The top four challenges and opportunities facing health plans today

Perspective: Connected care | Capability: Care delivery, | By: Carelon

With more than two decades of experience in the healthcare industry, Carelon’s chief growth officer, John Hastings, explores innovative approaches to solving health plans’ most pressing issues.

John Hastings has spent more than 20 years in the healthcare industry, much of it working with the country’s leading health plans, and he recently joined Carelon as our chief growth officer. In his role, John and his team have an opportunity to work with many of the leading health plans across the U.S.

In this focused interview, Hastings talks about the complex challenges that health plans face today — and how a strong partner can offer strategies to:

  • Control healthcare costs
  • Drive better quality and outcomes
  • Improve the member and provider experience
  • Optimize operational efficiency to enable innovation


What are the top challenges you see facing health plans today?


Across all lines of business, health plans are trying to succeed in an increasingly competitive market and deliver better experiences. And that it is all about having the most intuitive, personalized, and seamless experience for consumers and providers.

Driving quality is another priority for health plans, and that includes getting ahead of members’ health to help them stay well and helping those members with acute and chronic issues get the right care. To do that, plans need to identify the right people, engage them, and stay very connected to them. Plans are also very focused on cost of care, and they’ve got to have very strong offerings to address affordability while making sure members have access to quality care.

There are a lot of complexities involved in those efforts. Health plans are looking to streamline, become more efficient, and work with partners that can support these business goals.


How has the healthcare landscape changed recently?


It's a very competitive time for health plans, because over the past several years — while it's slowed now — there's been a tremendous amount of capital being poured in from private equity firms and venture capital, and there have been a ton of startups.

But health plans really do need to maintain as much of their provider and member interface as they possibly can, because that drives a more seamless, integrated experience. When there are too many disconnected point solutions involved, it is just very difficult to get that whole-person view.


Carelon is a new brand but has been operating in the industry for many years. Can you talk about the services that fall under the Carelon umbrella?


Carelon has solutions that span the whole person — including physical, behavioral, and social drivers of health — and along an individual’s entire care journey, from advocacy and navigation to care delivery, to post-claim services. We combine clinical knowledge with data to drive analytics to support the most appropriate care in the best clinical settings for health plan members, and we also manage their medications, including specialty drugs. We deliver highly personalized care to those with complex and chronic conditions, in our clinics and in members’ homes. We partner with life sciences firms by conducting research to generate insights — in essence creating the next generation of medical evidence.

We also use analytics to drive new models of payment accuracy through our payment integrity area. And, of course, we are becoming a digital platform-based company, so we can be that partner to health plans to support their operating efficiency. We help remove friction in the system for both members and providers, simplifying it to make it a more intuitive, personalized and guided experience. We’re also addressing affordability in many of our programs, providing strong ROI for health plans.

While they share common challenges, every health plan is unique, serving a unique set of employers and members in their different markets. That means partners need really listen to and understand their unique needs and be flexible with customized solutions to support them.

Carelon helps plans solve the challenges that we all face in this business, because we are designed — we are engineered, really — to support health plans. We come from that business. You can almost think of us as enabling health plans as the engine inside, helping to drive their performance.


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