5 Trends Shaping the Health Insurance Market

When searching for affordable health insurance companies that still meet your family’s needs and live on the “cutting edge” of the market, you need to have a set of criteria in mind, and preferably, written down on paper in front of you.

And while you can’t ignore the fundamental factors like premiums, deductibles, copays, and the like; finding an insurer at the forefront of modern health insurance industry trends is also a sign of a proactive, growing, and forward-looking company. And that, of course, is the kind you want!

And from the other side of the equation (the insurer’s perspective), staying on top of market trends is even more important.

So, for insured and insurer alike, here are 5 of the most dynamic trends in today’s health insurance market:

1. The Move to a B2C Focus

In the wake of Affordable Care and other seismic shifts in recent health care insurance history, more and more people are selecting their own plans. And this is true both of public and of private exchanges. And so, insurers wishing to compete have no choice but to move from a B2B to a more B2C focus.

This move is manifesting itself in more attention to the “customer experience” of online health insurance shoppers. There has to be high transparency of vital information to quickly compare with other options; and the presentation is as important now as it is on other e-commerce sites.

2. Those “Rising Stars”

Medicare Advantage Star Ratings are on the rise in importance with consumers. Scoring a “5” or at least a “4” is a huge edge over a mediocre “3.” And the 4-5 Star column also gets bonuses to reward them for their efforts. Thus, more clients and a higher reimbursement rate are both “star-related.”

And the fact that MA plans can now be enrolled in at any time of year makes the impact of star ratings even bigger, and of day-to-day significance for insurers.

3. A Gradual Shift to The Cloud

Legacy systems are an old, but increasingly expensive and inconvenient, tradition. Almost all other business types have already seen a major move from in-house IT to cloud-based file storage and management. Health insurance is finally catching up.

The Cloud reduces your IT infrastructure and staffing costs (and these savings can be passed on to consumers.) And Cloud services also keep themselves continually up to date technologically and in terms of cyber security. Taking all of this off the insurance company’s plate is a big help.

4. The Continued Growth of Private Exchanges

In the wake of ACA, employers began turning more and more to private exchanges as a means to outsource the administration of the health benefits of those on their retirement plans. But soon, the trend spread. Now, there are many private exchanges that are used to offer benefits to all covered employees, not just retirees.

But the increase in the number of private exchanges, along with the introduction of public exchanges, means that exchanges themselves are often competing. Some are owned by insurer’s, others only allow big businesses on board, and still others cater primarily to self-insured employers. Selecting which private exchange, if any, to use is now a major decision that takes careful consideration of numerous factors.

5. Big Data Is “Getting Bigger”

In the past, big data capabilities seemed more like a pipe dream than a reality in the health care (and health insurance) world. But now, the ability to centralize data from numerous sources and analyze it on a much more “granular” level is giving insurers insights that could fine tune (or even revolutionize) the kinds of plans they offer.

And with “non-relational” databases emerging in the healthcare world, less structured data like doctor’s notes or medical transcripts can be pulled up and compared alongside more traditional “structured data” in columns, rows, and tables. The end-result of this should be a better ability for insurers to create plans that are more in line with medical and demographic realities as big data continues to get “bigger” and “smarter.”


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