Some major currents are at the heart of this situation. Health plans are facing the highest cost increases in decades, fueled by the combination of new drugs, advanced technologies, and complex administrative burdens. Also, in the latter part of 2023, poor benefits portfolio performances caused many employers to reassess their health benefits programs as part of what industry insiders called the “Great Re-Evaluation.”
An over-emphasis on point solutions in past years is another contributor to a seismic shift on the horizon in how our industry views population health, engages members and employees, and measures success. To prepare, plans and employers are doubling down on their demands for more meaningful, measurable results for their health programs and solutions.
At MOBE, we see five major trends for plans and employers that will drive this positive transformation in 2024.
At MOBE, we believe VOI is dead. To remain viable in 2024, solutions must prove a clear, quantifiable return on investment (ROI). We’re seeing many employers and plans calling for more stringent, evidence-based metrics for outreach programs and point solutions. This includes a greater focus on behavior-based data that more accurately predicts costs and utilization, as well as interest in more complex models that incorporate more whole-person data, such as comorbidities and episodic health issues. This differs from current wellness solutions that target the entire population by identifying only those groups that can benefit specifically from health improvement and contribute to meaningful ROI. We believe this will be a true litmus test of success in 2024.
A low self-perception of health has long been considered a valid and robust predictor of morbidity, mortality, and health care utilization. Adopting comprehensive tools like the SF-36 Survey will also add each individual’s self-perception of their health to the picture. If done right, self-perception of health has been proven to correlate with utilization. Measuring changes to self-perception is a simple yet effective way to determine how well a program works. When you measure a person’s self-perception of health consistently over time, using statistically sound methods, you can compare the results to their health care costs, and the connection is quite clear.
Learn how MOBE uses the SF-36 scoring to demonstrate which programs deliver ROI in healthcare.
The death of VOI means that employers and health plans are set to embrace more robust, outcome-oriented metrics that drive meaningful decisions when planning and managing health initiatives. Solutions without a clear and measurable ROI will simply be unable to justify their place in the health benefits ecosystem.
Focusing on ROI requires deepening our understanding of meaningful engagement and how its measured. Our industry has become resigned to dismal engagement rates that average between 4% and 6% for programs and solutions. In some ways, engagement has become a mere checkmark when measuring the performance of these programs. Yet, as plans and employers focus on participation that is both meaningful and consistent, engagement is making a resurgence as the primary mechanism/measurement for reviewing the efficacy of health programs.
More and more, we’re asking not just whether people are engaging but if that engagement is impactful. Does it foster a genuine connection between a program and the individual’s unique health journey? This type of engagement doesn’t measure mere clicks or one-time assessments. Real engagement moves beyond superficial interactions to deliver tangible health outcomes and the added benefit of managed or lowered costs. That’s why it’s becoming such an important metric of success.
Call Out: MOBE programs typically experience rates at approximately 30% engagement, often saving 7.5% in claims costs in the first year alone. Discover the MOBE difference here.
A wealth of statistical evidence supports the positive impact of CMM on health outcomes and costs. By managing and reviewing a patient's complete medication regimen, CMM can identify unnecessary medications, reduce the risk of adverse drug events, and prevent costly medical interventions in the future. CMM contributes to the overall concept of whole person health as it serves to maintain health proactively. Through regular review and adjustment of medications, CMM also addresses the root causes of health problems while preventing the escalation of existing conditions.
An important point is that effective CMM programs deliver cost savings across a broad spectrum that may or may not include reducing actual prescription costs. In fact, CMM is a whole-person approach that is proven to drive improvement in a wide range of metrics, such as reducing office visits and lowering readmittance rates. In one study of a group of Texas primary care clinics, for example, CMM resulted in an estimated cost savings of over $1 million, primarily through the prevention of new hospital admissions.
As plans and employers seek new avenues of improvement, our industry will turn more attention to the crucial role of CMM in optimizing the health of individuals and overall populations and in lowering health care costs. These proactive, evidence-based programs can lead to significant long-term savings for health plans and employers and improved quality of life for employees.
We’re seeing a greater acceptance industry-wide that health improvement is not a linear journey but a complex, iterative process. We’re also seeing some significant data from programs based on the concept of whole person health that align with this understanding. As a result, we’re rapidly moving away from isolated interventions toward cultivating habits that contribute to sustained health.
Sleep programs provide some of the best examples for motivating health behavior in the long term, and the data proves it. Well-publicized research by the American College of Cardiology in 2023 stated that people with good sleep habits are less likely to die early. And, of course, we’ve seen plenty of data that explains how a lack of quality sleep can significantly increase the risk of many serious diseases and disorders. Meaningful metrics that address health in the long term, like sleep, diet, exercise, and others, will play a much bigger role in the months and years to come.
Perhaps the biggest trend in the coming year will be a continued migration away from the compartmentalized, vertical silos of information that have traditionally informed health solutions. Instead, smarter data models will be required, ones that offer integrated insights that account for nearly every determinant shaping health behavior and the resultant health outcomes. Whole person health, meaning health care tailored to the whole person, has already proven to be much more successful in prompting individuals toward healthful actions.
Here at MOBE, we’ve long championed this person-centric approach, and we’re eager to see the rest of our industry experience the gains from a more comprehensive view of health. New outreach methods, programs, and solutions tailored to each person’s unique needs, social determinants, and life situations will soon become the norm for health plans and employers.
As health plans and employers align to redefine the value and efficacy of health benefits, there is tremendous potential to dramatically improve health outcomes while keeping costs at bay. At MOBE, we’re excited to be a leader at the forefront of this transformation.
