From Global Trends & Opportunities to Engaging the Consumer: The times they are a changin'!

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An afternoon of sessions followed by the exhibit hall mania to the AHIP Opening Night Reception…..from the discussions to exhibits to the presentations, there is no doubt that the business of health insurance plans is changing…..but I am not convinced we are all on the same page as to how, where or why.

Anxiously awaiting the “Emerging Opportunities in the Global Healthcare Market, having presented at and attended both March’s World Healthcare Congress in Berlin and last week’s Irish National Healthcare Summit, I was anxious to hear other’s take on where the US can learn from European/Asian experiences and where the US experience can add value globally. I have to admit, I found the advice to 1. Offer private insurance globally; 2. Offer management capabilities, including re-insurance; 3.) Leverage EXPATS and 4.) Opportunities to direct members for cheaper better services outside of US networks (global tourism) to be less than what I would have expected for the audience. I truly believe that, IF we can get disease/population management, evidence-base performance metrics and ancillary service provision perfected to have demons ratable ROI for the investment here in the US, we can offer the world tremendous opportunities when public/private collaboratives are sought. Until then? I’d prefer to fix what we have and perhaps learn from some of the EU’s initiatives. It should be noted however that few countries, regardless of their primary source of funding, have failed to recognize opportunities for the private sector to bring value. Opportunities today can be enhanced down the road if we give proper attention to analysis here in the States.

Afterwards, I found myself hearing more about consumer engagement tools leveraged by WellPoint and Kaiser. I am 110% supportive of these initiatives and only hope that we as a healthcare community embrace them not just for immediate returns but for the potential to drive a behavioral change amongst both the member, patient or consumer and the provider. On occasion I do cringe when I hear of Zagatt patient satisfaction of physician/provider surveys similar to what WellPoint presented. Is it totally unreasonable to think it to be only natural for patients to generally say they have confidence in their physician, trust their relationship, like their methods of communications and the patient setting? What patient wants to say they have made the wrong physician selection? The bigger question is what the survey would reflect if a provider’s compliance with evidence-based protocols were made public to the patient before the survey and perhaps 6 months later. Nevertheless, these two leading-edge organizations are to be commended for their portal information sharing efforts, incentives to align modes of interventions with patient characteristics and recognition that the patient should drive the methods of communication. If it’s about mass outreach, “there ain’t no killer app” it was said. I would argue that these advancements make it clear that we are finally recognizing the importance to factor all data points & sources into the matrix for analysis, prediction and optimizing patient engagement. Value drives performance and member/patient outreach, though in its infancy, is beginning to leverage learning from other industries.

A new breed of marketing automation and campaigns directed both at members/patients and providers can take us to the next stage.

Taking a walk thru the Exhibit Hall tonight, there are many participants not here last year and even more not in existence 2 years ago. A good thing if they are each engaged in the past, present and future demands & challenges for the healthcare industry. But a warning flag perhaps if one believes new “Fixes” should outweigh intelligent discovery and exploration of data while being positioned to respond to new business intelligence expectations down the road.

The sun is setting over the Pacific, its past midnight back East, and yet a new dawn in health plan intelligence is within reach. The next few days might just reflect that. Stay tuned.

Onto to Day 2, Keynotes & Concurrent Tracks.

Rick

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About Author

Rick Ingraham

Principal Industry Consultant

Rick has served as Health Intelligence Officer within SAS Federal, LLC since April 2011. He presents 20+ years of executive-level health experience in both the provider and payer settings and served SAS as senior healthcare strategist for 1998 to 2008. He served as global health & life sciences director within Teradata until rejoining SAS in 2011

1 Comment

  1. Rick,
    I could not bear to quietly “lurk” in the shadows, so I thought I’d offer a comment on your points on consumerism’s role in transforming the industry.
    It’s clear that consumerism is changing the rules of the game for so many industries, and the players that embrace the changes as an opportunity will likely be the players that matter in the end. When I think about industries that have been transformed by the rise of consumerism, it usually has gone hand-in-hand with network connectivity as an enabler and with the pace of change accelerating as bandwidth and processing capacity has become cheaper. Consider the music industry and the rise of illegal file-swapping, which led to the current model for legally distributing songs on line (such as iTunes). In terms of travel, booking flights and hotel rooms on line is no longer the exception – it’s the norm (what DID we do before Travelocity and Expedia?).
    Healthcare is highly regulated and the complexity of the relationship among the stakeholders – the payers, employer groups, member/patients, providers, regulators, and shareholders - will affect the way that consumerism will change the rules of the game. But one thing is fairly clear – that complexity won’t stop consumerism from changing the industry.
    When trying to crack the code for how to turn consumerism into an opportunity for healthcare – the best starting point for analysis is the member/patient. Of course, when there are millions of member/patients, that’s where analytics can provide the means for finding the “path through the woods.” But in addition to getting value from the quantitative aspects of the claims and demographic data, I think a winning formula would include qualitative considerations. In other words, taking an objective look at the quality of the relationship that the member/patient has with both payers and providers can point to where the changes may be quickest and most profound. And addressing the consumer’s needs and wants is what consumerism is all about.
    What do you see will be the degree to which government will or should be involved in nurturing consumerism in healthcare?
    JB

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