EveryMove blog

What Would Jeff Bezos Do In Healthcare?

By Russell Benaroya

At a conference I recently attended a health insurance executive suggested that if health plans want to re-invent themselves they should evaluate their decisions by first asking, “What would Jeff Bezos do?”  What does that mean exactly?  So I pondered it.  Here are the top 7 things Jeff Bezos would do if he were leading a health insurance company.

He would demand accountability and high performing teams.   Now I’m not suggesting that the Amazon work environment is awesome (by many accounts it isn’t) but it does encourage conflict to drive toward the best decisions.  The culture eliminates the wrong people on the bus quickly and those that are able to stay on for the ride can be rewarded.  There is no place for complacency.

He would celebrate failure.  Hey, have you heard much about the Amazon Fire lately?  Of course you haven’t because it failed.  But failure is celebrated and expected.  As Austin Carr referenced in his article in Fast Company in January 2015, “Bezos has said that his job is to encourage more "bold bets" and to embrace failure inside the company in pursuit of the big successes that compensate for dozens and dozens of things that [don’t] work."   It has been said that the failure of the phone made room for what ultimately became Echo, the stand-alone voice activated digital assistant.

He would look for profit centers in his cost centers.  Today, Amazon Web Services (AWS) is over a $6 billion revenue business.  AWS offers computing power, storage, and other functionality to help other businesses scale and grow cost effectively.  AWS was borne out of the realization that their vast infrastructure could be used to help alleviate a burden for other businesses so that they could focus their costs on driving innovation.   

He would obsess about his customers.  Jeff is famous for his obsession over the customer as evidenced in this post.  Customers are precious sources of information.  There is always a seat at the table for a customer.  There is no guessing about how customers feel.  There is only data.  They listen.  They ask.  They interpret and they integrate that voice of the customer to improve their processes at every step.

He would strive to win.  My sister worked at Amazon when they were the world’s biggest bookstore.  Amazon is anything but a bookstore anymore.  They have totally changed the landscape for how we buy products and consume content.  They have taken on the establishment like the big box retailers and large media production houses and are kicking butt.  They want to dominate and that drive to win, to compete for the attention of the consumer is palpable in everything they do.  

He would operationalize innovation.  While Amazon is well known for driving new product innovation, much of that happens in a subsidiary called Lab126 where much of their R&D takes place.  But what is important is that R&D can get into the mainstream channel of the Amazon customer base and tested and iterated on quickly. 

He would redesign the delivery model.  What’s the Kindle of healthcare?  The Kindle totally changed the economics of an industry and redefined the utility of reading books.     What about drones delivering packages to our home?  How about a virtual assistant named Alexa as our digital companion?  There is no evolution....only revolution.

So what does this mean for the leaders of healthcare today?  It means there is work to do.  It means that bold leadership must replace personal fear, ego and the expectations of others with a higher purpose.  It means that complacency is not tolerated and that failures can be a celebration on the path of learning.  Who is the Jeff Bezos of healthcare today?  

Posted on April 27, 2016 03:24 PM


Running 100 Miles Toward the Health Evolution Summit

By Russell Benaroya

It’s quiet the morning of a 100 mile ultra trail race.  When all of the preparation and planning yields to the only thing that separates you from success:  100 miles of foot pounding, heart aching, mind bending, patience trying, majestic trails.

Last Saturday (April 8th, 2016) I completed the Zion 100, a 100 mile trail race that unfolds the human spirit like the deep layers of rock that created this epic canyon landscape in Southern Utah.  We started at 6am on Friday and at 9:30am Saturday I crossed the finish line having tackled 10,000 feet of elevation and a maze of trails designed to test just how bad I wanted it.  I wanted it bad.

I’m coming into this week with more commitment, more passion and more resolve to tackle life’s “trails”.  It is so apropos to gear up for the next “ultra event” at the Health Evolution Summit(HES) later this week.  Whether literally running 100 miles or figuratively navigating healthcare transformation, the attributes for success and the circumstances that determine them are similar.   

The Health Evolution Summit is the most concentrated display of leadership in healthcare, where athletes come together to figure out how to become better, faster, smarter, adaptable, and triumphant in leading an industry transformation that will improve the lives of millions of people. 

