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Health Care In Massachusetts – Carriers And Providers Collaborate To Enhance Service And Improve Engagement

Change is constant—the only thing you can count on is change. How many times have we heard those and other similar clichés over the past few years? They have a true relevance in the health care industry.

At a recent New England Employee Benefits Council meeting, I had the opportunity to listen and discuss the current and future states of health care in Massachusetts with the major insurance carriers. Present were Aetna, Blue Cross of Massachusetts, Cigna, Fallon Community Health Plan, Harvard Pilgrim, Tufts Health Plan and United HealthCare.

The conversation focused on health care costs for 2013 and beyond and included developing strategies to control costs and enhance quality.  Health care delivery models are changing in Massachusetts, and the outlook is positive. The carriers and providers will be working more collaboratively toward a goal to reduce administrative costs, and enhance the member and patient experience. Providers will use improved member/patient tools and information provided by the carriers which will help lower costs and deliver higher quality treatments and services. Payments to the providers will be aligned to compensate them for the delivery of both high quality and efficient care.

Other strategies included increasing member and patient engagement with their benefit coverage.  Enhanced technology is becoming available for members and patients to help them find the cost of treatments and search for access to the most efficient care. Tiered networks with incentives to use lower cost and high quality facilities and providers are being offered. In addition, a host of wellness programs designed to increase preventive care and help the member to understand their health risks are also available. All of these products can be imbedded in the member’s benefit program, along with incentives to use them.

So what is the cost outlook considering all the information presented above? The consensus among the carrier group was that health care trend is still on the rise to the tune of 5% to 9%, not considering the impact of Federal Health Care Reform (the Accountable Care Act). The Federal government program will impose new taxes along with mandated “Essential Health Benefits,” and a reduction in funding for public programs. All of these items will put upward pressure on the projected trend figures.

To counter the inevitable cost increase, a focused review of an employer’s benefit plan is in order. There are ways to work with the available market strategies and products which could have a positive impact on cost, as well as enhanced employee satisfaction. OneDigital is a recognized leader in guiding employers in this area. For more information, please contact us at 800.364.7575 or email us at [email protected].