5 models for the 'health insurer of the future'

A compass pointing to the word "Innovative"
Payers looking to adapt to the changing healthcare sphere must embrace a new business model. Image: Getty/Olivier Le Moal

As the healthcare industry faces uncertain regulatory change, PwC said payers must find a new way to do business in order to keep costs low and better serve enrollees.

Through a survey of health insurance executives, healthcare leaders and American adults, PwC’s Health Research Institute identified five models that the health insurance industry should adopt to become the "health insurer of the future" and provide a better consumer product.

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“To succeed in these uneven times, health insurers should make choices now about business model changes that will position them to prosper in the future,” according to the report. “Strategies that build enterprise resilience will focus on what is known—healthcare’s increasing drive to be value-based, consumer-focused and technologically-enabled—while preparing for the unknowns.”

RELATED: Payer-provider collaboration: Notable partnerships in 2016

The report examined responses from more than 100 insurance executives recorded before the 2016 election, after the election and earlier this year, alongside survey data from more than 1,700 American adults and interviews with healthcare leaders. Each of the five models provides different opportunities to improve consumer engagement and enable providers to make easier, better care choices:

  • Consumer advocate: Payers that embrace this model will offer easy-to-understand plans and provide timely, digestible information, likely through digital options
  • Bridge connector: The insurer of the future will actively be involved in facilitating conversation between patients and providers, and will play a key role in ensuring enrollees get needed care
  • Lean operator: This model encourages payers to make typical processes, like claims processing or utilization review, more efficient
  • Analytic sensor: Payers can provide important population health data to providers and help offer solutions, while also pushing for more value-based care options
  • Care integrator: Integrate different areas vertically so that care is better coordinated and costs are kept low

Payers that want to adopt any of these models must first identify the ones that best fit or are most needed for the population they serve, according to the report. Technology-based initiatives must be balanced with a human touch as well, and payers must be prepared to invest in employees that are knowledgeable on consumer engagement, data and new technological options.

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