If you want to know what if feels like to run 100 miles, connect with these concepts in building your healthcare enterprise and test them this week if you’re going to be at HES. 

You can’t do it alone.  I was feeling fresh for 40 miles.  But then my legs started hurting, my stomach ached and I started questioning if I had another 60 miles in me.  At just the right time (of course) I ran next to a gal who was running a bit faster than my pace, we struck up a conversation and we ran together for the rest of the race.  She gave me renewed energy, pushed me harder, and provided a new outlook on a shared journey.

Be grateful even when it hurts.  I had a three-word mantra during the run:  Bravery, Grit, and Gratitude (BGG).  When the chips were down I repeated my BGG but I think the most important word was “Gratitude”.  At the lowest points, in the pouring rain of a mud laden trail soup, I was grateful to have this unique experience.  Even in the dips, gratitude is a powerful force.

Constantly scan for the problem areas and fix them.  I often get asked, “What do you think about for that long?”  It’s always a little hard to remember in my delirium but most of the time I’m scanning my body to check in on my systems.  How are my feet?  Am I getting enough nutrition?  How is my self talk?  There is always a system that needs attention and when I focus on solving that system I can free my mind up to tackle the next thing.  Ignoring the primary source of pain drains energy in a big way if it isn’t addressed quickly.

Take off the smartwatch.  Who doesn’t love metrics.  They are essential rails to know if you’re on the right course.  But I’ve learned to be careful about over reliance on data for such a long event.  If my metrics are too stringent I won’t take risks because I want to play it safe.  If I had been monitoring my heart rate the whole time I guarantee I would have taken more breaks and probably missed a cutoff time to continue on.  Sometimes the most important metric is being clear on the goal and having the flexibility to do what feels right at the time to achieve it.  Sure I might fail but not for lack of “going for it”.

We’re all on this journey together.  What I love about the ultra-community is that it is so supportive.  I saw the fastest runners on the course a number of times and we always said the same thing to each other, “You’re doing great.  Way to go.  Keep it up.”  We all have a common goal and yes, we might achieve it at different times but we’re aligned and that alignment propels the whole system forward. 

So here we are, heading into this week at the Health Evolution Summit in Laguna, surrounded by a different kind of ultra-community but one that is running an equally challenging 100-mile race.   I’m grateful that I could complete the Zion 100 but it can’t match the grit and bravery that will be required to transform healthcare in our country. 

That we must do together.

I want to thank Julie Murchinson and her team at the Health Evolution Summit for providing some great support and encouragement leading up to the Zion 100.  I appreciate the relationship and all that you are doing to transform healthcare.

Posted on April 11, 2016 09:49 PM


Top 5 Ways Health Plans Win by Not Competing on Price

By Russell Benaroya

Competing on price is a privilege awarded to the lowest cost producer where a competitive advantage exists.  Think Walmart’s supply chain, Costco’s bulk buying, or McDonald’s volume purchasing.  Where price can sustainably differentiate in the market, it’s a good strategy (even if for some period of time).

Unfortunately, that doesn’t exist in health insurance. It could even result in disaster.  Obamacare created the health insurance exchanges to enable millions of Americans to purchase health insurance and about 20 million Americans have already taken the government up on that offer.  Health plans that have wanted to win business are doing so on price and yes, they are getting a fair share of members. But their business is getting hammered.  Here is what the innovators are doing:
  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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. 

Innovative health plans are going to make a mark and are in a great position to change the healthcare landscape for the better.  Yes, there will be bumps and bruises along the way, but they must stay their course.  And that course is not paved with driving down prices.

Posted on April 6, 2016 05:58 PM


Tandem is Gaining Traction [Infographic]

By Russell Benaroya

I'm excited to share that we're starting to get some results on Tandem.  The infographic below shows the results of a usability study that was performed by a third party for an upcoming launch.  Progress! These engagement results are notable given pretty paltry industry statistics.

Tandem is designed to make it easy and fun to improve your health while giving customers the ability to offer programs and incentives that are tailored to your needs, interests, and goals.  We will keep improving on these metrics but early signs are positive.

