Having analyzed the trends and the shifting winds in the payer marketplace, it’s time to gaze into the crystal ball and see what the future has in store.
More M&A in the payer space
This year’s mega-mergers have created large scale behemoth companies that may be difficult to compete with as a small carrier or health plan. With insurers increasingly looking to integrate with providers and other sites that can deliver more effective care at lower cost, we’re likely to see a new raft of M&A deals in the year ahead. One potential candidate on the docket could be the rumored tie-up between Humana and Walgreens.
Employers taking more of the healthcare baton
Direct contracting with providers have been seen as the realm of large nationwide companies. While that’s still true, continued increasing healthcare costs and more employers becoming self-insured means that they will likely bypass traditional carriers and work directly with providers. Walmart, for example, recently decided to mandate travel to select clinics for employees looking to undergo spinal surgery.
One potential way for smaller companies to dip a toe into direct contracting is through deals with the growing number of on-site and near-site primary care clinic companies, some of which offer flexible plans that allow companies to team up to share costs.
Increasing focus on social determinants of health
2019 will continue to bring more emphasis on social determinants of care and not a moment too soon given that research has shown that SDOH have a much stronger effect on health than clinical care. From a purely transactional perspective, investing in better health saves healthcare costs in the long run. Managed care organizations like Kaiser Permanante and insurers like Humana have started to invest in initiatives targeting homelessness, gun violence and food insecurity and social determinants look to be an increasing area of focus for Medicare and Medicaid.
Backlash to the healthcare data revolution
I’m writing this piece as yet another scandal breaks regarding Facebook’s use of “private” social media data. With all the breathless excitement about the open availability of healthcare data and the amazing possibilities of its use especially when combined with AI and machine learning techniques, it’s the cynic in me that looks at the potential dark side, especially when considering the extremely personal nature of health information. It’s bad enough when your email or credit card information gets stolen, what about when it’s your medical history or your genetic data?
“It isn’t too far fetched to imagine that consumers might become more cautious or there may be a backlash against connecting and collecting data about them and then using that data without the consent of the patients,” said AI expert and Booz Allen Hamilton Principal Joachim Roski, in an interview.
The real question is whether that concern is going to be too little, too late.
Picture: Getty Images, AndreyPopov
