Cigna | Health Care is Changing Fast, are Your Clients Ready for What’s Ahead?

Health care is undergoing a rapid transformation and it will be critical for plan sponsors to stay ahead of market dynamics. In fact, as employers face inflation, high interest rates and a tight labor market, they’re likely to find that a healthier, more resilient workforce is essential to their growth and success. By helping your clients to understand the latest trends in health care, you can support them as they adapt and thrive — now and beyond.

Here are four key trends and insight for an evolving industry.

1: Hybrid care solutions influence fragmentation in patient care. Over the past several years, healthcare has continued to evolve and expand beyond traditional settings, accelerating the availability of hybrid solutions that combine the best qualities of both virtual and brick-and-mortar models of care. While employees and plan sponsors both actively embrace virtual options, as well as more advanced health care technology, there is an opportunity to establish a more cohesive patient experience. Specifically, employees are voicing a need for care that's more efficient, more effective and more economical. 58% of privately insured employees say they have used virtual care in the past 12 months.

As care access points continue to move beyond traditional settings, employees are hesitating. Half of respondents express trepidation about what they perceive to be the diminished quality of care outside of brick-and-mortar clinical settings. Employees encounter significant challenges navigating their benefits in order to select and access the appropriate site of care. However, plan sponsors are confident that employees are informed and capable of navigating their benefits.

Takeaways:

1. By coordinating initiatives to improve awareness, plan sponsors can help to educate their workforce, informing them about all the care options available to them, including both virtual and brick-and-mortar care.
2. Education efforts will be critical to arming employees with the information required to access the care they need — for greater productivity, better outcomes and a more cohesive experience.
3. Growing technology options can provide employees with a stronger connection to their health, offering solutions to the fragmentation shaping the health care landscape.

2: Confronting Inequity across affordability and access. Discussions about health equity are growing in intensity and impact as social determinants of health continue to affect both delivery of care and health outcomes - particularly for minorities and underrepresented populations. Chief among those concerns in affordability, as employees note the rising cost of care amount their most significant barriers to access. In fact, 75% of employees say they have been struggling with unaffordable medical costs in 2022, up from 69% in 2020. Similarly, 73% say they are unable to afford rising premiums, compared to 66% two years ago.

As prices of prescription drugs continue to rise, even employees with employer sponsored health insurance are finding their resources strained. More than 7 in 10 employees express concern about the unaffordable cost of medications, while 6 in 10 say they are worried about whether or not they can even access less expensive drugs. A majority of plan sponsors believe there are multiple ways to contribute to health equity, with 69% of employers and 53% of health plan leaders identifying four or more roles they believe their organization should fulfill.

Takeaways:

1. Plan sponsors have made efforts to reduce barriers to health, especially rising costs and understand they have a role in addressing and supporting access to care.
2. As employees continue to prioritize issues of health equity, plan sponsors are poised to implement specific measures and strategies in order to address those concerns.  In order to maximize the potential of generic and biosimilar drugs, it will be important to educate both employees and providers about these new drugs availability and value.
3. Both employers and health plan leaders view health equity as a standalone strategy, with healthcare as the top area where they believe they can have an impact.

As employees continue to prioritize issues of health equity, plan sponsors are poised to implement specific measures and strategies in order to address those concerns.

3: Mixed messages in meeting behavioral health needs. Both employees and plan sponsors remain deeply invested in behavioral health, with tools and practices reaching a mainstream audience. For example, 31% of employees say they or someone in their family sought behavioral health care in the past 12 months. However, the research revealed a startling statistic:

43% of employees, more than 2 in 5, say that their own mental health has declined over the past year.

Looking more closely, a majority of Gen Z employees say they strongly agree or somewhat agree that their mental health has declined over the past 12 months. That number drops with age, with Baby Boomers being the least likely to report a recent deterioration in their mental health.

Employees who strongly or somewhat agree that their mental health has declined over the past 12 months.

55%	45%	40%	25%
Gen Z (18-24)	Millennials (25-40)	Gen X (41-56)	Baby Boomers (57-75)

Plan sponsors are highly confident about employees’ satisfaction with provided behavioral health benefits, a marked contrast to the number of employees who report that they are very or somewhat satisfied.

