Major health insurers capitalize on population health

Amid consolidation throughout the health insurance industry, major payers continue to focus efforts on the increasingly popular trend of population health, which quickly became a multi-billion dollar effort.

UnitedHealth Group, Aetna, Humana and Blue Cross Blue Shield (BCBS), for instance, are working to ease the transition away from fee-for-service reimbursement to value-based payment, reports Forbes.

For population health to work, however, both providers and payers need to be on the same page. Specifically, doctors and physicians need the right tools to deliver quality care to patients.

And while the market potential is huge, as the article notes, providers note they generally lack certain IT capabilities and administrative expertise to gather the necessary amount of data on patient populations.

But there's evidence that despite these hurdles, providers are embracing payers' plans to help them implement alternative payment models.

UnitedHealth's health services platform Optum--whose offerings are sold to various doctors, insurers and self-insured employers--racked up $26.4 billion in the first half of 2015, growing 15 percent year-over-year. Earnings from operations totaled $1.6 billion with 17 percent growth, according to the insurer's second-quarter earnings report.

Aetna, meanwhile, has invested more than $1.5 billion in its population-health-driven Healthagen business, Forbes reports. And the company expects Healthagen's growth to accelerate when it combines with Humana, which boasts its own population health managment businesses under the Transcend brand.

Then there's Horizon BCBS of New Jersey. In an effort to help providers manage their high-risk patient population, the insurer sends monthly reports to practices across a secure site. Those reports have information for practices on issues such as emerging ambulatory systems, emergency room visits, admissions and readmissions. They also detect rising risk of patients, Steven Peskin, Horizon's senior medical director for clinical innovations, told FierceHealthPayer in a previous interview.

For more:
- here's the Forbes article

Suggested Articles

Physician groups slammed a court ruling that overturns CMS' site-neutral payments rule for clinic visits.

Sixteen medical professionals, including six doctors and seven pharmacists, were among those charged in a Texas healthcare fraud and opioid takedown.

Blue Shield of California is piloting transportation benefits with some of its members in Sacramento.