IBM report predicts new role for U.S. health insurers

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IBM released a new report today that paints a bleak picture for the future for U.S. health insurers unless they make radical changes in their business procedures.

The report, “Healthcare 2015 and U.S. Health Plans: New Roles, New Competencies,” asserted that as consumers assume more financial responsibility for their healthcare, they will demand more flexible products, better customer service, more accountability from health insurers and providers and greater transparency in costs and quality.

The IBM report forecasted that health plan differentiation will be driven increasingly by the design attributes of products and services and they will be asked to deliver more personalized experiences for consumers. This transition will require more collaboration between all stakeholders.

IBM attributed the migration toward the “retailization” of healthcare to such factors as:
•    Increasing U.S. healthcare expenditures, which are 2.3 times higher per capita than in other developed countries and projected to increase 83 percent in 10 years.
•    Medical errors that are causing as many as 98,000 patient deaths each year, and cost at least $3.5 billion.
•    As many as 47 million Americans are without access to healthcare insurance.
•    An expected drop to less than 50 percent of employers who will offer coverage to working-age adults by 2015.
•    The decreasing commitment of and increased tightening of eligibility requirements by employers for retiree benefits.
In such an unsustainable environment, IBM says health plans should anticipate the following near-term changes along the road to 2015:
•    Purchasers of health plans will shift from employer-based to government-based and individually-purchased coverage. 
•    Consumers of healthcare will bear increasing responsibility and accountability for their health. This will put new pressures on health plans to redefine themselves and their relationships with their members, care providers, employers and brokers.
•    The healthcare industry will face an increasing array of new requirements, capabilities and delivery and reimbursement models to include prevention, chronic-condition management and better care coordination across more types.
•    Health plans and providers must align incentives and collaboratively innovate to help change consumer behaviors, anticipate care needs for health plan members, provide high-value care and streamline administrative functions.
IBM announced that it bears financial risk for the health of more than 350,000 employees and their dependants.