As CEO, I often get asked to talk about what’s next in healthcare, and what health plans can do to stay relevant and competitive. When I consider the events of the past few years, in addition to our experience helping health plans engage their consumers, I see 3 main trends on the horizon for 2019.

Prediction #1: Plans that embrace consumer centricity will win

The industry is buzzing about retailers like CVS and Amazon entering the payer space. While there are several implications to unpack there, one key takeaway is that consumer centricity will no longer be optional.

As retailers, both CVS and Amazon have invested heavily in the experience consumers have with their respective brands, and it shows. This kind of elevated consumer experience will become the rule in healthcare, not the exception—and it will change the way consumers expect to engage with health plans and other healthcare services.

In addition, consumers—especially Medicare Advantage members—have more choice and information than ever before, and they’re more willing to take their business elsewhere if they have a frustrating experience. It’s been said for years that plans need to start seeing members as consumers, and that’s more true now than ever before.

Successful plans in 2019 (and beyond) will win by taking a page from the retail industry’s consumer marketing playbook and build member engagement strategies around best practices like propensity modeling, sophisticated segmentation, personalization, and omnichannel communications.

Prediction #2: SDoH will shift from theory to practice

Plans have long known the importance of addressing the social determinants of health (SDoH) in theory, but in 2019, more plans are going to start addressing them in practice. CMS’s increased flexibility for supplemental benefits certainly plays a big part, but plans are also recognizing they need to move further upstream if they hope to impact downstream outcomes among their high-risk populations.

For plans that don’t know where to start with SDoH, leveraging the supplemental benefits to provide rides, meal delivery and in-home care is a great place to start. There are also a number of well-established community organizations already providing a wide range of services. Plans should consider building partnerships with those organizations to connect their high-risk members with the services they need.

In the end, the best programs in the world won’t matter if the people who need them most aren’t aware of them or able to take advantage. Plans should identify which members are most in-need and develop a personalized communications strategy to target and engage them.

Prediction #3: Quality and risk adjustment will integrate

Quality and risk adjustment teams within health plans have owned a different piece of the member engagement puzzle for far too long—which often leads to a fragmented consumer experience. When the structure of teams, departments and functions is driven by the org chart, and not a member-centric strategy, the consumer experience suffers.

Instead of competing for resources and member mindshare, smart plans are aligning these teams around a common goal. And they’re re-organizing their departments and reporting structure to foster better collaboration. Under this model, quality and risk adjustment can still have separate initiatives. But they start by working together to identify quality and cost drivers, and they agree on a member-centric strategy that drives their initiatives.

About NovuHealth
NovuHealth is the leading healthcare consumer engagement company, offering rewards and incentive programs that improve consumer health and plan performance. NovuHealth applies proven loyalty and data science strategies and leverages its deep industry and regulatory expertise to motivate high-value consumer activities. Headquartered in Minneapolis, NovuHealth has worked with nearly 40 health plans and served more than 15 million consumers across all 50 states. Learn more at

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