“While our specialty products (dental, vision, life and disability, and voluntary supplemental health plans) are available on a stand-alone basis, they can be packaged with our health plan products to better coordinate care, which results in more efficiencies, better health outcomes and bigger savings,” he said. “This is made possible by Anthem Whole Health Connection. This unique approach to a person’s whole health connects claims and clinical data to identify and impact gaps in care, lowers costs, and delivers a simpler healthcare experience to our consumers.”
He notes healthcare is inherently personal and Anthem Blue Cross Blue Shield’s (Anthem) Specialty business is focused on helping to make the delivery of healthcare as personalized and tailored as possible for every consumer.
“Our integrated approach to ‘whole person healthcare’ means we have the opportunity to help our consumers better manage their health conditions through early intervention and by closing gaps in their care,” he says.
John Nicolaou, a healthcare payer expert at PA Consulting, says payers need to acquire customers from their competitors in order to grow organically.
“The biggest focus we are seeing is on brand and service differentiation rather than product or benefit differentiation,” he says. “An example would be tools to help predict out-of-pocket payments, or to encourage and reward healthy lifestyle behaviors to help members manage their health costs.”
There are also similar avenues for employers to better manage the cost of care, including improved claim analytics or to reward healthier behaviors.
Related article: Why Consumer Engagement Must Be a Whole-Person Solution
“It will be critical to make these brand and service differentiations attractive and relevant and valuable for members, rather than gimmicks for payers,” Nicolaou says. “Key to this is to understand not just who their members are, but rather to understand their member relationships with payers and the health system overall to find ways to differentiate.”
Chris Seib, CTO and co-founder of InstaMed, a healthcare payment network in Walnut Creek, California, says payers need to focus on improving the member experience and look at the consumer experience in other industries to understand the benchmarks.
“According to the Trends in Healthcare Payments Ninth Annual Report, 86% of consumers want to make all of their healthcare payments in one place,” he says. “Payers can help consumers meet this need by offering payment capabilities within their member portals. Payers can take the friction out of healthcare payments and increase member satisfaction, increase member portal traffic and tool utilization, and accelerate payments to providers from members.”
Lissy Hu, CEO of Boston-based CarePort Health, says payers leverage the CarePort care coordination platform to drive financial and quality outcomes.
She explains specific opportunities for payers to leverage CarePort include: guiding members to the most appropriate level of care, enabling ED diversion, tracking patients in real time to power effective transitions of care, and increasing first submission success around post-acute authorizations.