Health Plans: 5 Consumer-Driven Needs That Deserve Closer Attention

4/14/2023

From price transparency to health equity, consumer needs are influencing how health plans will operate, stay competitive, and provide the best possible care for their members in the coming years. Here are five that shouldn’t be ignored.

1. Price transparency

According to an InstaMed Consumer Healthcare Payments Survey (2021), nine in 10 consumers want to know payment responsibility upfront and 87% admit to being surprised by a medical bill. These numbers provide perfect context for the U.S. Government’s 2022 legislation calling for increased price transparency.

Health plans must prioritize price transparency in order to meet the evolving needs of their members. This means clearly communicating — or making available — the costs associated with healthcare services and treatments, including deductibles, co-payments, and out-of-pocket expenses.

To meet these needs, insurers should look to new technologies and tools that allow members to easily access and compare prices for different services and providers. Two examples include the Healthcare Bluebook and Experian’s Healthcare Cost Estimator.

Bottom line: Most Americans agree that health care costs should be more transparent. This transparency will lead to an improved healthcare system where fewer consumers avoid the care they need due to concerns about medical care costs.

2. Non-clinical care

Amazon’s recent acquisition of One Medical, a technology-powered primary care organization, suggests the potential of non-clinical care (e.g., in-home care, telemedicine, retail-based care, employment and other community care settings) remains large with plenty of opportunity to push forward the adoption of digitally-enabled care.

As health plans look to strategize ways to drive healthier outcomes for members, telehealth services will play an important role. According to the American Medical Association’s vice president of digital health innovations:

“It's not whether telehealth will be offered, but how best to offer telehealth services as we move toward what we're terming digitally enabled care — which is not just hybrid care, but more so fully integrated in-person and virtual care based on clinical appropriateness.”

Bottom line: Convenience is king. However, there’s more than that to the telehealth story. Health plans paying close attention to their members' preference for non-clinical care settings can generate value in multiple ways, including cost savings, improved member satisfaction, increased access to care, improved health outcomes, and a competitive advantage.

3. Consumer-driven wellness

McKinsey estimates the spend on wellness products and services to be more than $450 billion in the U.S. and growing at more than 5% annually. Several reasons account for this. One major factor is the growing awareness of the importance of preventive healthcare and self-care practices.

As chronic diseases such as diabetes, heart disease, and cancer are projected to rise, per research by Frontiers in Public Health, consumers are seeking out ways to take control of their health and reduce their risk of developing these conditions. This has led to increased spending on health and wellness products and services, such as gym memberships, dietary supplements, self-monitoring devices, and alternative therapies.

Bottom line: Advances in technology and social media have made it easier than ever for consumers to access information about health and wellness and connect with like-minded individuals who are also interested in improving their well-being. Health plans need to embrace and empower member accountability by providing needed devices and reputable content for personal wellness.

4. STAR ratings

While consumers use STAR ratings to evaluate health plans, health plans also have an opportunity to use the ratings to identify areas for improvement and to benchmark their performance against other plans.

The following strategies may help health plans improve their STAR ratings:

Focus on preventive care (e.g., screenings and vaccinations)
Enhance care coordination with providers and community organizations
Offer additional benefits and services (e.g., transportation assistance or home health care)
Improve medication adherence with at-home monitoring
Identify high-risk patients and early interventions through data analytics
Invest in virtual care technologies (e.g., telemedicine, wearables, and mobile apps) to improve access to care

Bottom line: By providing high-quality, coordinated care and prioritizing member satisfaction, STAR ratings will improve as a byproduct. And by investing in preventive care, technology, and customer service, and by collaborating with providers, health plans will be in a much better position to provide the best possible care for their members.

5. Health equity

Health equity is crucial in 2023 because despite significant advances in medical technology and knowledge, disparities in health outcomes persist, particularly among marginalized communities.

Today’s members want their health plans to remove barriers to care and replace "walls'' with "bridges" for those who struggle with the traditional health delivery model.

To ensure health equity, start by addressing the root causes of health disparities (e.g., structural racism, poverty, and inadequate access to healthcare) and identifying the populations that are most affected by them. Consider these as effective next steps:

Collect and analyze data on health disparities
Develop culturally and linguistically appropriate services
Improve/Increase access to care
Address social determinants of health
Promote health literacy
Eliminate cost barriers to essential health services

Bottom line: By prioritizing health equity, we can improve health outcomes, reduce healthcare costs, and build a more just and equitable society — regardless of background or circumstance. Health plans that can meet these evolving needs will be better positioned to attract and retain members in an increasingly competitive healthcare landscape.

In short: member needs are driving a consumerism model that will ultimately improve the healthcare system

As we continue to navigate the challenges of a complex healthcare landscape, health plans must remain focused on these consumer-driven needs to ensure that they are providing high-quality, affordable care that meets the needs of all members.

This approach embodies a consumerism model that supports those taking an active role in their healthcare decisions. I see this model empowering members with increased autonomy while simultaneously disempowering the wider medical establishment. This shift in power favors the member as the focus chances to their benefit over institutional priorities.

Bottom line: Members who are engaged and knowledgeable about their healthcare options are more likely to make informed decisions, adhere to treatment plans, and achieve better health outcomes — win, win, win. Additionally, a consumerism model in this space encourages providers and healthcare organizations to compete on the basis of value and quality, which can incentivize innovation and improve the overall efficiency of the healthcare system.

Cindy Thomas is the Director of Payer Business Development for RRD Healthcare Solutions.