocacy services exist already that can seamlessly bring healthcare navigation and bill negotiation services into your offerings. The status quo is behind in the dust, but you can move forward with the positive changes listed in this blog.