Health Insurance Industry Issues and Legislation

The COVID-19 Pandemic has significantly reduced the number of patients seeking preventive care, properly managing their chronic conditions, or having elective surgeries before their conditions worsen. Non-COVID-related inpatient and outpatient volumes are off by 35% or more while immunizations and preventive care services for newborns and kids under 5 are all down dramatically. Smart self-funded payors are acting now to improve the health and healthcare outcomes for their plan enrollees while mitigating the impact of the anticipated surge on their bottom lines.

Low health literacy leads to more hospitalizations and less use of preventive services which drives up group and enrollee costs. Well informed empowered employees make smarter, more cost-effective health care decisions. The key to smart, money-saving decisions includes comprehensive, ongoing communications programs that educate employees to give them the information they need to make those wise choices. Low health literacy leads to more hospitalizations and less use of preventive services which drives up group and enrollee costs. Both the "what" and "how" are key, so the information must be important, and the presentation must be engaging. Multiple channels, including mobile apps and websites, should be used to deliver the messages and vital information for member decision making.

A user-friendly member mobile app and web site, like HHC Group's Health Plan GPS (HPGPS) powered by Medxoom, is an excellent vehicle for messaging and providing key plan information. HPGPS is part of HHC's Reference Based Pricing (RBP) suite of services. It gives H.H.C. Group's RBP clients a powerful, modular tool for increasing member engagement and satisfaction while reducing plan and member healthcare costs. By using HPGPS, members can receive messages from their plan, track the status of their benefits, review plan information, pay providers and notify their group administrator in case they get balance billed.

Virtual healthcare is exploding. Spurred by the pandemic, the number of Americans using telemedicine shot up by 57% in 2020. Telemedicine claims for diabetes, hypertension, and osteoarthritis all increased by triple digits. Estimates are that 35%-50% or more of care can be delivered virtually. The challenge now is to move from a carbon copy of in-person care to develop a system that is designed around patients' needs. To maximize virtual care's potential, healthcare platforms will have to be a one-stop-shop that patients can use to find a care advocate, receive care, review plans, and their billing information all in one place.