The report also included analysis of trends that may affect provider profits moving forward.
Twelve key takeaways:
Payer profit pools:
- Pools are shifting heavily to government lines and led by Medicare Advantage growth
- As the economy recovers from COVID-19, shifts from Medicaid to commercial lines are expected to increase commercial enrollment by 1.5 percent.
- Pools are expected to rebound to $57.4 billion in 2025 from $40.1 billion in 2021.
- Potential for return to pre-pandemic profitability, with pools rising at a 9 percent compound annual growth rate.
Opportunities:
- Payers are creating healthcare services and technology companies to serve members and sell services to other organizations.
- Management services organizations are being created to actively manage patient care.
- Diversification is creating new value pools and creating value for existing business by lowering care costs through better analytics and improved coordination.
Value-based care:
- Value-based care models are looking to create better care costs, access, quality and experience.
- Medicare Advantage lines are evolving to facilitate ownership of physician practices and virtual, home and pharmacy providers.
- MA plans are also taking more control over care management, medication adherence and enablement services.
- Value-based care models are facilitating more data- and analytics-enabled clinician services, which may increase profit pools by two to three times.
- To increase value-based care, payers are looking to acquire, partner with private equity firms, or invest to become minority partners.
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 17–19 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.
