The Benefitfocus Health Plan Executive Summit is an annual event pulling together select executive leaders in the health plan space to collaborate and share trends they are seeing in the industry. This year’s event included several leaders who have expertise in the field with decades of experience between them, in addition to the Benefitfocus Health Plan leadership team. The theme focused on commercial healthcare payer trends and how the evolution of the broker’s role is helping to shape the commercial payer market as we know it. Let’s dive into learnings from this topic and how carriers are best positioned to lead the charge in enabling the best technology solutions to support all stakeholders.
Key Trends shaping the Commercial Payer Market
Here are the top five trends we are seeing:
- Health care costs are up, while insurer profits are down. Commercial costs are rising about 8 percent per year and margin decline is hitting the fully funded space the most1.
- Small groups have entered the spotlight. Small group employers have more choices and therefore, more flexibility because of innovations in funding mechanisms such as level-funded health plans, Qualified Small Employer Health Reimbursement Arrangements (QSEHRAs) and Individual Coverage Health Reimbursement Arrangements (ICHRAs).
- Betting big on technology. Investments in technology such as automation and Generative Artificial Intelligence (GenAI) are driving top and bottom-line growth. Care coordination claims processes and quality management are considered top investment priorities.
- Meeting the consumer wherever they are. Payers are looking to invest in omni-channel consumer experiences to promote retention and increase profitability.
- Shifting selling patterns. Brokers are driving fractured plan purchases while large employers are leading efforts to adopt innovative plan offerings sold directly to employees to optimize employer cost benefit.
Evolution of the Broker
The broker’s role continues to evolve as they assume more responsibilities across multiple products and point solutions, acting as the primary consultants and advisors to their clients. This expanded role along with fragmented buying trends, requires access to more data and sophisticated technology to effectively manage plans and provide valuable insights. The tech capabilities that brokers should consider include such things as:
- Predictive modeling and scenario planning capabilities to anticipate future needs and recommend proactive strategies.
- User and mobile-friendly platforms that provide a seamless experience for brokers and their clients.
- Data-driven insights and guidance tailored to each broker's unique client base.
A saturated market with countless point solutions means that brokers, more than ever, need help parsing through the sheer volume of offerings. Streamlining administrative tasks and reducing manual work through automation and self-service tools will free brokers to focus on strategic planning and client relationships. Brokers will look to carriers to provide data and technology solutions that help their clients make informed decisions, optimize benefits plans and integrate easily with their existing systems.
How Health Plans Can Help Lead the Charge
Health plans serve as the foundational providers of insurance coverage and care management services, while employers and brokers play complementary roles. Employers are responsible for selecting health plans and managing employee benefits, often relying on brokers for their insurance landscape expertise. Brokers, as intermediaries, provide guidance on plan options and help employers navigate and understand the implications of their choices. This collaborative dynamic enables employers to help manage costs and compliance effectively while ensuring employees receive the necessary support and access to care.
Tech Implications for Carriers and How They Can Partner in a More Seamless Way
One priority for carriers should be investing in and adopting technologies that facilitate better integration with employers and brokers to create a more intuitive and integrated experience that benefits all stakeholders. This includes:
- Interoperable Systems: Developing platforms that allow for seamless data exchange between carriers, employers and brokers intended to enhance communication and streamline processes.
- User-Friendly Interfaces: Carriers should prioritize user experience, ensuring that their platforms are intuitive for both employers & brokers.
- Collaboration Tools: Implementing tools that enable real-time collaboration and data sharing can help to foster stronger partnerships and improve overall service delivery.
What Does This Mean for Data Exchange with Solution Providers?
Effective data exchange with solution providers is critical for optimizing care programs and point solutions. Establishing common data standards will facilitate easier sharing of information between health plans and solution providers, improving interoperability. Additionally, providing stakeholders with access to real-time data will enhance decision-making capabilities and allow for more responsive care management. Developing a successful exchange of data hinges on keeping that data secure and is easier said than done. Privacy and security are always top of mind when it comes to data. Ensuring that data exchange adheres to strict privacy and security protocols is essential for maintaining trust and compliance with applicable regulations. Carriers are fundamental stewards of sensitive data and need partners with equally stringent data security.
Creating an Open Market
Carriers should encourage secure third-party integrations, promote transparency and facilitate collaboration. Allowing various solution providers to integrate with health plans will likely create a diverse ecosystem of care options, enabling employers to tailor solutions to their specific needs while differentiating from carriers with disparate point solutions. An open market prioritizes transparency in pricing and outcomes, allowing employers to make
informed decisions based on value. Platforms that encourage collaboration between health plans, employers, and solution providers can enhance the overall effectiveness of care programs. By fostering an open market, carriers can lead the charge by empowering all stakeholders to leverage a broader range of resources and expertise meant to ultimately drive better health outcomes and cost efficiencies.
The healthcare market continues to evolve and as a result, the roles of health plans, employers, and brokers are becoming increasingly intertwined, particularly in the context of care partners, care programs, and the proliferation of point solutions. Health plans that invest in robust data and technology solutions will put themselves in a better position to attract and retain brokers as partners. Carriers that can provide seamless integration with multiple plans and carriers will not only be well-positioned to better support brokers and drive value for mutual clients, but they will also likely have a competitive advantage in the fragmented buying landscape. Partnerships with third-party vendors like Benefitfocus will also be crucial for brokers to access specialized tools and services that may not be available from carriers alone. When faced with the decision of where to invest limited resources, carriers should ensure that these three areas are considered for great impact on their business.
1US Bureau of Labor Statistics, KFF – Health Systems Tracker (July 2024); PwC Health Research Institute.
The information provided does not, and is not intended to, constitute legal advice; instead, all information and content herein is provided for general informational purposes only and may not constitute the most up-to-date legal or other information.
Artificial intelligence (AI) may pose inherent risks, including but not limited to: issues with data privacy, intellectual property, consumer protection, and anti-discrimination laws; ethics and transparency concerns; information security issues; the potential for unfair bias and discrimination; quality and accuracy of inputs and outputs; technical failures and potential misuse. Users of AI-based technology and tools should take these risks into consideration prior to use of the technology.
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