Electronic Health Reporter

Guest post by Anand Natampalli, MBA, vice president, global business development, HGS, and Daniel A. Schulte, MBA, CHFP, senior vice president, provider healthcare, for HGS.

If there is one constant in healthcare and health IT it’s change. Technological advances, growing workforce needs, regulatory reforms, and the continued shift to value-based care will all continue to have a profound impact on the industry in the coming year. Here is what we think will be the major changes affecting payers and providers:

Payer Predictions:

Data Grows More Critical in a Value-Based World

Payers used to leverage analytics to look for ways to reduce operational costs. In 2016 and beyond, the focus will be on creating highly targeted products, channels and service offerings that keep patients healthier. For example, payers will use highly personalized behavioral data to make wellness recommendations for members. This targeted approach of wellness is possible with analytics resulting in higher adoption rates compared to a traditional outreach.

Greater Focus on the Customer Experience

Members purchasing health insurance on the exchanges will be faced with a choice each year, and those choices will be right in front of them for them to compare. A poor customer experience this year will increase the likelihood of finding a new payer next year. Based on 2014-2015 data, 38 percent of members changed their health plans in state exchanges with in one year. With price points remaining comparable customers will continue to look to service and experience as key differentiators when choosing a health plan.

Provider Predictions:

Engagement and Activation

Technologies that enhance and improve patient engagement and activation will be critical to healthcare moving forward. Through population health management we are learning more about how to create wellness strategies and to stratify patient populations based on their conditions and adjust for nuances in age, race, diagnostic groups, and the like.

A critical aspect of engaging patients is delivering a unified, seamless experience across the channels or devices of their choice, be it via smartphone, laptop, landline, email, or online chat. This is a very different experience than many members have had with providers in the past, but it represents the level of convenience and service consumers have come to expect in markets ruled by the consumer experience across the economy.

Telehealth Grows

Three elements are required for telehealth to become part of the mainstream of healthcare: It needs to hold healthcare costs down, providers must be reimbursed for the time spent on telehealth, and patients must be comfortable with a remote visit instead of in-person visit.

The first and second requirements are being taken care of by the Centers for Medicare and Medicaid Services (CMS) and its use of a code that pays providers to deliver remote care management services to patients with two or more chronic conditions. The goal is to help those patients get better and stay well.

As for the third requirement, teleconferencing applications are making consumers comfortable communicating electronically. The ability to visit a physician via a smartphone, tablet, kiosk or other technology creates convenience. For many, 10 minutes via video conference versus long waits in waiting rooms for a 10-minute visit will become the preferred method of interaction for many simple healthcare encounters.