It’s the season of Q2 financial earnings calls for health insurers, and Forrester is listening closely. During the past year, the healthcare industry faced massive disruption, and health insurers are at the tip of the spear. Increasing pressure from new healthcare entrants such as retail titans Amazon, CVS, and Walgreens demands that health insurers up their game — especially when it comes to customer experience. To win, health insurers must deliver proactive and personalized customer experiences, a strategy that proves even more important for Medicare, Medicaid, and chronically ill populations. To navigate this transformation, health insurers are sharpening their focus on value-based care, building out new care models (such as acute care in the home), and investing in technologies like remote patient monitoring and telehealth.

Key Takeaways From Health Insurers’ Q2 Financial Earnings

Forrester healthcare analysts spent the last few weeks tuning into the Q2 earnings calls of the top health insurers as they discuss their priorities, stock prices, the looming recession, and the impact of a new COVID variant. As key executives discuss the strengths of their portfolio, a deeper dive into these discussions reveals where the healthcare industry is leading health insurers to focus on:

  • Completing the shift from fee-for-service to value-based care. The future of healthcare is value-based care — this is nothing new. But heightened demand from consumers for greater cost transparency is pushing health insurers to adopt episodic-based care, including capitated arrangements and bundled payments. Among other benefits, a value-based, affordable plan hopes to lower preventable clinician visits and reduce the burden on the healthcare ecosystem. As health insurers continue to pivot to value-based care, they would do well to remember that it is not enough to simply move members to value-based care — this in itself will fall short. The next stage of focus for health insurers must be making those arrangements flourish. For example, UnitedHealth Group announced its plan to eliminate co-pay and out-of-pocket costs for critical medicines such as insulin, epinephrine, and albuterol by 2023. Health insurers are taking on more risk to make value-based care a reality.
  • Engaging vulnerable populations to achieve the Quintuple Aim. The chronically ill and elderly populations face many barriers to healthcare. Customer engagement and experience is quintessential to achieving better patient outcomes, preventing unnecessary trips to the emergency room, and lowering the burden on the healthcare system. UnitedHealth Group cemented its position to expand home-care initiatives to benefit its expansive Medicare members, noting that, for the elderly, their ability to get into their homes and influence their care is pivotal. Executives noted digital product innovation as a top priority for the commercial payer, especially for their expansive Medicaid population.
  • Building out home care investments and capabilities. Care outside the brick-and-mortar space is making healthcare more affordable, enhancing patient satisfaction, and improving patient outcomes, especially for the chronically ill and the elderly. For payers, home healthcare modalities are critical to expanding value-based care and driving down the $4.1 trillion annual healthcare spend. Despite the Centers for Medicare & Medicaid Services’ plans to decrease payments in this arena by 2% in 2023, we expect payers to increase their investment in this space in the coming months and years as they reap the cost benefits. For example, Humana is building on last year’s partnership with DispatchHealth to provide its members with convenient and proactive care, targeting populations with multiple chronic health conditions.

Health insurers will continue to bet big on healthcare and digital innovation by:

  • Investing in technology to provide proactive, personalized customer experiences. Digital front door solutions are still a priority, but health insurers are ramping up their investment in technologies like conversational AI, CRM, and SMS text messaging to support their digital initiatives. The elevated consumer demand for ease, immediacy, control of data, transparency, and insights driven by consumer experiences in retail will encourage payers and providers to arm consumers with the tools, insights, and recommendations that enable more prescriptive and preemptive care. For example, Elevance’s suite of advocacy focuses on creating proactive, personalized experiences that are designed to guide members on their care journeys. Elevance is relying on data analytics that enable advocates to proactively respond to the needs of their participants.
  • Joining forces with providers for mutual benefit. Fueled by M&A activity, we expect an uptick in health insurers entering the healthcare services space. As an example, Humana announced its plans to expand its CenterWell investments by developing 100 new centers between 2023 and 2025. Last year, UnitedHealth’s Optum further expanded its physician network with the acquisition of physician groups Atrius Health and Beaver Medical Group. Early this year, Centene acquired Magellan Health, a benefits manager for behavioral health, for $2.2 billion to solidify its foothold in that field. The rise of the pay-vider will continue as providers look to provide healthcare services, driving M&A activity. As a result, insurers will have more control over the care that their members receive and can enable higher-quality, more cost-effective care.

At Forrester, we are expanding our health insurance research. If you are a health insurer devising your next-gen strategy, schedule a call with us — we would love to speak with you!