A recent survey from Mercer highlighted a growing trend among large employers- the search for alternative health plan options to address rising healthcare costs. The survey focused on a number of the most important factors for employers looking to increase the potential for cost savings while maintaining a competitive benefits package – designing high-performance networks and offering variable copay plans.
What does this shift mean for payers today? In the complex healthcare landscape, payers need to adopt innovative approaches to plan design to meet employer needs. High-performance networks and variable copay plans can not only save costs but also maintain partnerships with valued organizations and improve member experience.
The data-driven recommendation:
Drawing from the report’s findings on employer trends and insights from PurpleLab®’s industry claims data, it is recommended that payers use comprehensive provider-centric data to develop competitive packages and innovative plans, ultimately improving the overall quality of care and ensuring accessible coverage for their members.
It is essential to regularly evaluate network performance to identify areas for improvement and innovation and to maintain accurate provider directories by using provider-centric data, including verifying provider contact information, affiliations, specialties, and network participation.
Data can be particularly valuable in helping payers monitor trends and regulatory changes, make informed decisions about healthcare strategy, provider networks, and cost-saving initiatives, and ensure effective patient navigation and network management. Regularly updating and maintaining provider information can streamline administrative processes and enhance the overall efficiency of healthcare delivery.
Payers should conduct a thorough evaluation to assess the potential increase in market share and partnership opportunities that come from adopting new initiatives compared to traditional options.
Putting data to work:
Data can help payers identify opportunities for cost savings, such as optimizing referral networks or promoting preventive care. Real-world data can also help identify high-cost providers and facilities, enabling payers to redirect patients to lower-cost alternatives or contract with high-value facilities. By benchmarking cost and quality scores against peers, payers can negotiate value-based contracts and incentivize better patient outcomes, ultimately reducing costs. Leveraging affiliations and referrals, payers can strategically identify and recruit out-of-network providers to fill adequacy gaps and keep patients in-network.
It is crucial for payers to make data-driven decisions to stay competitive in an evolving value-based market. Incorporating comprehensive data and insights into their business development plans can help them more effectively improve the quality of care for their members and establish long-term partnerships with cost-conscious employers.