With the introduction of health insurance exchanges, guaranteed issue will bring 35 million (approx.) new customers into the U.S. healthcare marketplace by 2016. It is highly likely most of them will have higher than average medical costs, thereby raising premiums for everyone in the insurance pool. The onus will be on the individual members to take the ownership of their own healthcare expenditure and support the payors in controlling the rising premium.
We will focus in this blog how the payors can involve the members more by introducing member centric programs in the plan design and how big data will be leveraged to provide the required intelligence to the payors to achieve it.
The member wellness and preventive care program is already a key focus area for the payors. However, these programs need to be customized for the specific needs of the members rather than being offered as a generic program. In my point of view, following could be reasons why this is not very effective yet.
• The wellness and preventive programs are generic which might not suit to the needs of the members.
• The members who need specific programs often do not find those being offered by the payors or do not get the required incentives or mandates from the payors for adequate usage.
• The patients are often not knowledgeable on the needs of the wellness program so as to take it seriously.
If we analyze the problem critically, it can very well be inferred that payors usually lack the intelligence (information perspective) which will enable them to customize the wellness program for a member. With the help of Big Data analytics, the data, already available in abundance from multiple sources, can be analyzed to get the information on the risk exposure of an individual to certain diseases (current or in future). Utilizing this information, the payors can come up with the following.
• Design the wellness and preventive programs for a member.
• Come up with the incentive or penalty structure to encourage the member to take up these programs seriously.
• Continually educate members on the diseases and on the availability of the required preventive programs.