EHR and Market Growth

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Individual plans see technology as a way to engage the consumer.

In a world of skyrocketing health costs and dwindling employer-based insurance members, the individual market is one of the few areas of growth opportunity for health insurers. And while the market is rife with politics and uncertainties, experts say insurers have an opportunity with individual markets to largely expand their programs.

For Priority Health, based in Grand Rapids, MI, individual insurance plan growth has become a priority.

Priority is the second largest insurer in Michigan, but is dwarfed by Michigan BlueCross BlueShield. Sometime this month it plans to launch an expansion of its individual market PPO program, says Joan Budden, marketing officer for Priority. The move reflects a basic business strategy: Go for customers with growth potential, while making a dent in competition with the big guys.

As part of Priority's strategy, a focus for individual markets will be on college graduates and people who own small businesses, while implementing detailed case management programs, says Budden.

The tough economic times have been the impetus for the Priority plans. "The economy does provide the opportunity for more people to embrace our products. But it's also our mission. Each year, employer-sponsored plans have decreased by 1%, and there are fewer employers providing coverage in Michigan and more people are starting their own businesses," says Budden. "We see a growing share of the market buying individual coverage."

For insurers, "there are a lot of reasons to be cautious about individual markets," says Bob Stone, cofounder and executive vice president of Healthways, a Franklin, TN-based population health management company. "Growth is every business executive's objective. And they will keep looking at this and find a way to do it."

Like Priority, there are other insurers taking steps to embrace the market by implementing electronic health records, for instance, and encouraging wide-ranging wellness programs. But some experts say not enough insurers are doing enough to reach their potential, and health plan leaders should especially step up their efforts, whether in technology or wellness programs, to enhance value of the individual market programs in these economically sluggish times.

Some of the nation's largest insurance plans say they have been working in recent years to diversify their individual insurance plans for possible expansion. Insurers are trying to do more to get consumers involved.

At a White House meeting about premium insurance rate hikes in March, Aetna CEO Ron Williams told HHS Secretary Kathleen Sebelius that the industry has spent almost $2 billon to give consumers access to secure personal health records.

Companies such as Kaiser Permanente, UnitedHealth Group, and BlueCross BlueShield market plans that they say enhance patient satisfaction in the individual markets. Recently, BlueCross BlueShield of Tennessee added information on its Web site to help insurers measure the performance of its doctors. And the American Medical Association teamed up with Ingenix, a subsidiary of UnitedHealth Group, to implement electronic health records to help physicians develop new programs.

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