Thanks for all the support.  If you're interested in learning more about your health plan or employer being on Tandem shoot James an email at james.andrews@everymove.com.

Posted on April 5, 2016 09:54 PM


What are your health goals? Who do you want to reward you? What is the reward?

By Russell Benaroya

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
What other health related activities would you want your employer, health plan or physician to acknowledge with an incentive?  What would be motivating for you?

Posted on March 30, 2016 04:51 PM


[Infographic] The Value of Creative Consumer Retention

By Russell Benaroya
As you saw last week I wrote a post looking at the opportunities for health insurance plans to keep selling once they have a member join their health plan.  When I say "selling", I mean getting offers and services in front of people that will actually improve their health.  I mean being very clear on the value proposition of the service that's being provided and doing what you can as a health plan to make sure members are experiencing the best of it.  I put together this neat infographic to reinforce my point.    Enjoy.

Posted on March 29, 2016 08:02 PM


Health plans that build a culture of sales can improve the health of their members

By Russell Benaroya

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.

I had the opportunity this week to attend a Medicare Sales and Marketing conference in Nashville, TN and realized the other side of healthcare – customer acquisition.  Most of us don’t see this side because most health insurance selling is shielded from the consumer and sold through brokers.  But Medicare sold through health plans (Medicare Advantage or Medicare Supplement) is different.  It’s direct to the individual and quite honestly, it’s pretty exciting.    There are 55 million Medicare beneficiaries today and 10,000 people are enrolling daily.  It’s huge. And health plans are all over it.

The gloves are off to acquire Medicare eligible consumers and short of knocking door to door (which you can’t do), all tactics (subject to disclosures) are on the table.  There are TV advertisements, a ton of direct mail (the #1 customer acquisition strategy), paid search, promoted social marketing, call centers, outsourced sales organizations, sponsorships, and seminars.  Health plans are willing to pay around $1,500 to acquire a new member and about half of that will go to commission related payments.  This is sales and these sales organizations are cranking.  I’d expect nothing less when competing for a scarce resource.  Get out there and sell.  Get what’s yours.  Go!  It’s all about revenue.

But then something really strange happens once that member is sold.  All of a sudden the relationship with the health plan changes from selling to silence and it’s uncomfortable.  Maybe the implied talk goes something like this:

Consumer:  “Okay, I purchased your health insurance now please don’t bother me.”
Health Plan.  “They purchased our health insurance product so let’s not bother them”

Why the passive aggressive stance?  Well it’s partly due to a general distrust of health plans and partly because members aren’t clear what’s expected of them so they get defensive/annoyed when you ask them to do things.   

But isn’t this when the real sales should begin, when health plans start working to make sure that they are inducing new customers to do what they’re supposed to which would actually result in reducing everyone’s expenses?  By working to keep members engaged, compliant and healthy, health plans will improve retention and that will save them the $1,500 to acquire a new customer next year.  If a health plan applied the same energy to selling an existing customer as they do to trying to sell a new one we would have a much healthier relationship with our health plan and probably be healthier.  Here are some ideas for how a health plans can “sell” their existing customers:

Hi, my name is Elizabeth and I will be your care navigator this next year.   Companies like Accolade are eating health plan’s lunch by building teams of people that help individuals navigate their benefits.  They have proven to lower costs.  When I sign up for insurance I should be introduced to a named person who will be my representative throughout the period.  I may not call on them but I know they are there.  18% of Medicare Advantage members switched to other health plans last year.  That’s not insignificant.  Their #1 reason was their dissatisfaction in the help they received in understanding their coverage.  Do these things:
  • 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
Here is your personalized roadmap for optimal prevention this yearIf you need me to do something, let me know.  Don’t be bashful about telling me I need to go get a screening or see my physician.  Heck, the health plan is taking financial risk for my health so they should feel entitled to call me and make sure I’m doing the right thing for me and them.  Health plans need to know what kind of risk they just purchased because they get paid more when they know.  They should do what they need to do to find out.

