State of the Industry Survey: Health plan respondent results

December 29, 2015
Aubrey Westgate

Survey reveals how size impacts health plan challenges, priorities, outlook, and technology use.

 

 

How does your health plan match up to other health plans of a similar size? Does it face the same challenges and opportunities? It is acquiring similar technology and is it implementing the same initiatives?

To help you find out, we analyzed the results of Managed Healthcare Executive's 2015 State of the Industry Survey.

At the outset of the survey, we asked respondents to identify what type of health plan they represent:

  • Small (located in one region and serving only one region)

  • Medium (located in multiple regions and serving multiple regions)

  • Large (located throughout the country and serving individuals throughout the country)

Here are some of the key findings based on the more than 600 survey responses we received.

 

 

 

 

1. Value-based momentum

Overall, the majority of respondents (all sizes) said they are participating in initiatives focused on value-based care. Only 14% of respondents said they are not yet participating in any such initiatives.

Not surprisingly, larger health plans are farther ahead of the curve in this area, with 44% of large health plans indicating that they had many initiatives start, 37% of medium-sized organizations indicating they had many initiatives started, and only 13% of smaller organizations indicating they did.

In addition, 31% of larger health plans said most of their business and operations is focused on the movement toward value, while only 13% of smaller organizations selected this response. 

Perhaps most troubling, 20% of smaller health plans and 16% of medium-sized health plans said they have not yet started on any value-based initiatives. 

 

 

 

 

2. Big data

When asked about the use of big data to improve healthcare quality and reduce healthcare costs, all respondents (regardless of size), indicated positive movement in this area, with 63% saying they "have come a long way but still have a lot of work to do in this area." Only 4% of respondents indicated they are doing "very little" when it comes to applying big data to improve quality/reduce costs.

Larger organizations were the most likely to say their organization is using big data "very well" and that it is "making a big impact" (32%), followed closely by medium sized organizations (10%). No smaller organizations selected this response.

 

 

 

3. Technology tools

Overall, 51% of respondents said they are using patient registries, 83% said they are using business intelligence analytics, 52% said they are using health information exchanges, 43% said they are using remote health monitoring/telemedicine, and 60% said they are using applications that alert providers to gaps in patient care.

All respondents of all sizes indicated heavy use of business intelligence analytics (with 83% of small organizations, 86% of medium organizations, and 81% of large organizations saying they are using it).

The largest gaps in technology utilization between healthcare systems of different sizes were in the areas of remote health monitoring and health information exchanges. Sixty seven percent of large systems said they use remote health monitoring/telemedicine, while only 17% of smaller organizations said they are. Sixty eight percent of large organizations said they are using health information exchanges to share information with other organizations, while only 36% of smaller organizations said they are. 

 

 

 

 

4. Consumerism

Organizations of all sizes appear to be stepping up their customer service efforts, consumer outreach efforts, cost transparency efforts, and consumer relationship management efforts.

For all health plan respondents of all sizes, the top two areas of focus were increasing consumer outreach and expanding customer experience improvement efforts.

However, there appears to be a large gap in how smaller organizations and larger organizations are prioritizing financial counseling with patients. Only 7% of smaller plans said it is a top area of focus, while 32% of larger plans said it is.

 

 

 

5. Consolidation

The majority of respondents (56%) said the increasing consolidation of payers and providers will lead to higher overall healthcare costs.

Smaller organizations tended to fall on the more negative side of the spectrum (with 57%) saying it would lead to higher costs, and only 24% saying it would lead to lower costs. 

Medium-sized organizations were more positive about consolidation, with 35% saying it would lead to lower healthcare costs and only 52% saying it would lead to higher costs.

Larger organizations were nearly split with 41% of these organizations saying it would lead to higher costs and 45% saying it would lead to lower costs.