As health insurance exchanges take shape across the country under provisions of the Affordable Care Act, technology will play a central role in improving payment models within a more consumer-focused environment.
That’s the view of a two industry analysts and consultants, Jean-Pierre Stephan, healthcare senior executive at Accenture, and Vaughn Kauffman, principal and U.S. healthcare advisory leader with PwC.
“We are seeing the acquisitions the payers are making have been around the managed care businesses that focus on Medicaid and that is clearly a play to attain membership. The other one is the payers are looking at acquisitions of non-traditional companies in the technology space around mobile platforms,” said Kauffman. “The whole point of that is the opportunity to improve the care coordination and innovation [with] technology that, quite frankly, is pretty ubiquitous in other industries.”
Kauffman noted the increasing number of payers that are launching mobile apps for their members that can help them make care choices on the fly. For instance, a person needing immediate treatment for a condition or an injury might consult their payer’s app to determine whether they need to seek care at an emergency room or a cheaper walk-in clinic. And those apps will provide a list of the nearest resources that are in the member’s network.
“As there are more caps put on the ability [of insurers] to increase premiums, looking at other trends around utilization and the severity of the care is what is really going shape the value curve,” Kauffman added.
While employing technology to engage current members will help insurers manage their overall health costs, the other side of leveraging technology lies in the upcoming expansion of the health insurance market under the Affordable Care Act, said Accenture’s Stephan.
As he sees it, insurers will continue to focus on so-called non-traditional acquisitions of technology platform companies as a means of helping those companies shift their focus from business-to-business activities to acquire new members to those that directly target individual consumers. Here the focus is clearly on acquiring new members from among the group of what Accenture estimates will be 51 million consumers who will be a part of the individual healthcare marketplace in the coming years.
“Over 97 percent of what we call retail [healthcare] consumers are on the Internet daily or on email daily. Over 50 percent of them are using mobile apps,” Stephan said.
Yet despite the heavy use of digital communications, roughly three-in-four consumers still want some kind of direct human interaction to help them make decisions.
“Insurers will be focusing on their digital capabilities but it may also require new types of channels, more face-to-face channels,” Stephan noted.
In order to accomplish this, Stephan said 2013 insurers will continue to look for ways to complement their digital strategy with brick-and-mortar retail locations or even branded clinics bearing their name. And for this, they may look to the model used by one of the most successful digital companies of our generation: Apple.
“Similar to what Apple did over a decade ago, opening these digital stores, they focused on the in-store shopping experience and married that with the digital experience,” Stephan said.