Payers, growth challenges may be hiding in your sales model

1. With more government spending, sales models need to adapt their strategy and composition

• CARES Act, the Inflation Reduction Act, and PPA stimulus in 2020-2021, though temporary, boosted patients’ ability to consume care and accelerated ACA adoption, resulting in the largest enrollment ever in 2021 and 2022 ^1,2
• Implication: Many sales models are not well-adapted to high volume, digitally driven motions are required to access and serve this market

2. Increasing payer and healthcare service consolidation puts pressure on sales leaders to act more nimbly and strategically

• Many organizations are increasing economies of scope rather than scale (e.g., buying up complementary services, ancillary offerings, and sites of care) to diversify their portfolio, capture more of the value chain, and improve data capture on outcomes
• As a result, traditional large health insurance carriers now generate significant revenue and margin based on non-insurance products and services
• Implication: Smaller payers will face increasing competition, from vertical integration and well-funded competitors, and need to relook at where and how they will win

3. Rising acceptance of telehealth by providers and patients requires new digital sales motions and new expertise

• COVID-19 accelerated the use of virtual technology by patients and providers, making them more comfortable with these technologies, and employers are increasingly offering this as a standard benefit
• Centers for Medicare & Medicaid Services (CMS) changes in 2020 and 2021 opened doors for comprehensive telehealth coverage and virtual clinic models, making these platforms and approaches financially feasible for providers and payers
• In 2022, < 25% of clinicians said they will go back to "business as usual," and anticipate making telehealth a normal part of patient service³
• Implication: Increased comfort by providers, employers, and members with telehealth means that sellers can expect to both offer new tech-focused products as well as change how they sell to accommodate new buyer preferences

4. Rise of behavioral health intervention apps (both home grown and stand-alone) require new business models and sales models to be successful

• Wellness and behavior-change applications and their supporting service offerings are high margin and have high potential for growth
• Several large national health insurance carriers have created "home grown" behavioral health solutions with varying success as they compete with these digital-native and well-funded health tech companies
• Implication: Selling these products requires a new B2B2C model that requires sellers to sell differently, to work with new business partners, and to work closely with patient success teams that drive adoption (which operate with a much higher touch than standard health insurance patient care teams)

5. New market entrants with deep pockets will challenge legacy sales models

• Relaxed Blue monopoly regulation is allowing large and new carriers to play in previously protected markets
• Well-resourced and focused health insurance offerings and partnerships are continuing to grow from non-traditional tech and retail players such as Amazon and Walmart, which are focused on growth
  
• Implication: Sales leaders need to both assess their markets and segments for competitive threats, while working with product, finance, and actuary to prepare for creative pricing and contracting