2019 Outlook: Employers to Push Insurers for More Value, Innovation

by Leslie Small

In the year ahead, employer clients will be expecting a lot from their health benefit plans, including a stronger focus on behavioral health, creative uses of data and technology, and a greater emphasis on high-performing, industry experts say.

"If I was sitting on the insurer side and I was wondering what I was going to hear from my employers this year, I would be prepared to sharpen pencils or to least expect a little more competition, a little more RFP action, a little bit more pushback," says Suzanne Taranto, a principal and consulting actuary for Milliman, Inc.

Among the health benefit trends and themes that employers are focused on:

✦ Behavioral health.

"For so long, behavioral health has been a secondary thought, and I think that employers large and small are realizing that this is such an important area where the system is truly, truly broken," says Renya Spak, who leads Mercer's Center for Health Innovation. To fix it, employers are looking for "true innovation," whether that means partnering with startups or pushing their existing partners to operate differently.

✦ High-performing provider networks.

Taranto says employers are increasingly concerned about whether they're sending employees to the lowest-cost, highest-quality providers. Thus, they're interested in steering employees to Centers of Excellence for episodes of care like cancer treatment and knee, hip and back surgery, she says.

✦ Social determinants of health.

"In the commercial market, I am seeing a much greater interest in addressing the social determinants of health," Sandeep Wadhwa, M.D., tells AIS Health via email. "…I now see an increased focus on the needs of lower wage workers where the last week of the month, for example, may lead to trade-offs between medications, food, or transportation," adds Wadhwa, former Colorado Medicaid director and now chief health officer and senior vice president of government programs and market innovation at Solera Health.

✦ Artificial intelligence.

In the employee benefits space in 2019, "it is all about AI," Spak says. In part, that's because there are many new tools focused on AI-powered triage — in which users enter their symptoms and answer questions, and are then given advice about, for example, whether to simply rest a sore ankle or see a doctor.

From Health Plan Weekly