Managed Healthcare Executive|September 26, 2019
More than 100 C-suite and director-level executives voted on and then ranked the top 10 critical challenges, issues, and opportunities they expect to face in the coming year, during the 2019 HCEG Annual Forum. The HealthCare Executive Group (HCEG), a 31-year-old networking and leadership organization, facilitated discussion around the issues the Forum, which took place September 9 to 11, in Boston.
Turning challenges into opportunities
Reducing costs means lower revenue for providers and almost all of the players in healthcare––except for consumers and payers, says Mark Nathan, CEO and founder of Zipari, a health insurtech company. So while there are many incentives to keep healthcare costs high, if consumers are provided with the information they need to improve their health and drive down their personal costs, then we could see consumers en mass making decisions that drive down costs across the industry, he adds.
“Predicting cost in the traditional health insurance environment is shockingly complex,” Nathan says. “The most advanced payers can simulate claims and predict the cost of procedures. However, as you layer in full episodes of care, such as knee surgery, it becomes much harder to accurately predict the patient’s total out-of-pocket cost. Bundled value-based payments start to make cost transparency a little easier to predict, but most plans still have a way to go to get to that type of offering.”
The greatest opportunity to drive down health costs––for payers, consumers, and system-wide––is with the payer-consumer relationship, he says. “Payers have the information consumers need to make better decisions about their health and finances––if plans can build positive and trusted relationships with their members. Once a payer proves it can make valuable and trusted recommendations, the consumer can make the decisions that will not only lead to better health outcomes but also to reduced cost of care.”
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