With employers seeking new solutions to address rising healthcare costs, Health Care Service Corporation is rolling out its Edge health plans, a new alternative option aimed at simplifying the member experience.
Edge is supported by a proprietary plan design called Easify, with the goal of making the coverage easier for members to understand and use. Members pay a simple copay, and will not have a deductible or coinsurance for care that's in-network. The plans also includes a broad, PPO network.
The goal, the insurer said in an announcement, is to help connect members with high-quality and cost-effective care. Members are provided digital tools and personalized supports that are designed to explain options clearly and help them find appropriate care.
In addition, Edge plans offer incentives to members who select high-quality providers, according to the announcement.
Brian Cheney, divisional senior vice president of sales operations at HCSC, told Fierce Healthcare in an interview that the launch reflects demand in the market for these alternative products. The new Edge plans are a revamped version of HCSC's existing offering, reflecting the current environment.
He added that this is a growing space for innovation in insurance, with many of HCSC's competitors launching alternative plans that aim to reward the use of high-quality, cost-effective care. Industry leader UnitedHealthcare, for example, has seen success in managing cost through its Surest plans, and the company is making a big push around this coverage option.
"It's not surprising that we're here," Cheney said. "The employer market has been asking for this."
Cheney said that the approach with Edge was built on two key pieces of feedback from employers. For one thing, they were seeking an offering that would allow members to manage their own care in a language that they can understand. Consumers get that experience in other areas of their life, such as finance, and want that intuitive experience from healthcare, too.
In addition, employers wanted a platform that made the financial part of the equation easier for workers to track as well. The plans' platform offers key insights into the costs members see, such as what their copayments may look like at in-network or out-of-network providers, as well as any rewards they could receive for seeing certain doctors.
Cheney said that while the team did lean on artificial intelligence to support the Edge program, it wanted to ensure that members could still call in for help if needed. If they do make a call, the agent is looking at the digital experience alongside them to explain what they're seeing, he said.
"We didn't want to rest on just saying that the mobile app will be more and more intuitive, more native, because that doesn't capture everybody," he said. "We still believe a human touch is helpful, and they can help them understand what those cost and quality tools mean."
Easify Edge plans will be available to employers on Jan. 1, and Cheney said that HCSC is expecting significant interest. That makes the work the team is doing now to build out the onboarding experience even more critical. People already struggle to understand their coverage as it is, so introducing a plan with set copay structures will require new outreach, he said.
Cheney added that HCSC has developed a multi-year roadmap to continue building out the Edge plans, such as more personalization around specialty care and enhancing capabilities for employers operating across regions or multiple states.
In addition, he said that employers are looking for greater insight into which employees are engaging with certain offerings, particularly as it can serve as an early indicator of a looming problem.
"They say, 'It's great that you're managing my sick population, like I want you to be managing the folks for me that are not in a critical place,'" Cheney said.