The coronavirus legacy for contractors of health insurance companies

We have reflected on what we are feeling and living in times of coronavirus and its possible or desirable legacy for supplementary health. We agree with many who have said that we are at a watershed between the world before the coronavirus (BC) and the one that will emerge after the coronavirus (AC). Specifically, in relation to supplementary health, we have reflected on the possible consequences for the companies contracting health insurance and their respective benefit managers.

In our view, it is certain that finally many of the companies that grant health insurance will be urged to rethink the way they have been managing the benefits of their employees.

Even with the economic crisis that started in 2014, few were reinvented in this regard. In practice, most opted for formulas already known and that ended up proving to be a palliative or temporary solution, based on the adoption of measures such as:

  • Switching to a more vertical operator with more accessible entry products in the hope that the cost escalation would be less;
  • Downgrades on the products offered and / or
  • Increase in the contribution of employees and their dependents.

Other measures were more drastic, such as establishing an entry plan subsidized only to the holder and any difference or cost of dependents leaving to the employee, eliminating the concept of benefit and creating only access to a product through the company. Even for those who had a larger base of beneficiaries and who, due to this, made a correct migration to the post-payment model, what has generally been seen so far has been that the beneficiary (patient) and the efficiency in resource management are little occupied a leading role.

Expanding a little this reflection, it is true that in the last few years, a few health insurance operators started to structure themselves to offer assistance projects aiming at greater efficiency of the available resources. It occurred in the same way with certain hospitals that began to rethink their strategic role, expanding the scope of their historically tertiary performance to include a focus also on primary care and coordination of care.

The regulatory body, in turn, also began to dedicate an important effort to induce better care practices and standards aimed at expanding access and contributing to greater efficiency. Even so, the practical result of all this has not yet been realized to the point of neutralizing at least part of the three million lives that no longer have access to the system. In practice, reigning inefficiency, in one way or another, almost always only restricted access.

As already mentioned above, we believe that the coronavirus pandemic will be a milestone in changing attitudes. Of course, any change first passes through the company’s view of the health insurance. For those who see the health insurance only as a cost to be managed, the change may be less, since, when managing only the budget, the tendency is always for short-term solutions. As for companies that see the health insurance as an important benefit that fulfills a mission of giving real access to health, the changes tend to be more strategic, more lasting. That said, we risk sharing some reflections (many of which are already known, but little practiced) of what may happen from now on from the perspective of companies that grant health insurances to their employees and who see it as a benefit far beyond the cost:

  1. Companies, mainly medium and large ones, motivated by the frustration of previous results not achieved in cost management, will change their attitude towards the health management of their collaborators more quickly, participating in a more effective and proactive way, leaving delegate the management of your costs to third parties in the sense that neither the product nor the underwriting of the risk belongs to the company, but the responsibility and the risk already exist. They always have been;
  1. Companies will finally demand greater efficiency in their interrelationships in aspects such as the alignment of economic incentives of those who provide services, modular products effectively guided by health policies that meet their needs, exempt production and the dissemination of care results, among others;
  1. To date, the vast part of the system’s inefficiency account has fallen to the contracting companies’ laps in the form of recurring and unsustainable adjustments. We believe that a growing trend will be the demand for transparency in the costs included in the premium, such as the broker’s remuneration or the operator’s administrative costs, greater demand predictability and treatment costs and effective risk sharing;
  1. Companies will make a more refined analysis of intermediaries in the healthcare chain and will most likely eliminate or reconcile with those who do not effectively add efficiency and who have based their strategies purely on commercial and / or operational aspects;
  1. Although short-term measures have to be taken to a greater or lesser extent by companies, depending on the intensity of the impact of conoravirus on their respective industry, and especially the impact on layoffs, we believe that they will also adopt more structured and medium to long term solutions long-term health management of its employees, understanding that the path of efficiency does not end in the short term and that it is the well-managed demand on a healthy or well-treated population that brings lasting results;
  1. We will observe an increasing participation of technological solutions in health in support of benefit managers and employees of their respective companies, either in the production and dissemination of management indicators and outcomes that make management more efficient, or in the provision of internalized health services and integrated with the operator that contribute to better access, diagnosis and treatment;
  1. Benefit managers will have to recycle themselves, as they will be demanded for more technical knowledge from the late understanding of companies that their actions around the management of employees’ health must be based on objective data and exempt indicators. Something uncommon so far;
  1. The discussion of health value will be expanded beyond the patient’s perspective, also encompassing the perception of value in the provision of services from the perspective of health insurance companies. In fact, it is a recurring and frightening addiction to little discussion from the point of view of the contractor of the collective plan, except on the issue of readjustment. It seems that the entire contribution to be made by companies in the discussion of the health of their employees is the choice of the operator, the payment of the readjustment and the realization of the “health week” once a year. But it is much more than that. We usually say that the health plan manager in companies is like a health secretary in the company deciding access and policies related to the way people understand and consume health resources;
  1. A more structured communication with the employee will be necessary. Instead of just communicating actions and eventually inviting employees to participate in any health programs or even accessing the company’s outpatient clinic (considering those who can do this), companies should create a pact with their beneficiaries involving topics such as: it is the best access, what is a quality service network, what are the cost challenges and how to contribute to more rational use, what is the pact to be formed with the inactive employee and how should the assets sponsor this generation transition;
  1. Companies will need to hear from the employee. In times of pandemic, work at home (home office) brought other forms of leadership and cooperation in companies. It awoke a new collaborative spirit challenged by social isolation. Perhaps companies now have an open channel with employees that goes far beyond climate surveys and health questionnaires. It is necessary to be close and show a legitimate concern for the employee’s health. It will not do much good to invest in a plan that has a good brand, but it lacks policies in the employee’s view. In practice, it is worth reflecting:
  • Is the plan’s eligibility well aligned with the job and salary policy?
  • Can the grid of compulsory plans be expanded with optional plans?
  • Does the employee understand that his family is assisted?
  • What are the resentments about using the health plan side by side?

Of course, we are not romancing communication with employees in line with “we are a big family”, but at least middle management leaders can be important agents of change.

In conclusion, we believe that in large part what we will see from now on will be a transition from discourse to practice as much of what has been said above is already known by many. So, who knows, the time has come to balance bold and technical actions that will be needed by companies with respect for the perspective of the beneficiaries of the health insurance (the employee and their dependents) as to how he sees the access to health that he has. was given. Who knows, we may find more efficiency to meet your demands? There is no other route than this to serve even companies.

Adriano Londres and Luiz Feitosa

Founding Partner – Arquitetos da Saúde

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