A lot of attention is being focused on implementing health reform (PPACA) as new regulations are pushed out of HHS. There’s no doubt this is time well spent since the future belongs to those able to anticipate, adapt, and manage in a new world order of reformed markets.
PPACA is a disruptive event set to transform the industry. Transformation yields opportunity. The ability to capitalize on opportunity means getting out from under the weight of PPACA compliance and start to prepare for a future that looks a lot different. This means taking a broad view of health care trends likely to dominate over the next few years.
- Health Improvement Preventive health care can save 2 million lives and $4 billion annually. With every employer seeking to reduce benefit costs, improving employee wellness is at the top of the list. And now, with employee premium contributions and deductible levels soaring, they are just as motivated to reduce their personal health expenditures.
- Chronic Care Chronic medical conditions account for $3 out of every $4 spent on health care. Over 85% seniors and almost 50% of people ages 20-59 have at least one prescription. Dedicated management of chronic medical conditions is vital if there’s any hope in slowing growth of the country’s health care bill.
- Risk Alignment Patient-centered medical home, where payers and providers collaborate in an accountable approach to care delivery is mentioned 19 times in PPACA. This new model, where everyone has skin in the game, calls for care structured around a primary care physician that is accessible, continuous, and family-centric.
- Provider Capacity If half of health reform’s promise of access for 32 million people comes true, we’ll see millions of “health hungry” consumers with unmanaged chronic illness entering the medical delivery system…a system where 65 million Americans already live in community with shortage of primary care doctors, and where a caregiver shortage may top one million by 2020.
- Decision Support Caught between changing benefit designs and an ever-broadening choice of “where, when and how” medicine is delivered, navigating health care is challenging every consumer. They’re desperately seeking guidance in structuring and budgeting their health coverage, as well credible information to sort through today’s clinical maze.
- Value Chain Health reform’s new “rules of engagement” affect every aspect of a health insurer’s business, from compliance to product development to administration to sales. The ability of these individual activities to be effectively linked together, each adding value to the next, will be the difference between profitability and extinction.
- Senior Market Our nation’s 78 million boomers have $2.5 trillion and control 75% of our country’s total household net worth. And, 3.6 million are turning 65 every year. Get ready; their tremendous buying power is grounded in a mentality of convenience, online purchasing habits and a trust in friends vs. brands.
- Cyber Health With 206 million Americans online and 2.5 billion text messages sent every day, technology is extending healthcare’s reach into unimaginable direction – mobile diagnostics, physician e-consultations, 24/7 tele-caregiver access, monitoring medi-gadgets, and social networks facilitating consumer reviews and information exchange.
- Engagement Marketing In an environment where low-engagement traditional marketing has been overtaken by “tradigital” social engagement customer interactions, telling customers why you are different and what value you deliver has changed forever. But one standard remains: marketing must deliver sales; sales must deliver profitable revenue, and; spend less for both.
- Distribution Diversification Travel web portals (aka – exchanges) have 90+ million visitors annually. With 24 million people expected to purchase their health insurance on a Health Benefit Exchange, what’s the future of sales distribution? Most likely it’s a balanced mix of selling outlets such as field sales, telemarketing, online, retail outlets and worksite.
Health reform could push more than 100 health insurers with fewer than 200,000 members out of business. While dealing with health reform is a daunting task, maintaining the status quo or succumbing to decision paralysis means certain demise. It’s time to focus your organization on where it wants to be and design an enterprise roadmap for how to get there.