The top changes MCOs should expect in 2016

As the U.S. healthcare system’s historical transformation continues in 2016, we will see an increased focus on consumerism, cost transparency and value-based reimbursement. These developments will create both opportunities and challenges for all managed care stakeholders. Here is a preview of industry changes to expect in the coming year:

Patient out-of-pocket costs will likely increase

Healthcare costs continue to outpace inflation, creating greater incentives for insurers to offer plans with high-deductibles and narrow networks. These plan designs are offered typically at lower premiums but require much higher consumer cost-sharing levels. According to a PwC’s 2014 Touchstone Survey, 44% of employers across all industries were considering limiting their offerings to high-deductible plans within the next three years. Indeed, today many of the health plans with the lowest premiums on public and private changes have high deductibles. A 2015 Robert Wood Johnson report showed that 41% of provider networks available through silver plans on the Affordable Care Act marketplace are “small” or “extra small.”

Consumer education will take the spotlight

With consumers responsible for a greater share of their healthcare expenses, and employers, providers and insurers being rewarded for controlling costs and improving health outcomes, consumers will need to learn more about both the financial and clinical aspects of their care. As the healthcare system moves toward value-based reimbursement, consumer incentives must be aligned with those of payers and providers.

In 2016, employers, insurers and providers will allocate more resources to providing online and mobile tools to help consumers understand their healthcare plans’ costs and benefits so that they can know the cost of their treatment while obtaining the healthcare services that address their needs.  Tools that are well-designed and accessible can aid consumers in evaluating their provider networks, researching prices, learning about the importance and cost effectiveness of preventive care and screenings and improving their overall healthcare literacy and their personal health status. These tools also will be able to explain the differences between plan designs so that consumers enrolling through public or private exchanges can select the option that’s best for them.

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