Gradual but steady progression away from fee-for-service toward value-based care presses onward, especially as employers – wanting national value-based contracts to curb spending – create a greater number of opportunities for payers to accelerate this shift with partnerships.
The Rise of
big data proliferation
Merger activity is hot. Large players are making huge bets that they can find a better way to serve the customer and disrupt the traditional value chain. The risk to small players sitting on the side-line is: “What if they are right?”
The once harsh line existing between managing medical cost and pharmaceutical cost is diminishing. More plans are tightly managing volatile pharmacy costs and outcomes, especially as pharma costs skyrocket. The market demands better solutions for managing pharmacy spend.
Consumers want simplicity, convenience, responsive products, and even more responsive people. Plans need to better shape solutions – many of the best ones not necessarily tied to technology – will offer consumers more choice, greater trust, and stronger levels of rapport.
Actionable data is the new industry focal point, and shifting from data collector to data enabler will advance tomorrow’s technology implementation. Plans need to further break down the silos across industry players to enable greater insights and convenience.
Government programs continue to represent a growing portion of the overall market. Winning in government programs requires specialized assets and capabilities. Being a reluctant participant in government programs, as many incumbents are, is a recipe for mediocrity at best.
SIX Market Trends Shaping the State of the Blues