Healthcare Consumer Engagement Gap With Payers: They Want…?

Change Healthcare (CH) announced payer insights revealed in The Engagement Gap: Healthcare Consumer Engagement in 2017, a new national study of 89 payers, 251 providers, and 771 consumers. CH asked payers about the factors influencing their consumer-centric initiatives, and how these strategies are altering their organizations. Health plans surveyed were generally aligned in pointing to value-based care as the primary factor driving their focus on consumer-centricity, with 74% reporting it as the leading factor.

Health Plans Hit New Low: 360° View Of Trust In Healthcare

Findings from the 11th Annual ReviveHealth Trust Index™ reveal trust in healthcare is dismal across the board, and trust in health plans hit new low. The survey represents the first 360-degree view of trust in healthcare – digging into consumer, physician, health plan, and health system executives’ views of each other – showing the industry as a whole has a long way to go. Factors driving widespread distrust in health plans by provider organizations include the hassle of doing business with payers and a lack of progress toward new models of payment and care. Consumers feel slighted by health plans as well, compared to the higher trust ratings in physicians and hospitals.

Key Payer Competitive Differentiator: Analytics

Many health plans are facing uncertainties: the changing health insurance landscape, the speed at which value–based care is approaching, and growing demands from customers, to name a few. But one investment may help executives meet each of these challenges—an investment in analytics. Health plans are data rich, yet those data are not always leveraged to understand what happened and why, or predict what is likely to happen. Health plans that don't take advantage of their data may risk being disrupted and left behind. Analytics can be a key payer competitive differentiator setting your organization ahead of the pack.

Who Decides Medical Necessity For Mental Health?   Massachusetts State Bill Challenges Notion

Massachusetts bill (H 1070/S 1093) adds to the definition of “medically necessary services” and challenges the notion of who decides medical necessity. Medical necessity criteria sits at the center of case and claim determinations. Laws, policies, and procedures evolve through time and the various administrations both locally and nationally.

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