We asked the Managed Healthcare Executive editorial advisory board to predict the biggest challenge healthcare executives will face this year. Here's what they said.
Responding to Healthcare Consumerism
"The healthcare system has barely touched on what consumers care about, and as consumers take a more active role in plan selection and healthcare decision making, plans need to respond accordingly. The system is currently oriented around providers and not consumers, and plans need to find ways to gather meaningful data, such as what consumers want from their health plan, and provide it to consumers in an understandable way."
- Don Hall, principal of DeltaSigma LLC
Ensuring the Sustainability of Smaller Health Plans
"Plans working in the health insurance marketplace environment will confront growing enrollment-a good thing-but the reinsurance and risk corridor market stabilization provisions of the Affordable Care Act sunset in 2016, leaving plans with risk adjustment alone. So to ensure a stable business environment in the marketplaces going forward, it will be vital to ensure that payments adequately account for any cost, outcome, and quality differentials seen in plans focused on serving primarily low-income, vulnerable populations."
- Margaret Murray, chief executive officer, Association for Community Affiliated Plans
Dealing with Rising Drug Costs
"Already a topic of significant focus and debate, inflation rates amongst drug manufacturers have, for the third consecutive year, ranked as the top most significant factor in driving year-over-year drug expenditures within managed care. More recent egregious increases in the pricing of select brand and generic, drugs have brought this issue center stage and will be a primary topic in upcoming elections."
- David Calabrese, vice president and chief pharmacy officer, OptumRx
Ensuring Patients Have Access to Care
"As more patients move into higher deductible plans, plans need to ensure that the costs of medications, diagnostics, devices, and procedures do not preclude the patient from seeking treatment. We need to improve how providers will code for telehealth services so that coverage and payment can be timely and appropriate."
- Joel Brill, MD, medical director for Predictive Health, LLC.
Simplifying the Healthcare Experience
"We must make the healthcare system easier to navigate. Today’s savvy consumers expect to get what they want when they want it and exactly how they want it. We must offer a healthcare shopping experience that’s as convenient as booking a hotel room or banking online. And it can be. At Independence, we’ve built a broad and varied portfolio of health plans designed to meet the changing needs of consumers, and we’ve made investments to improve our operational capabilities and customer service experience."
- Daniel J. Hilferty, president and chief executive officer, Independence Blue Cross
Dealing with the Impact of Reform
"As employers stop offering group health insurance, plans will need to determine how to respond as patients act more like consumers."
- Perry Cohen, chief executive officer, The Pharmacy Group