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In 2016, employees are in the healthcare driver's seat


The healthcare industry is evolving from a business-to-business model focused on employers buying group plans, to a business-to-consumer model influenced by the actions and needs of the individuals seeking care.

We've already embraced the following consumer-controlled features of modern health coverage:

  • Individual coverage plans offered by the Affordable Care Act means employees can now keep their coverage as they move jobs.
  • Increased deductibles across all types of plans means the more plan participants are required to pay out-of-pocket, the closer they will scrutinize the cost and quality of their care.
  • Wellness programs encourage employees to commit to and be held accountable for their personal health.
  • Cost comparison and second opinion requirements means insurers can charge a fee to employees if they fail to shop around before booking certain procedures, treatments and planned hospital stays.
  • Health savings, health reimbursement, and flexible spending accounts means incentive for employees to calculate their annual health-related expenses to set aside pre-taxed money.

In 2016, consumers will continue to drive the need for more independence and open communication in the healthcare industry, with:

  • A focus on the primary care physician. Networks, as always, are critically important because they determine the providers where plan participants are covered under their insurance plan. But the more consumers take advantage of preventive health services, the more closely tied they become to primary care physicians. In 2016, networks can actually be a deal-breaker if employees are offered a new plan and their primary care physician is not included.
  • The community care comeback. Just like any consumer market, buyers want their service when and where it is convenient to them, at the cost and quality they desire. When given the opportunity, consumers increasingly support community clinics over large physician groups within hospitals. Here they have a shorter commute from home or work, they can form relationships with the physicians and medical and office staff, and in some cases they pay less for similar services offered by large health systems.
  • Price transparency. Access to pricing and the standardization of pricing are efforts underway as part of the next generation of the Affordable Care Act. In the meantime, consumers who are educated about their coverage are demanding in-network and out-of-network cost information from providers. This trend puts significant pressure on health systems with complicated pricing structures. In 2016 we can expect to see increased reliance on third party consumer advocate companies such as Alithias, who do the legwork of tracking down pricing and analyzing claims, helping employers save millions on healthcare costs.
  • Multi-channel challenges. When it comes to communication, there are three demographics of healthcare consumers: the tech-savvy mobile app users, the ease-of-use Internet users, and traditionalists who prefer communication via paper mail and telephone. In 2016, we will see more employers, insurers and providers adjust to make information available in a way each demographic prefers to access it.

The future of healthcare is an industry driven by patient needs and measured by productivity and the wellness of the workforce. As a business owner, the best way to prepare for that is to approach 2016 health plans with a consumer lens. This means picking plans that offer the broadest options for employee choice, education and access to information. In turn, these types of plans will keep employees productive in the workplace, allowing you to focus more on your business and less on benefits.

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