Payors

The Affordable Care Act will add 32 million more members to the healthcare system, and these new members will drive payors to compete by offering more competitive prices and benefit plan structures that are better tailored to meet individual health care needs.

In addition, new spending caps on medical costs and laws that prevent payors from denying coverage have spurred a shift from traditional fee-for-service reimbursement models to reimbursement that’s increasingly contingent on evidence- and value-based health care. With these changes, there’s an increased emphasis on engaging members (patients) and creating a collaborative health care model that puts greater responsibility on the members to take charge of their own health. This change also puts an onus on payors and providers to provide information to patients in a more seamless and transparent fashion.