Much attention since the election has been paid to the future of the Affordable Care Act (ACA), and rightfully so—especially now that Congress failed to generate a House vote last week on The American Healthcare Act, its Obamacare repeal and replace legislation.

Health coverage for millions of Americans is at stake, and repealing or reworking the ACA could lay waste to the tremendous amount of effort and innovation on the part of healthcare providers, insurers, employers and government entities.

There is no doubt the ACA has been a key driver of private sector innovation to address the cost and complexity of healthcare benefits. One such innovation is the expanded use of technology to help individuals choose and use their health benefits wisely, select the right healthcare provider and manage their health and wellness. The evolution of data, mobile and cloud-based technologies has made this possible.

Technology has played a role in healthcare for decades. But the advent of the ACA and the introduction of public exchanges, combined with continued healthcare cost increases and the associated rise of the healthcare consumer, brought urgency to a digital transformation where individuals are better informed and feel more empowered.

These goals are not mutually exclusive—as a recent Kaiser Health News article suggests, “Simply calling the patient a consumer doesn’t make buying healthcare anything like buying cars and computers.”

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More refined technologies—such as wearables, mobile apps and telemedicine—are enhancing the consumer experience.

The trick that we as an industry must continue to confront is how to bridge the gap, because regardless of what happens to the ACA, we need consumers to continue to be empowered digitally so that they can help “move the needle” in both improving their own health and in transforming healthcare to be a more patient-centered, cost-effective system.

Here are key reasons why.

Unsustainable healthcare cost increases. Healthcare costs continue to increase at unsustainable rates. Over the past few years, employers have experienced a slowdown in the rate of healthcare cost increases. However, according to a recent study by PwC Health Research Institute, healthcare costs are still expected to grow by 6.5% nationally in 2017 (excluding the impact of plan design changes). In the meantime, real wage growth is growing at 3.5% to 4% per year and has grown more slowly than healthcare costs for more than two decades, effectively compounding the personal family impact of cost increases year over year.

In fact, according to the Benefitfocus State of Employee Benefits report, the average deductible for a 2017 preferred provider organization (PPO) family coverage plan on its platform was 9% higher than in 2016, nearing the Internal Revenue Service minimum to be considered a high deductible health plan, or HDHP. Given these numbers, it’s no surprise that reducing the rate of healthcare cost increases remains a top concern among employers and a key driver of employers’ benefits strategies.  Providing consumers with more cost-effective healthcare options—and the digital tools to make smart choices—will help.

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Healthcare consumerism on the rise. Findings from the Benefitfocus State of Employee Benefits 2017 reported that 60% of large employers offered and 36% of employees covered by employers offering them enrolled in HDHPs. The study suggests that healthcare consumers need more timely and relevant information to help them choose and use their health benefits wisely. This includes health plan selection, cost transparency and provider match tools. Consumers want to compare prices and understand the value of one benefit package over another. Digital platforms are better enabling these choices, but only when they derive better insights from the oceans of data available to them to drive smarter choices.

Sources such as claims data analytics and web user statistics can drive consumers to decisions that not only are based on their own usage patterns, but also are personalized to their individual needs. In the same way that companies including Netflix and Mint drive personal recommendations from a deep, algorithmic approach to understanding individuals, so too can—and should—healthcare and benefits companies use data and analytics to drive better consumerism.

Healthcare is personal and complex. More than ever, consumers expect a more customized experience from the healthcare system. In this regard, digital transformation is one and the same with consumer transformation. For example, consumers have come to expect an “Amazon-like” online shopping experience, even in healthcare. In fact, data-driven decision support and guided shopping are more important when buying healthcare benefits than virtually anything else.  And communication is equally as important as transparency in helping consumers understand their benefits.

What we know of the Trump administration’s preferences for healthcare policy only heightens the urgency to get consumerism right. The Trump Administration and Congressional Republicans (and a good portion of Democrats as well) are aligned on accentuating the importance of employer-based health coverage, as well as advancing consumer-centric models like HDHPs with a health savings account. Yet, if we provide HSAs without also providing the data-driven tools that help consumers understand and use them, we run the risk of leaving families more exposed to health and financial adversity, not less exposed.

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Through expanded use of technology, we see that employers, payers and health benefits administrators have an opportunity to deploy new tools and resources to create a better communicated, more personalized healthcare experience. Overall, consumers need more education on the value of contributing to HSAs, although the Benefitfocus State of Employee Benefits 2017 report did find millennials are contributing more so now than in past years (43%, up from around 30% in 2016).

Consumers are concerned about their well-being. Consumers are concerned about employee well-being, and employers are increasing their focus on it, including physical and financial health. New, more refined technologies—such as wearables, mobile apps and telemedicine—are enhancing the consumer experience and increasing the ease and efficiency of access to healthcare.

For each of the four reasons noted above, digital transformation in healthcare is critical. Specifically:

Technology can help an employer address many strategic imperatives, including:

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  • Reducing total healthcare costs without compromising their ability to attract and retain talent
  • Providing expanded consumer choice
  • Minimizing their own administrative burden

While it cannot solve every one of an employer’s HR/benefits challenges, the right technology can help an employer:

  • Offer employees more benefit options and simplify the shopping and enrollment experience
  • Enhance employee communications and decision support
  • Guide employees to make better plan selections and reduce financial exposure
  • Reduce the employer’s administrative burden by assuming at least part of the plan shopping and enrollment experience

The world of employee benefits and the technology that supports it will continue to evolve, regardless of what happens to the ACA. Continued cost challenges and ever-increasing consumer expectations will require new strategies and tools. The digital transformation in healthcare must continue if we are to meet these challenges and expectations.

Rosemarie Day, is president at Day Health Strategies and she co-authored this column with Shan Fowler, senior director of product strategy at Benefitfocus. Ross Weiler, principal at Day Health Strategies, also contributed.

 

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