The top four challenges and opportunities facing health plans today
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, he 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 highly 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?
Our solutions really support the whole person — including physical, behavioral, and social drivers of health — and the entire care journey, from navigation and care delivery to post-claim services. We scale that support in many ways, including:
- Combining clinical knowledge with data and analytics to support clinical decision making so members receive the right care in the right setting at the right time.
- Helping to manage medications, including specialty drugs.
- Partnering with life sciences firms in conducting research to generate insights and, in essence, uncover the next generation of medical evidence.
- Delivering deliver highly personalized care to individuals with chronic or complex conditions in our clinics and in members’ homes.
- Working to remove friction in the system for both individuals and providers, making the healthcare system a more intuitive, personalized and guided experience.
Many of our solutions address affordability, as well. Our use of analytics to strengthen payment integrity is just one example of how we provide a strong ROI for health plans. And we are continuously innovating and growing our digital capabilities to be a trusted partner to health plans, one who can meaningfully support their operating efficiency while also improving experiences for their stakeholders.
While health plans share common challenges, each one is unique, serving particular employers and particular member populations in their different markets. Success requires us to understand their respective needs and support them with flexible, customized solutions. Luckily, we are designed to do just that, given we originated from a health plan business. You can think of us as the engine enabling health plans to drive their performance.