Have you considered upgrading your supplementary benefits or purchasing a life insurance plan?  If I could benefit from other products, tell me.  Why not try and sell me on a catastrophic health policy, life insurance, or more comprehensive dental or vision.  I’m not going to find out about it on my own and if you’ve built some trust then I’m going to take your advice.  Don’t screw me or I’m leaving but if you have a valuable service to provide where the perceived value is more than the cost, I’m in.

We pride ourselves on benefits that are cool, different…and you’ll use.  Health plans often use programs like Silver Sneakers (a senior gym membership network) as an enticement to join them.  It’s a dated program but it works.  That’s what a lot of people care about and would stay with their health plan because of it.  The problem is that every health plan has Silver Sneakers so it’s not differentiated.  What about unique benefit programs with:
  • Grocery stores
  • Ride sharing companies (Uber)
  • Travel (Expedia)
  • Ecommerce (Amazon)
  • Fitness classes (Classpass)
  • Select premium mobile apps
Now we’re talking.  Now this gets interesting.

We have been conditioned to get very sensitive when talking about financial matters and health as if it’s taboo and you can’t put a price on it.  Until an individual become a member of the health plan it’s okay but once on the inside then we start using terms like patients which changes everything.  People aren’t patients.  They are people who entered into a financial transaction where each party has responsibilities and obligations.  Selling takes on a different form but make no mistake that health plans that continue “selling” will not only be more financially successful but they will improve the health of their population.

Posted on March 24, 2016 03:34 PM


End of the Line for Health Risk Assessments? What's Next?

By Russell Benaroya

Register today for one of the most exciting and actionable webinars of the year that impacts virtually every health plan and employer.  Andrew Sykes, a nationally recognized actuary (trust me, he’s entertaining) will be the guest on the inaugural EveryMove webinar scheduled for March 23rd at 10am Pacific Time.  The title of the Webinar is: 

While health risk assessments are still widely used to benchmark individual risk and determine the best course for prevention, they are fraught with error and haven’t necessarily yielded a return on investment.  So what’s a better option?   Reserve your spot today for March 23rd at 10am Pacific / 1pm Eastern to learn:

  • 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.

 Russell Benaroya, CEO of EveryMove, will be hosting.


Posted on March 10, 2016 04:27 PM


Poor Digital UX is Expensive in Healthcare

By Russell Benaroya
It’s no mystery that healthcare has been considerably behind the times in keeping up with modern day consumer software experiences.  When you think about your primary technology interactions with healthcare today it probably consists of your:
  • Health insurance portal.  Yes, you have access to it even if you didn’t know.
  • Employer wellness portal.  Yes, it’s that thing you go to once per quarter to make sure you check enough boxes to get your $50 gift card.
  • Physician portal.  That blue and white circa 1996 experience where you can see some of your lab results and theoretically exchange secure and cryptic emails with your physician.
And generally speaking, these are experiences for the more progressive among us.  Of course I’m setting this up here because it really is a much bigger problem than health plans, employers and physicians realize.  When you stretch people’s mental capacity to navigate poor user experience it has the dual effect of degrading the customer’s perception of your value and reduces the follow-through of the intended behavior.   So what’s the big deal?  Does it really matter?  We know solutions aren’t optimal but hey, that’s healthcare, right?  Wrong.  Here are three reasons why poor user experience matter to everyone:
Poor experience increases friction. Friction increases effort.  Effort increases time.  Time is money.  And that financial burden gets pushed down to each of us. 
Where’s the Money?  When it’s too hard to figure out how to pay a bill (or what it’s for or why it’s so much money) we set it to the side and choose not to pay it (I may have implicated myself here).   That’s a pretty big deal as millions of consumers have the upfront cost burden today with both their premiums (individual market) and deductibles (high deductible health plans). 
The Result:  Billions of dollars of working capital due to past due transactions that ultimately get transferred into premiums to the consumer.
The Solution:  Simplify the payment process through mobile payments, Health Saving Account integration, predictive pricing (transparency), and collection at the time of care (tighter provider / health plan data integration).
Out of Sight.  Out of Mind.  If I need to go to my health insurance or physician portal to see that it’s time for my flu shot or annual physical I’m in big trouble.  If there is a new service like telehealth, I'm unlikely to hang out on my health plan portal to learn about it.  Further, if I’m going to build a rapport with my physician I don’t want to have to go into a separate email system to ask if I need 250mg or 500mg of Niacin only to forget that I sent it from there and get frustrated that I didn’t get a response.   
The Result:  Health plans will lose out on impacting risk adjustment, utilization, retention and quality measures.  Physicians signing value based contracts will have little visibility into their population.  Employers that want to measure action, not box checking, will be disappointed.  Consumers aren’t aware of what they need to do and don’t act.
The Solution:  Provide an easy way for people to set up their preferences at the time of enrollment and then show up in a way that works for that person.  For many people, that may be a more invisible interface for interactions via text or push messaging on mobile.    Portals display information.  Invisible interfaces trigger and acknowledge action in a welcomed way.
Portals display information.  Invisible interfaces trigger and acknowledge action in a welcomed way.
Lack of Empathy.  The subtle message to the consumer when we force them to use antiquated user experiences is that we don’t really care and that they are really data points and not people.  It’s why companies like Oscar Healthcare get so much recognition because they lead with empathy. 
The Result:  Poor customer experience = poor retention.
The Solution:  Just ask!  When we ask individuals what they want to achieve and how they want to engage we can learn a bit.  It will drive personalization and tailored interactions.  It will also allow for more authenticity and some self-deprecation. 
Let’s be clear that the biggest loser here is the individual.  Poor experience increases friction. Friction increases effort.  Effort increases time.  Time is money.  And that is financial burden getting pushed down to each of us.  So when we are talking about ways to improve the customer experience through consumer technology there are very real economic reasons to doing so.  And the answer isn’t putting more content behind a portal.  It may be getting rid of most of that portal after all.

