What Health Plans Can Expect in 2011

Jeff Elliott, for HealthLeaders Media , December 29, 2010

HL: And healthcare costs aren't likely to retreat anytime soon …

Keckley: Underlying healthcare costs are going up at a minimum of 6 percent this year, if not higher, and Medicare is projected to go up 8.4 percent. There is also an urge to merge with doctors, hospitals, and long-term care providers consolidating into integrated delivery systems, which makes contracting a challenge. When these factors are combined with healthcare reform, it's the perfect storm for health plans.

HL: Sounds dire. Is there anything positive that health plans can hang their hats on?

Keckley: The notion that the industry is somehow mortally wounded is simply false. There is a degree of clarity about what will happen with healthcare reform. No one is delusional. Each company seems to be developing a number of future-state scenarios. It's not that the industry is going uniformly in a single direction. Companies are weighing a lot of options. We are seeing substantial investments of health plan resources in new service lines. They have an enormously rich asset in data. We're seeing some plans monetize their data in various ways. Many see themselves in the personal health management business selling services around how patients care for their health—wellness and healthy living as a major focus of new services. The fact is, the industry will remain very viable and in fact grow, but don't expect it to look quite the same in five years.

HL: I'm hearing more and more about health plans considering global markets. Is this a bona fide trend, or just a strategy for a handful of plans?

Keckley: Some believe the global market has more growth potential. But it's very difficult to break into another country's health system. You need a balance sheet with substantial liquidity to really make that bet.

[Editor's Note: To hear an audio interview with Keckley on the topic of ACOs, click here.]

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1 comments on "What Health Plans Can Expect in 2011"

bob (12/30/2010 at 9:58 AM)
Another likely direction for individual health insurers: compete to be the sole source of "reimbursement" in the marketplace for individual hospitals, group practices and health systems, taking over the entire collection function, and guaranteeing payment for all budgeted expenses, based on negotiating the management of a collaborative budget. A disciplined, collaborative approach to healthcare reform with [INVALID]ed providers is the key to the future of insurers and prepayment agencies. Payment to providers based on a negotiated budget, rather than on services to individual patients, as in the VA, is the way of the future. The provider's [INVALID]ed insurer will, of course, collect money from other third party payers and individuals, on the basis of services to individual patients , but the provider need not be involved, greatly simplifying the collection problems.




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