How are Payers Responding to Current Market Trends?

 In Member Experience

In today’s competitive job market, healthcare remains among the top considerations that influence a person’s decision to join or leave a company. Employers must be able to offer competitive salaries and good healthcare benefits to prospective employees looking for the right opportunity. This has continued to mean new benefit programs and solutions that enhance the employee experience. But such perks are becoming increasingly important because they can have huge financial implications (sometimes without a clear ROI).

Employer groups have to balance value-added offerings for employees, including new types of benefits preferred by Gen Z employees such as personalized wellness services, holistic medicine, non-traditional medical or pharmaceutical options. Modern, young professionals desire a shift toward digital tools focused on fitness, mindfulness and sleep. They often prefer experiential perks and work-life balance over traditional healthcare benefits.

As a result, payers are being challenged to address more specific member needs proactively with better, more resilient benefits, and billing solution flexibility. They are trying to keep pace in a market where members’ expectations have shifted. They face additional pressure to go above and beyond just to retain valuable employer group business. The competitive landscape is as dynamic and complex as the benefits themselves, causing both traditional competitors as well as niche players (or even third-party administrators) to be considered by employers.

Of course, there are financial considerations at stake as well. Employer groups are looking to payers for ways to manage the costs of such novel employee benefits. They are trying to determine how to implement programs that mitigate the high cost of healthcare in terms of the types of programs they offer, the savings, more targeted condition management, and other options that help personalize benefit offerings while also confronting cost.

To that end, employer groups are requesting that payers provide more visibility into the performance, adoption, and usage of their programs to ensure those benefits are actually providing the value that was promised. Therefore, payers are looking for a single solution that can accommodate these needs in a flexible manner where they can customize what they’d like, but not at the expense of delivering those benefits in a fast and flexible way at a good, healthy margin. That way, the contractual and financial commitments that have been established can be easily traced and realized through that end-to-end experience of what was bought and sold, what’s being utilized, and how it’s being financed. This speaks to the complexity of the market and how its needs must be met with more robust benefit and billing solutions.

The pressure has always been on payers to deliver better benefits while keeping costs contained, but that is only gaining momentum. Payer solutions poised to look beyond the traditional benefit, to support the expanse of benefit and program types, and to enable creative and flexible product models will be in a solid position in their markets to compete. And when they are able to add enhanced economic models to power them, they will be better positioned to win.

Creative benefit design and delivery will only increase in importance as medical treatment changes, as members’ needs change, and if healthcare costs continue to grow unchecked. Hopefully, however, payers view this situation not as a challenge, but as an opportunity to take a fresh look at benefits and figure out how to offer them in a new, more consumable way.

 Linda Leigh Brock, NASCO’s Vice President of Product Management, is responsible for leading NASCO’s product strategy and product management organization across the breadth of NASCO’s product portfolios. She has more than 25 years of experience in information technology across healthcare, telecommunications, and other high-tech industries. Linda Leigh began her product management journey as Director of NASCO’s Enrollment and Billing Portfolio, where she led an empowered product team to institute a product management discipline and operating model that enabled the delivery of a highly customizable and feature-rich solution.