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The new benefit every plan should offer

Miss AHIP's 2018 Institute this year? We've got you covered. Get five takeaways from the conference including how plans are redefining the value of their data and the new benefit plans should offer.


Miss AHIP's 2018 Institute this year? We've got you covered. I wanted to share what I learned from both the speakers as well as conversations with our members throughout the conference.

Read on for five takeaways from the conference including how plans are redefining the value of their data and the new benefit plans should offer.

1. Who owns the member? Whoever's most reliable.

Plans remain focused on strengthening providers' relationships with the members. Plans hope that the trusted PCP relationship will do more than they could to steer members in the right direction.

But many plans spoke about their efforts to improve member relationships, even at the expense of provider-member interactions. Whether through concierge navigation or behavioral analytics, plans are trying to predict what members will want and deliver it.

Before getting too ahead of ourselves, other plans cautioned against asking about a multitude of member needs unless the plan was prepared to change their operation to meet them. In fact, speakers noted it is better to not ask members what they want than to ask what they want and then not deliver.

2. The power of data, redefined

Plans have historically viewed their vast claims data as a huge window into a local market. But given providers' access to rich clinical data and lags in reporting encounters, plans' advantage is now a commodity.

Strengthening plans' datasets will help not only with member management but also member relations. New sources of data discussed include collecting personal health motivations to inform care advice and consumer preferences for interaction with the plan.

Data is no longer just used to predict member utilization, but rather anticipate member views of the plan.

3. Diversifying drug activity

Plans, PBMs, providers, and manufacturers blame each other for high drug prices. But AHIP speakers talked instead about stepping outside their traditional roles to support drug value.

One challenge facing providers is the high price and limited supply of generic medications. Intermountain spoke of its investment in generics manufacturing to provide an alternative to a consolidated generics market increasing supply and keeping prices low as a non-profit.

And as specialty medications become increasingly expensive, pharmaceuticals companies (not unlike providers) will need to offer outsized value to justify the high price tags. In addition to outcomes based contracting, pharma is investing in tools for medication adherence to ensure members have the greatest potential to achieve the same results demonstrated in clinical trials.

4. The loneliness benefit

Much has been written about social determinants of health and its strong correlation to medical needs. And while there is a demonstrated ROI for investing in food, housing, and transportation, plans are looking at what else they can do to support their members' social needs.

In many of the discussions, speakers noted how loneliness can impact members' health and spending. Loneliness and social isolation leads to depression and overall cost meaning plans will need to address it to support their members. Plans (especially those in MA) are investing in additional home visits to create a personal connection, retail sites to support community well-being, and tools to facilitate member-member interactions.

5. Dissolved boundaries in health care

While few at AHIP fear an additional overhaul of the ACA in the short-term (or even single payer in the long term), some spoke with trepidation about the future vision for health insurance. With so many mergers, partnerships, affiliations, and alliances happening, it's not clear where the health care sector ends and the rest of the economy begins.

Ultimately, the plans' value will not lie in its ability to manage spending through network curation or wellness engagement. Instead, plans will need to serve as a central point of trusted insight for members' health, wealth, and happiness.

Interested in more information about the future of plans?

Join us at our national meeting on October 2, 2018 in Chicago, Ill.

Register Now


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