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Three predictions for the future of health plan design

November 14, 2022
Taylor Goldsmith

Price transparency, rising healthcare costs, and the member experience all factor in to the health plan design of the future.

The rising cost and complexity of healthcare is well documented. In fact, the original intro to this blog started with eleven questions about its rising complexity. Now, we’ve boiled it down to one. 

What are we going to do about it?

At HLTH 2022 in Las Vegas this week, care innovation, the future of health, and the big question - ‘what are we going to do about it’ - will be at the forefront of conversation. As an effective response to controlling rising costs and managing systemic complexity, innovations in health plan design will likely be a hot topic as well. Here are three major trends we anticipate coming to health plan design. 

Networks and plan designs will get more complex, but also more creative

Healthcare rates are increasing past inflation, putting more stress on plan sponsors and fueling the need to find innovative ways to contain healthcare costs.

“Those who thrive will tap into the $1 trillion of improvement available by redesigning their organizations for speed-accelerating productivity improvements, reshaping their portfolio, innovating new business models to refashion care, and reallocating constrained resources.”

We are seeing increasing evidence that plan designs will go beyond offering a fixed set of in-network providers and continue to trend toward including narrow networks, tiers, more carve outs for mental health and prescriptions, direct contracts, reference-based pricing, Centers of Excellence (CoE), and much more. These innovative network designs are meant to drive plan members to high-quality care, increase the availability of and access to care, and curb skyrocketing healthcare costs. 

The member experience will become even more essential

With rising costs and plan complexity, a growing number of point solutions, and decreasing healthcare literacy, members will continue to struggle to make sense of the wide range of available health benefits to make the best healthcare decision possible. More than 60 percent of Americans don’t know the difference between in and out-of-network care, don’t understand co-pays, and often leverage the emergency room as their primary care provider. This low healthcare system literacy translates into $47 billion in avoidable medical spend every year—and we know that plan sponsors foot the bill.

We see innovative payers and consumer health companies turning to highly configurable healthcare navigation solutions to present a simplified, unified member experience that allows members to experience the benefits of health plan innovations without the burden of becoming a healthcare expert. Founded as a B2C company, Amino Health has long stood behind the importance of an intuitive, elegant member experience. We have seen how digital navigation technology that puts members first increases healthcare literacy and reduces costs across the healthcare system. 

Price transparency will make plan members better healthcare consumers 

Plan members have become accustomed to the opacity built into the healthcare system - from how providers are designated as in-or-out of-network to the actual cost of a medical procedure. 

Price transparency regulations are challenging that status quo. Amino Health has long been invested in price transparency for providers and facilities, and we’re interested to see the industry-wide impact of revealing hidden prices and allowing plan members to shop for care with accurate pricing for the 500 most common healthcare services. We anticipate product growth to support regulatory compliance and a surge of new information about consumer behavior as patients begin to shop for care. 

We’re looking forward to the HLTH event kicking off this week so we can have more of these conversations and work with payer and consumer health partners to get creative on the future of healthcare. Our Head of Sales, Liz Swaminathan, will be there walking the floor taking it all in - connect with her here! Stay tuned for our takeaways after the show.

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