Opportunity Knocks: What 2022 May Deliver for Health Plans

The start of 2021 seems so long ago. The year seemed to both speed by and creep along. However, one thing became clear. Healthcare is experiencing both unprecedented challenges and extraordinary opportunities. Although the pandemic continues, the new year is often a time for reflection, and this year presents unique opportunities to explore what’s possible.

Here are a few predictions for 2022 from our world.

Transparency Mandates Drive Consumer Experience

Price transparency mandates get real this year for group and individual health plans and insurers. Instead of just checking the box on compliance, forward-thinking plans will innovate their member experience. Rather than stopping at delivering mandated data and functionality, they will harness price transparency data to curate experiences that help members better understand, select, and access care. Price transparency shouldn’t be more data to parse and yet another task for people accessing care. Leading plans will help members concerned about the cost of care make better choices without extra work and leverage the different ways a member engages with healthcare in that process. People need guidance in their care journey–whether they need a lab, imaging or something more expensive, like surgery. Using a consumer-centric approach and creating trust-building experiences will help plans to realize their long-planned digital initiatives and transformation.

Payer and Provider Collaboration Prior to Care

Similar to price transparency data sharing, the No Surprises Act also requires plans and providers to share provider data updates at least quarterly. They must also remove providers from their directories when those providers don’t respond—eliminating a major source of new patients for those providers since 54% of people look to their health plan website for information on in-network providers. Plans can advance their consumer-centric experiences by going beyond sharing the minimum provider data required—like name, location, and contact info. Offering members more detailed, up-to-date provider profile data, like photos, scheduling information and approach to care, can help members find the right provider for their health needs and preferences. Going beyond the letter of the mandate can help innovative plans support health equity, improve member experiences and satisfaction, and help their provider partners.

Sharing the Benefits of Transparency (and Value) with Members

As price transparency goes mainstream, health plans have a new opportunity to help people with individual and group coverage see the cost of care more clearly, and also act to use more cost-effective, quality care. Through shared savings and incentives, a member can go online to compare, save on planned care, and earn a financial reward. These programs help members get cost effective care today–even when their deductible is met and they have no out-of-pocket costs. The federal government even changed Medical Loss Ratio calculations to encourage plans to share savings with members. Incentives can encourage members to compare options and select a center of excellence to improve health outcomes and save on long-term care costs. This supports plan benefit designs, helps manage the cost of care for groups and plans, and empowers people to make better choices—and not shy away from needed care due to cost concerns. This shared savings opportunity drives engagement and savings for plans and employer groups–and builds satisfaction with members.

While mandates certainly are driving these opportunities, plans that build on the foundation of compliance can build member trust. It goes without saying that trust is a critical element in healthcare. It is also one that can improve health and outcomes in a global environment of fear and uncertainty. As I look at 2022, I see an opportunity to use creativity and strategic thinking to remake the experience for people interacting with healthcare.