What the future of health care might look like

I don’t have a crystal ball, but if I did and could see what health insurance may look like in five, 10 or even 20 years, I would see you, the patient, in the center of the process.

You aren’t sitting on the sidelines, uncertain about what questions to ask because you don’t have enough information — or you don’t understand the complex information you’ve been given. In the future, you’ve been given the tools you need to make confident, informed decisions about the health care you receive.

The good news is that the future is starting to happen now.

The health care industry has already undergone significant changes — and will continue to do so. The biggest difference in recent years is the passage and implementation of the Affordable Care Act, along with Medicaid expansion in several states. Those changes have resulted in increased regulations on insurance carriers, employers, and others, aimed at improving access to health care for all Americans.

Here's what to expect as we move forward.

More access to vital information

If you’ve had an office visit lately you’ve seen both the nurse and doctor entering information about you into a computer. Having one place that they can go to find out everything they need to know about your medical care helps to reduce treatment mistakes and medication errors. If you end up in an emergency room, that same electronic record that holds your information can be a lifesaver. They will know instantly what you might be allergic to and what’s in your medical history.

Better all-around care

You’re going to see more doctors moving to treating a person as a whole, not just by symptom. This value-based approach rewards doctors for keeping a patient healthy by setting up regular exams, educating patients about their health, how to take their medicine and following up to see if they do. It sounds like an old concept but having one doctor care for you most of your life can be better for your health in the long run.

Tech in the driver’s seat

We’re also on the verge of changes that are being driven by technology. Similar to the changes in other industries, where technology advancements have shaped your behavior (cell phones/computers/television), I think advancements in technology will drive how health insurers either catch up to or help lead the revolution.
Do you have a smartphone? You can refill your medication from a pharmacy app now.

Have a sinus infection? No need to wait to see a doctor. You can combine grocery shopping with a stop at a quick care clinic.

What if you have a sick child and can’t leave work for hours to take them to a doctor? Access tele-health services from the comfort of your home or office.

Maybe you’ve been told you need knee surgery; now you can get a “report card” on your smartphone that shows the best places to have the procedure performed.

Technology is improving medicine and closing the knowledge gap for consumers. That empowers doctors and consumers to make the best decisions. It is no longer about treating a symptom, but the entire person, both physically and mentally. This is what will really drive the health care revolution far more than any regulation or guideline.

Looks like I don’t need that crystal ball after all.

By Tom Gilsdorf, director, BCBSNE product development



The percentage of the bill you pay after your deductible has been met.


A fixed amount you pay when you get a covered health service.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider. 


The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

Any covered services received in a hospital emergency room setting.


Includes behavioral health treatment, counseling, and psychotherapy

in-network provider

A provider contracted by your insurance company to accept an agreed upon payment for covered services. 

OUT-OF-network provider

A term for providers that aren’t contracting with your insurance company. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)


Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.


If you can afford health insurance, but choose not to buy it, you must have a health coverage exemption or pay a tax penalty on your federal income tax return.


The amount you pay to your health insurance company each month. 

Preventive services

Health care services that focus on the prevention of disease and health maintenance.


Services and devices to help you recover if you are injured or have surgery. This includes physical, occupational and speech therapy.

special enrollment period

The time after the Open Enrollment Period when you can still purchase health insurance only if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).


A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.