Posted on March 1, 2016 05:49 PM


Why Guaranteed Issue Creates a "Guaranteed Issue"

By Russell Benaroya

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.

The government put in place three pillars designed to stabilize the market.  The Kaiser Family Foundation explains this in terrific detail but here is the summary:

  • 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. 
Risk adjustment is designed to be a permanent fixture of the Exchange.  Risk Corridors and Reinsurance are temporary and to be phased out in 2016 which is going to be a big problem for consumers and definitely result in higher premiums and create a “guaranteed issue” in the pocketbooks of consumers and small business (pun intended). 

So what’s the problem?  Guaranteed issue (and the elimination of most dollar limits) creates tremendous challenges for organizations in the business of insuring risk.  More to the point, there is so little information shared with health insurers that they are literally “flying blind” in figuring out how to engage the right people.  They have no idea.  As such, they spend more administrative dollars in outreach but to no avail and they don’t have the systems to tie back and know whether the dollars they spent actually yielded engagement of any material kind.

Less information in the market creates risk and that risk gets priced and passed to the consumer.  There is so much uncertainty in the Exchange that premiums will absolutely need to rise dramatically without the government capping risk.  On the flip side, health plans don’t want to get priced out of the market by being too expensive but those efficient market forces may not play out.  The result may be unsustainable pricing pressure that puts the current insurance Exchange in jeopardy.

One way to address this is to have the government be the re-insurer of very high risk cases.  In other words, extend the Reinsurance program beyond 2016 and make it foundational to the individual marketplace.  When someone signs up on the Exchange with a rare enzyme disorder that costs $3 million /year in medication that is going to have to get paid by a health insurer whose hands are tied.  In these cases, is it reasonable that the government would reinsure and act as a stop loss for the health plan for these outlier situations? 

Another way to address this is to have every new member that joins the Exchange be required to get an annual health exam in order to activate their new insurance plan.  In that case, every member would have a primary care physician they are connected to with results that will help the health plan determine how to best support that individual.  Is this unreasonable?  Isn’t the primary care physician the very best starting point for every insured member?

I want the insurance exchanges to work.  They can work.  There needs to be more opportunities for the health plan to build an early relationship with each member so they can spend their resources wisely to serve each member’s needs most appropriately.  Guaranteed issue is creating a guaranteed issue but it can be solved through a regulatory extension of Reinsurance and a mandatory physician evaluation at the beginning of each plan year.

What other ways can we address the problem?

Posted on February 5, 2016 08:39 PM