One of the nation's largest self-insured employers predicts bad times ahead for U.S. health insurers unless they make radical changes in how they do business.
As consumers take on more financial responsibility for their healthcare, they will demand more flexible products, better service, more accountability from health insurers and providers, and greater clarity in information on costs and quality of care, says a new report by a study group for IBM Inc., Armonk, N.Y.
Increasing U.S. healthcare expenditures, rising medical errors and an expected sharp drop in employer-paid health care insurance are some of the pressures driving changes in the industry, IBM notes in its report, "Healthcare 2015 and U.S. Health Plans: New Roles, New Competencies."
These developments will stimulate consumers to make better health and wealth decisions, the report predicts. "Such changing market dynamics will in turn create new opportunities and daunting pressures for health insurers," says Dan Pelino, general manager of IBM's Global Healthcare & Life Sciences Industry unit and a contributor to the report.
If health plans are going to provide successful new delivery models, they must first recognize that health care purchasing is becoming akin to a retail atmosphere, he says. "Those that fail to do so will face rapid marginalization," Pelino warns.
Health plans will be asked to deliver more individualized experiences for consumers while being increasingly valued by healthcare providers as helpful business partners, the report predicts. Chances for collaboration include opportunities to anticipate care needs, provide and compensate high-value care, streamline administrative functions, and to move consumers to adopt healthier life styles.
To meet changing market and consumer preferences, health insurers would have to transform their leadership, culture, competencies, business models, organizational structures, sourcing strategies, processes and information technology, according to the report.
