AHIP18: Payers face threats from all directions
SAN DIEGO — Payers are watching all around them as the healthcare industry shifts. Digital and mobile health tools are becoming more commonplace, data and analysis are prized and more companies — some of them giant names — are mulling skipping insurers altogether and contracting directly with providers.
These themes dominated the talk at the annual America’s Health Insurance Plans conference in San Diego, along with further embrace of population health measures, market consolidation and a growing need to focus on customer service.
Here's a round-up of key takeaways.
The elephant in the room
Some of the biggest news to make waves at the conference came before it even began, when Amazon, J.P. Morgan and Berkshire Hathaway announced they had chosen the CEO for the company they are forming to address employee healthcare costs.
Their pick, surgery professor and author Atul Gawande, had been booked months earlier to speak about end-of-life care. While he declined to discuss the new role in any detail, he expressed excitement and said he’s up for the challenge. “We will come to a place where we can get scalable solutions that change the practice of medicine anywhere,” he said, adding: “It’s a long road but it clearly is possible.”
Barak Richman, business and law professor at Duke University, said elsewhere at the conference that the buzz from the three companies’ initial announcement told him people are looking toward outside actors to disrupt healthcare. With their previous successes in other industries, Amazon, JPM and BH have a chance to shake up the system. “There’s so much enthusiasm and so much intrigue behind it, even though they haven’t done anything yet,” he said.
The new initiative could still use help from within the existing healthcare infrastructure, however. Emmet O’Gara, EVP of Total Population Management at HMS, told Healthcare Dive his product and others with more niche capabilities might appeal to outside companies that don’t want to reinvent the wheel. He sees an engagement opportunity and the potential to gain by running toward the new company rather than away from it, he said.
Looking to Apple, Netflix as models
Health insurers are becoming painfully aware that new forms of competition require them to put more focus on making patients feel like valued customers.
This shift is coming from a broad move in the industry from wholesale to retail, and from consumer experiences outside of healthcare. People are seeing banks, hotels and myriad other businesses mold an experience exclusively for them, and they’re starting to expect the same from health plans, Kaveh Safavi, senior managing director of Accenture’s global health practice, told Healthcare Dive.
Payers have regulations controlling how much they can charge for premiums, so they’re more likely to attract customers with outstanding service than with great deals. “In our business, you probably can’t extract a higher price, but you can extract loyalty and market share,” he said.
Blue Cross Blue Shield of Rhode Island has taken the retail concept to heart, and developed three retail locations giving them a physical presence within five miles of 70% of their customers, said Christina Pitney, who manages strategy and strategic partnerships at Blue Cross & Blue Shield of Rhode Island.
“We actually designed around Apple and thinking about the simple experience you have with Apple,” she said.
Kathleen Elmore, managing director at Engagsys, said she looks to Netflix for inspiration, particularly its capabilities in personalization, which can help consumers inundated with options. Netflix can prompt a user to pick up right where they left off in watching a TV show and can find other shows they may like. For healthcare, that could mean encouraging a patient to schedule follow-up appointments and refill medications, as well as showing them what other types of services they could benefit from.
Consumers are dynamic and unique. “It’s a constantly evolving process of refreshing those practices and figure out what works,” she said.
That requires gathering and analyzing a lot of data. O’Gara said a tool Total Population Management recently rolled out called Elli can run models to determine the best time and method for engaging someone without bothering them. Some people prefer a text or an email, others want to have an in-person visit. “I don’t want to be a number and get a cookiecutter approach,” he said.
Doing all of that correctly can create a powerful asset — brand loyalty. Health plans need to understand what value they bring to customers, Katie Catlender, head of customer experience for Blue Cross Blue Shield Massachusetts, said. “We all know as consumers that the reason we’re loyal to certain brands is the things they do for us,” she said.
Mark Nathan, CEO of Zipari, which advises payers on consumer engagement, told Healthcare Dive that of the more than 250 payers he’s met with in the past year, more than 90% have some kind of customer experience project underway. “What I find interesting . . . is that with the ACA everybody became focused on the end market, of course, and consumerism was really important,” he said. “So everyone started investing in consumerism.”
Now, that shift is happening in the group market as well, he added.
Consolidation has broad implications
M&A activity continues unabated in healthcare. Payers are watching some of the major deals, including the CVS bid for Aetna, but also the myriad mergers among providers. AHIP CEO Matt Eyles said consolidation among hospitals and physician practices is troubling, sometimes amounting to “charging more money for the same service with just a new logo on the entrance.” He added, however, that he would not “exclude payers from those hard conversations.”
Richman said horizontal mergers like those between hospitals isn’t new. The vast majority of hospital markets are highly concentrated, and that drives up prices. “I think really without much doubt at all it’s a bad thing,” he said.
He felt the same way about the ultimately failed mergers in the payer market between Cigna and Anthem and between Aetna and Humana. Vertical mergers like CVS-Aetna, however, have more of a chance cut costs and improve care. “We might be on the verge of a new architecture, a new model for the delivery system, and this is what I’m actually quite hopeful of,” he said.
Safavi said payer markets are prime for disruption because while the cost of doing business continues to increase, customers aren’t paying more for the services. This provides an on-ramp for small startups without legacy costs and will force established companies to rethink their business model.
But there are numerous partnership options that don’t reach to the level of mergers and acquisitions. Some payer companies are trying to incorporate provider services as well. Others find a niche service they can do very well and sell that to what might otherwise by strictly rival companies.
“The payer side is moving into a quadrant where there’s a lot more vulnerability,” Safavi said
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