This topic was the focus of a breakout session at Outcomes+ 2022.
Getting exceptional care shouldn’t be hard. However, right now, the patient experience is complicated, costly and confusing. Plan sponsors and members are frustrated by high costs of care and low quality. And health care workers are overworked, especially as a result of the COVID-19 pandemic.
Trends both inside and outside of health care indicate that there is a better way in how care is delivered.
Trends that are impacting health care delivery
When looking at what’s impacting care, it’s important to start with the patient perspective. While they have always been concerned with affordability, this concern has only exacerbated: over the past 15 years, medical deductibles have risen eight times faster than wages, which means that the cost of care is hitting consumers more and more.
Additionally, consumer expectations of health care are changing: compared to prior generations, millennials and members of generation X are more willing to shop around for care. And they expect technology to be a part of the solution through the use of mobile devices, remote monitoring devices and access to online tools. There’s no doubt that standards within other industries are influencing expectations for health care.
For plan sponsors, fallouts from COVID-19 like a virtual workforce and employee turnover under the Great Resignation have altered the benefits that they’re expected to provide to meet their member needs or to remain attractive to current and future employees. Some of these new benefits include:
- Virtual care and digital health resources – 81% of plan sponsors expect that digital and virtual care will be a key part of the answer
- Behavioral health services
- Voluntary benefits, like life and disability insurance
- Targeted point health solutions like those offered within the Evernorth Digital Health Formulary
Finally, the Great Resignation has also hit health care: by 2034, the health care industry expects a shortage of primary care providers (17,800-48,000) and specialty care providers (21,000-77,100). This means that alternate forms of health care delivery, especially through the use of digital tools that are sometimes self-serve, are crucial to providing members access to the care that they need.
What plans sponsors can do to address these health care delivery trends
- Continue to emphasize and provide access to primary care. Research has shown that $1 spent with high performing providers equipped and incentivized to deliver quality can save $13 of downstream total cost of care.1
- Integrate care. Breaking down silos between medical, pharmacy and behavioral care, while overlaying social determinants of health, can see a 30% favorable impact on the total cost of care.
- Provide options to access care where members want it. Not only is there an opportunity to digitize how health care is accessed and delivered by moving from brick-and-mortar locations to more digital options like virtual care and digital tools, some members might want to receive care at their workplace or in the home.
- Look at alternative care models. Historically, providers have been incentivized for their volume of patients seen over quality of health outcomes because of a fee-for-service care model. More and more, plan sponsors are considering a value-based care model that could deliver a better experience for members and providers, better health outcomes and, ultimately, more affordability, due to downstream impacts.
Innovation and the acceleration of health care trends as a result of COVID-19 have made it an exciting time to be a part of the health care system. With the promise of better care experiences, more health care delivery options and a reduction in the total cost of care comes an opportunity for plan sponsors to prioritize solutions that meaningfully address healthcare trends and improve affordability.
1 Oregon Health Authority’s Patient Centered Primary Care Home Program