Healthcare 2015 and U.S. health plans: New roles, new competencies

The U.S. healthcare system is on an unsustainable path that will force its transformation. As a result, we are witnessing changes to the purchasing, consumption and delivery of healthcare that will redefine the way health plans compete and operate. With this in mind, U.S. health plans should reassess what their future role will be, what competencies are needed to support this role, and how they will create value for customers and outperform competitors. They must also help shape and lead this healthcare transformation, or risk being marginalized.

The environment in which U.S. health plans operate is fundamentally changing as the healthcare system struggles to address ever-increasing cost, quality and access pressures. U.S. healthcare expenditures per capita are 2.3 times higher than that of other developed countries¹ and are projected to increase 83 percent over the next ten years.²

Despite this spending, there are quality concerns. For example, medical errors cause between 48,000 and 98,000 patient deaths each year³ and medication errors cost over US$3.5 billion annually.⁴ There are also significant access issues as 47.0 million Americans are uninsured⁵ and an additional 15.6 million are underinsured for catastrophic healthcare expenses.⁶ Although cost, quality and access issues are not new in the U.S., we believe today's healthcare environment has fundamentally changed, and, more importantly, is unsustainable.

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References
¹ "OECD health data 2007: Statistics and indicators for 30 countries." Organisation for Economic Co-operation and Development. July 18, 2007.
² Poisal, John A., Christopher Truffer, Sheila Smith, Andrea Sisko, Cathy Cowan, Sean Keehan and Bridget Dickensheets. "Health spending projections through 2016: Modest changes obscure Part D's impact." Health Affairs. February 21, 2007.
³ Kohn, Linda T., Janet M. Corrigan and Molla S. Donaldson. To Err is Human: Building a Safer Health System. Washington D.C.: National Academy of Sciences. 2007.
⁴ Aspden, Philip, Julie A. Wolcott, J. Lyle Bootman and Linda R. Cronenwett. Preventing Medication Errors. Committee on Identifying and Preventing Medication Errors, Board on Health Care Services. Washington, D.C.: National Academy of Sciences. 2006.
⁵ "Income, poverty, and health insurance coverage in the United States: 2006." U.S. Census Bureau. August 2007. Available at http://www.census.gov/prod/2007pubs/p60-233.pdf (accessed on August 28, 2007).
⁶ Schoen, Cathy, Michelle M. Doty, Sara R. Collins and Alyssa L. Holmgren. "Insured but not protected: How many adults are underinsured?" Health Affairs. June 14, 2005.