The health plan market is undergoing a drastic transformation. In the past, the competition had been lean with just a small number of payers. However, the market dynamics are changing. Since 2017, the number of MA plan choices per county has increased by 49 percent. The competition is said to grow even more in the coming years as more health plans are set to enter the market, owing to the fact that nearly 26 million baby boomers will age into Medicare through 2030.

Rising healthcare promises have been tied to cloud technology in the most recent tech-talks of the town. While the majority of care providers are not holding their breath due to previous disappointments, we wanted to translate the often vague statements made into discrete simplified processes for healthcare.

“Technology was always meant to empower healthcare practices; action needs to be taken where it is causing more harm than good.”

One of the many aspects that insurers focus on to create more value through their health plans is to improve communication with the members. In the era of growing digitization, most payers have started to offer online services. However, many beneficiaries still use traditional channels to interact with insurers. 

PCPs are supposed to be the first touchpoint for patients in the healthcare system, and they often wear multiple hats, a genuinely rare trait that most of them seem to enjoy. However, more often than not, they do not achieve the desired outcomes for completely no fault of their own. They simply do not have enough bandwidth to talk at a stretch with their patients. 

Why are payers still suffering with tedious grunt work? What could be the solution to their problems?

Statistics suggest that one out of three people eligible for Medicare are enrolled in Medicare Advantage Plans. This option is deemed to be more attractive than the traditional Medicare Part A and B because it offers more coverage (for instance, dental and optical insurance). Additionally, some plans offer no-cost premiums and feature out-of-pocket spending limits. MA Plans are overall more convenient for beneficiaries; they offer medical and hospital benefits (prescription drugs included) in just a single plan.

Healthcare leaders across the US are of the view that the transition to value-based care should happen, however, not many have the answer to the question of how to do it cost-effectively. Healthcare organizations have to innovate and adapt to the new dynamics or else they might risk their long term viability.

The soaring high costs and utilization rates have made it essential for the US healthcare sector to make the transition to value-based care quickly. Value-based remuneration is the only way to incentivize cost-efficient quality care against more volume of services. However, to measure the quality of care, CMS needs providers to report on hundreds of quality metrics. With the advent of EHR technology, physicians are already overwhelmed with the documentation requirements. Now, the additional burden of quality reporting requirements can increase the risk of physician burnout.

From an employer's viewpoint, healthcare costs turn up as the second-largest expense after employee wages. On average, employee absenteeism and poor health cost employers around $530 billion dollars a year. Forestalling these issues requires employers to create efficient benefits package for their employees, and understand their employee health journey at each step.