Posted on April 27, 2016 03:24 PMComments:
Posted on April 11, 2016 09:49 PMComments:
- NOT selling insurance at a negative gross margin and trying to make it up on volume J . Remember buy.com or pets.com in the go go 90’s? These companies sold products for less than it cost the company. You don’t make it up on volume. Many health plans are selling insurance for less than their cost of sales (as defined by a medical loss ratio) and volume is only going to exacerbate the problem. That’s why certain health plans have stopped taking enrollees into their higher costs programs.
- Narrowing their networks and avoiding the PPO death spiral. Preferred Provider Organizations that give individuals a lot of flexibility on physicians and services are a major Achilles heel for the health plan. It’s like leaving your kids at home with a marshmallow sitting in front of them, telling them not to eat it. You can’t expect people to adhere to boundaries if you don’t create them. So now we’re back to the HMO (Health Maintenance Organization) model where cost boundaries can be better put in place.
- Not expecting anything from the government. As we saw back in October, the Feds would only be in a position to pay 12.6% of what health plans were owedunder the risk corridor arrangement. So much for the government as a savior as half of the Co-ops failed along with some commercial plans. The government isn’t saving the health plans and in an election year, no one is touching this topic.
- Attacking risk adjustment and member engagement. Historically, health plans could manage risk primarily on pricing passed thru to the employer. Here that’s not possible so the levers for managing risk really come down to two areas: risk adjustment and member activation. Risk adjustment is about getting paid for the risk that is being assumed, which can be accomplished by a physician coding a member to certain health conditions. Activating the member is about having them do things to improve their health. Whether that’s diabetes prevention, med adherence, screenings, wellness, or using quality services like telehealth, the point is that members have to be engaged.
- Focusing on retention. Retention, lifetime value, reducing churn – whatever you want to call it – health plans want to create switching cost. Why join and stick with a health plan? Retention represents the benefits, the technology, the customer service, the incentives, the personalization, and yes…the price. But you can’t build a differentiator around price, so magnify what makes you special and make it compelling to stick around through open enrollment.
Posted on April 6, 2016 05:58 PMComments:
Posted on April 5, 2016 09:54 PMComments:
I'm excited to present this survey we put out to our community to get a better sense of their goals and who and how they are interested in being rewarded. With our launch of Tandem we have created a very flexible way for any types of sponsors to deliver rewards and incentives for a whole range of health related activities. These could be lifestyle related or more specific to managing your health in the health system. Examples include:
- Visiting your physician
- Getting your flu shot
- Enrolling in a prevention program (e.g. diabetes)
- Getting a screening
- Using telehealth services
Posted on March 30, 2016 04:51 PMComments:
Posted on March 29, 2016 08:02 PMComments:
It's All About Sales in Healthcare - Created with Haiku Deck, presentation software that inspires
Health insurance is partly a game of hardcore sales and then a game of mitigating risk.
- Help me schedule my appointments
- Offer some training webinars/seminars
- Give me a chance to meet “my navigator person” in person
- Let me connect with them over phone, text or email
- Grocery stores
- Ride sharing companies (Uber)
- Travel (Expedia)
- Ecommerce (Amazon)
- Fitness classes (Classpass)
- Select premium mobile apps
Posted on March 24, 2016 03:34 PMComments:
- Why HRAs don’t work, and may even leave individuals LESS likely to change health habits.
- How new behavioral influence methods help people create sustainable healthy habits.
- How hyper-personalization drives engagement.
- Why you’ll never want to roll out a traditional HRA again, when you see what’s possible instead.
Posted on March 10, 2016 04:27 PMComments:
Poor experience increases friction. Friction increases effort. Effort increases time. Time is money. And that financial burden gets pushed down to each of us.
Portals display information. Invisible interfaces trigger and acknowledge action in a welcomed way.
Posted on March 1, 2016 05:49 PMComments:
What is guaranteed issue? Guaranteed issue prohibits insurers from charging differentials based on health status and requiring them to offer coverage to any purchaser. What this means is that anyone can buy insurance at an established price regardless of their health status. The risk in guaranteed issue is the adverse selection death spiral where only people that need to use the insurance buy it. That’s why regulations require that everyone have insurance or face a penalty.
- Risk Adjustment: Redistributes funds from health plans that have low risk to health plans that have higher risk enrollees. The idea is that health plans shouldn’t be penalized because they got a bunch of high risk members (i.e. adverse selection).
- Risk Corridors: Limits losses beyond an allowable range with the idea of encouraging health plans to keep premiums down. The government would step in and manage payments to reduce big swings in the initial years of healthcare reform. This has not worked. If you read my post “Insurance Co-ops and the Risk Corridor – Land of the Lost” you would see that insurers asked for $2.87 billion while only $362 million was available for payout. The result? Half of the co-ops set up for the Exchange are out of business and more are falling (see the recent news on Moda).
- Reinsurance: Provides payments to plans that enroll higher cost individuals. The idea is to protect against rising premiums by capping risk for high cost enrollees.
What other ways can we address the problem?
Posted on February 5, 2016 08:39 PMComments:
Awesome blog posts
- What Would Jeff Bezos Do In Healthcare?
- Running 100 Miles Toward the Health Evolution Summit
- Top 5 Ways Health Plans Win by Not Competing on Price
- Tandem is Gaining Traction [Infographic]
- What are your health goals? Who do you want to reward you? What is the reward?
- [Infographic] The Value of Creative Consumer Retention
- Health plans that build a culture of sales can improve the health of their members
- End of the Line for Health Risk Assessments? What's Next?
- Poor Digital UX is Expensive in Healthcare
- Why Guaranteed Issue Creates a "Guaranteed Issue"