Ring in the New: 2021 Predictions for Employers and Health Plans

Most of us in the health plan and benefits community have found our daily thoughts focused squarely on the health and well-being of a global workforce.

As we move into the holiday season, after trudging through what has been maybe the most difficult year any of us has yet experienced, we’re left trying to forecast what might be next.

So, what’s on the horizon?

Here’s a glimpse of what I think health plans and employers can expect in 2021:

Increasing utilization means members need even more guidance. Once a vaccine is in wider circulation and elective surgeries are back on the table, benefit leaders will seek ways to ensure members act on the best advice available. We have much room for improvement, considering that 30% of elective surgeries are unnecessary, and when avoided, can save our system $30 billion. [ConsumerMedical Whitepaper, 2020]

Sharing responsibility with employees. I anticipate more benefit leaders will look closely at requiring second opinions to empower and encourage employees to become partners in managing their health. Specifically, more focus will be placed on requiring surgical decision support programs that affirm best practices— from diagnosis to treatment— and navigation to centers of excellence. What is probably most interesting, though, is that high member satisfaction still correlates strongly (98% and beyond) with shared responsibility programs. Regardless of the destination, requirements (like seatbelts), will begin to become standard practice for many healthcare journeys.

Extending the virtual journey. With a global telehealth market that’s expected to represent $560 billion by 2027, the next frontier in virtual expert opinions will give members with complex conditions convenient, tech-enabled access to specialists across a broad clinical model— with more integrated, dedicated guidance layered in. [Fortune Business Insights, 2020]

There are three other areas to note:

a)  Virtual access to behavioral health providers will continue to grow. There is a significant opportunity to go beyond simply offering access to a virtual tool. As we know, taking the first step is often the hardest, and getting support with navigation, finding the right clinician and facilities accepting new patients, as well as scheduling and keeping appointments, are significant barriers to those with mental health needs.

b)  Virtual access to leading specialists for international plan members will grow in importance at more progressive employers. The goal is to ensure consistent, unified healthcare experiences for all, regardless of geographical location.                                                                                                         

c)   Virtual access that furthers health equity and addresses social determinants of health (SDoH) within a population will also move to the forefront. Weaving in supporting services that approach each member through the lens of his or her unique circumstances and needs, whether it is overcoming language barriers or finding community resources, will be a bigger part of the benefits conversation.

Focusing on the “DAD” factor. I believe stakeholders will rely more heavily on predictive analytics to activate patients, build health literacy and encourage consumerism. This will include looking to their partners’ data sources to reach members within the fewest days-after-diagnosis (DAD) time frame. What kinds of data? Likely the kind that will enable the correlation of events like imaging, new prescriptions, lab work and other procedures, to better predict the onset of illness and disease. I expect the market will also hear more about speech analytics programs that can identify keywords to help predict future problems before a claim is even submitted and content interaction data that provides similar clues, like if a member downloaded articles on a specific health topic. 

Overall, I think building out dynamic, bidirectional data flows will help us to encourage patients to engage earlier and more fully in their care, leading to improved outcomes and better quality of life. 

Optimizing for quality in networks. As with predictive analysis, we will all reap the benefits of big data and machine learning as employers and health plans seek out the highest-quality providers within their networks and implement solutions to give members access to them. Harnessing that data with an employee-friendly tool (more on that soon) will ensure people get the best care, from the highest quality providers, at the safest facilities. I believe we will see stakeholders look increasingly to their partners to help optimize their own networks.

While the future presents us with challenges, we know that by identifying opportunities to improve, we can work towards helping people get the best healthcare possible. As we all may be patients at some point in our lives, that’s an important goal to achieve, not only for our clients, and our communities, but also for ourselves.

Here’s to a kinder, gentler year ahead.

Kevin