What health insurers can do about rising medical costs

What health insurers can do about rising medical costs

US medical costs have increased each year for the past 60 years, and CMS estimates the prices for medical goods and services are projected to grow an average of 2.4 percent annually by 2028.

Despite rising costs, medical outcomes aren’t improving, nor are they expected to. This is a serious problem for everyone, carriers and policyholders alike, but it doesn’t have to be. It’s up to long-term care and health insurance carriers to leverage data and new technologies to improve those outcomes. Here’s how they do it.

When costs rise and outcomes don’t improve, everybody loses

Healthcare costs have been consistently rising for decades, but consistently poor health outcomes mean the financial burden on carriers and policyholders continues to worsen. In order to reduce carrier’s costs and improve policyholder’s health and wellbeing, there must be increased investment in improving wellness outcomes.

Carriers are well aware of this, and many are focused on developing wellness intervention programs, leveraging social determinants of health, and better understanding their customers to accomplish this. At the heart of all these efforts, however, lies the need for better data and the right technologies to properly leverage the insights it can generate.

Leveraging different forms of data can deliver insights policyholder’s and their needs

While they have access to a wide array of data, many LTC and health insurance carriers only use medical data to inform their decision making and wellness initiatives. Without expanding into wider sources of data, carriers miss significant opportunities to better understand their customers, their wellness, and the drivers behind high-cost events like falls, hospitalizations, and readmissions. Not only does this negatively impact companies financially, it makes it impossible for carriers to move the needle on medical costs and improve wellness outcomes for their policyholders.

Gaining access to third party data, macro and micro social determinants of health data, and medical data means carriers gain a holistic view of their policyholders. This understanding is crucial for carriers looking to design effective intervention programs, improve wellness management, and reduce medical costs.

Taking a holistic approach to wellness means a holistic approach to data and analytics

Medical costs are constantly rising, but available data and modern technologies mean there’s now something LTC and health carriers can do about it. Once carriers have access to the data they need, and the right tools to gain real insights from that data, they can tackle their most pressing challenges with regards to wellness management. Decision Science provides that solution.

The only way to get ahead of rising health and medical costs is to improve carrier understanding of policyholders. By Integrating third-party and macro/micro social determinant data into the decision making process, carriers can model, develop, and deploy holistic wellness management programs. Those who tackle this challenge effectively will see improved health outcomes, reduced preventable costs associated with social factors, preventable (re)hospitalizations, and chronic condition management, and fewer claims costs.

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