EveryMove blog

higi Acquires EveryMove

By Russell Benaroya

I am excited to announce that EveryMove has been acquired by higi, the nation’s largest network of health screening stations in the country.  With over 11,000 locations and having performed over 36 million screenings for unique individuals, higi represents the future of consumer engagement.  The acquisition accelerates higi’s strategy to create the most extensive set of tools to transform population health activities through the collection and workflow integration of health and lifestyle data.

As you know, EveryMove began to focus its efforts on a new product platform in 2016 called Tandem.  Tandem is a health action driver, delivering targeted health offers to consumers to help them meet their health goals, drawing on data from their medical history, survey responses and engagement with wearables and apps.  Combining with higi provides Tandem an exciting path to get more reach and make more impact.

When we started EveryMove we began with a mission to improve the lives of 10 million people in 10 years.  I was pretty sure that we would need some great partners along the way.  Companies like Premera Blue Cross and BlueCross Blue Shield of Nebraska were invaluable partners on this journey and validated the importance of engaging consumers in their health.  We definitely took some twists and turns along the way but being part of higi certainly gives us the best shot of hitting our goal.  Over 4 million people/month sit down at a higi screening station.  I think we’re going to improve the lives of 10 million people well before 10 years!

There are a lot of people that have been on this journey since we launched in 2012.  To say I am grateful only scratches the surface of the emotions I feel around the end of one chapter and the opening of another.  Everyone who ever signed up for EveryMove, gave us feedback (good and bad), built a community, met their goal, earned a reward, or Shared the Love, gave us our wings to fly.  We experimented.  My co-founder, Marcelo Calbucci, was the ultimate experimenter, and I can’t tell you how I much I appreciated his partnership and learned so much from him.  Thank you.

higi has some big plans and the team in place to make it happen.  What does that mean for the EveryMove community?  We are working through all of those details now and making sure we are all aligned in the same direction.   We created something special and that will live on as higi expands its reach around the world.

Onward to the next adventure.  Relentless.  Committed.  Energized.  Expect nothing less from the team that started with a 10 million in 10 years mission and will not stop until it is achieved.


Russell and the EveryMove Team

Posted on March 29, 2017 12:46 PM


Can Google Maps Save Healthcare?

By Russell Benaroya

I don’t really remember what life was like before Google Maps or Waze.  My relationship with my wife certainly has improved. Even in the city that I live (Seattle), I always use Google Maps because hey, maybe there is some traffic I can avoid. So as I was winding my way through the all too familiar maze of traffic last Friday, I thought, “How awesome would it be take the power of Google Maps and apply it to consumer driven healthcare?”

What I love about these traffic apps is that they satisfy my innermost anxieties by:
  1. Letting me know how long it will take to reach my destination.
  2. Providing turn by turn notification soon enough before I pass the intended turn.
  3. Delivering visual cues to see why my route is the fastest (“Those suckers”).
  4. Reinforcing that I’m on the fastest route (“Makes me feel smart”).
  5. Rerouting me if I make a wrong turn (“Lots of ways to get to a destination”).
  6. Showing me where others might have run into problems (“I’m so glad that guy flagged the roadkill!”)
  7. Rewarding me (intrinsically) when I nail the destination time to the minute! (“Woohoo”)

Healthcare is like the city street map to an out of town visitor before Google Maps came along to help make sense of it. Sure, there are streets and signs and landmarks and coordinates on a map just like in healthcare there are health insurance plans, doctors, specialists, hospitals, bills, benefits, deductibles, copays, premiums (should I stop with this list now)…..and on and on.  But what if….what if…..I had a Google Map that knew my starting point and my destination and helped me get there step by step?

Am I talking digital healthcare nirvana? No. Like I said in my last post (See“Technology is Not the Problem in Consumer Healthcare”) the technology is available to make this happen…today! Is the problem a lack of evidenced based understanding of how to give someone turn by turn directions? Nope. Is the problem that we don’t know the destination? Nope. So what is the problem? The problem is that it’s structurally really hard to bring these pieces into a central place to serve the consumer. But let’s try and get a V1 launched here why don’t we? Here is how a health insurance plan can do it.