Employers and health plan leaders who say employees are satisfied with their behavioral health support	Employees who are satisfied with their behavioral health support
Employers                             Health Plan Leaders 72%                                       78%	Employees 68%

Takeaways:

1. Employees report a significant decline in their mental health over the last year. It will be important for plan sponsors to address employees' changing needs. 
2. Younger employees appear to be participating in efforts to address their behavioral health; however, they are much more likely than older employees to report challenges.
3. When it comes to implementing future behavioral health resources, plan sponsors may wish to consider age-specific outreach and education efforts.

3: Transforming the Health Care Industry.  The U.S. health care system suffers from a serious condition: fragmentation. Fragmented care is a source of many inequities and negatively affects people and health systems alike. For example, employees with one or more chronic diseases often require care from a wide range of different medical professionals. The care experience can feel disconnected for employees when undergoing lab work, visiting a primary care physician, seeing a specialist or getting prescriptions filled. Opportunity lies in synthesizing this data in order to better coordinate care. By employing data science, predictive modeling and machine learning, it will be possible for both plan sponsors and providers to improve employees' health outcomes while also lowering costs.

7.5% expected annual growth from 2020 to 2027 and 21.4% expected compound annual growth rate from 2023 to 2030.

The reason for this growth is simple. Data analytics promises improved patient outcomes, prevention of health crises and reduced expenditures, all the while transitioning the industry from a fee-for-service care model to value-based care reimbursements.  As a result, health care analytics are being incorporated into every aspect of the industry to enable better operations and improved patient care.  In fact, health care providers who offer integrated benefits have the power to harness data across the full spectrum of health channels, including medical, pharmaceutical, third-party, claims and digital devices. By utilizing data, clinical attention opportunities can be identified automatically, allowing for interventions tailored to each patient's clinical condition and engagement preferences.  This information can, in turn be used for preventive outreach, resulting in better health outcomes and lower customer costs.

"If you want to understand a person's health care outcome and their journey, you have to understand the person outside of traditional health care.  Being able to understand who's stressed out caring for a child at home with autism, who's recently gone through a divorce, who was recently laid off, who doesn't live within 20 minutes of a primary care provider - that type of information can be just as powerful as, say, a radiology or pathology scan." Doug Melton, MD | Head of Clinical Analytics, Evernorth

Advanced modeling and machine learning techniques can help detect patterns, predict potential health gaps, and assess financial risks for employers to optimize their options. The power of data will allow employer plan sponsors to:

1. Gain a multi-dimensional view of an employer plan using advanced diagnostics.
2. Prevent future gaps in care and cost drivers by using predictive models to target patient interventions. 
3. Identify specific plan challenges and target certain geographical locations for more focused attention.
4. Understand how to better engage through a combination of analytics and behavioral science for more efficient and effective individual outreach.

15% of health care organizations are equipped to make quick data -driven decisions.

Key barriers:

Lack of integrated infrastructure
Information silos
Incompatible systems
Insufficient funding
Security concerns
Lack of skill in analytics

The future of health care depends on improving not only employees' experience - including quality and satisfaction- but also the health of populations and the per capita cost of care.  The ability to share, aggregate, integrate, and analyze data effectively will enable a more complete and more transformation of the industry.

Takeaways:

1. Fragmented care negatively affects both employees and health systems.
2. The global health care analytics market is expected to maintain rapid expansion.
3. Data science, predictive modeling and machine learning can improve health outcomes while also lowering costs.
4. It will be critical for health care organizations to overcome key barriers in order to use data effectively.

Looking ahead, the disruption and fragmentation that have characterized health care over the past year are clearly reflected in the perspectives of both employees and plan sponsors.  Their sentiments suggest a rich opportunity to provide a more cohesive care journey, as well as a higher standard of health care benefits delivery.  These valuable insights and trends power innovative thinking -  which, in turn, allows us to improve efficiency, accessibility, predictability and create connections to care for communities, for business - for all.  

 

Contact your Amwins Connect Sales Rep to learn more.