Step 1: Know the Starting Point:  Health insurance plans know my demographic and benefit plan information and are increasingly building a richer profile of who I am, using predictive data. They also may have my medical claims history, and heck, if it’s worth it I might share some information to make sure the starting point is accurate.   

Step 2: Define the Destination: Now this gets a little tricky but let’s take it from a medical standpoint for a second. When it comes to chronic condition management the destination is a set of metrics that signal a condition is being well managed. It could also be keeping someone on a path of health through recommended screenings, physician visits and immunizations.

Step 3: Create a Turn by Turn Map:  Our work with Tandem is to break down the desired health goals into turn by turn health actions that individuals can take to get to their destination. It’s also the work that companies like Accolade are doing by making Health Assistants available for live person navigation. Building these roadmaps takes thought but they are essential to creating all the various mappings to help each person get to the right place proactively. The system must be smart enough to know that a turn has been made which is why data integrations to verify completion of an action is so important.

Step 4: Reward the Accomplishment: When individuals arrive at their destination, let them know how awesome they are. Reinforce the positive feedback.  Reward them. Encourage them to do it more often.  Show me other people that have achieved the same success. Let me know that I’m not alone. If health plans really want to build a new member relationship (outside of processing claims) this is 100% the way to do it!

Step 5: Store the Information for Future Drivers: While we may all have slightly different starting points and destinations, roads are well traveled for a reason because they cater to a vast majority of the population. Health plans would benefit from storing the data on how someone managed to get to their destination to know how/if to apply that same agenda to another person with a similar goal in mind. Today’s technology is available to do it but the data rarely gets accessed.

Can we do this? You bet! My life is better today because of Google Maps. Sounds kind of silly but it is. What is really exciting, however, is how much better my life could be, and the life of millions of others, if we applied these same learnings to consumer driven healthcare.  Drive on!

Posted on October 17, 2016 07:37 PM


Technology is Not the Problem in Consumer Healthcare

By Russell Benaroya

We don’t have a technology problem in consumer healthcare.  What I mean is that it is not a lack of technology that is holding back progress.  The reason our healthcare system is broken is because improving process (that can be aided by technology) is stymied by a cryptic maze of perverse incentives, misaligned interests, and regulatory misunderstandings. 

If we don’t have a technology problem, then why did digital health take in $2 billion in venture funding in the first half of 2016 with over 150 companies raising in excess of $2 million (source:  Rock Health)? Because professional investors (and I used to be one) are chasing shiny objects unaware of the structural chasms that exist to commercial traction.    It’s not like mobile apps are a failure in healthcare so we need to move to AI and chat bots.  No, the technology isn’t the problem here.  The problem is that most digital health startups are in the “pilot” abyss and can’t get enough adoption to gather the necessary data to iterate smartly. 

We mask progress by inventing new terms that look like the industry is advancing.  Wellness is now “Wellbeing” and Engagement is now “Personalization”.  But terminology doesn’t trump traction and digital health is hungry for traction.  Here are some key suggestions for digital health companies that want to overcome the non-technology obstacles to building a viable business:

Align with strategic distribution early.   Whether you bring on a strategic investor like we did at EveryMove or sign a strategic alliance relationship like Jiff did with Towers Watson it is very valuable to bake in some early distribution.  There are no guarantees here but it gives you a leg up early.

Build an end to end solution.  If you can build a business that is not reliant on another party disintermediating your relationship with the consumer (e.g. a health insurance plan), then you’re in more control.  It’s why companies like Oscar and Clover garner such attention because they obliterated one of the biggest healthcare obstacles by going around traditional health insurers that tend to be highly risk averse to innovating quickly.

Recruit “adults” to your company.  Many digital health businesses get started by great technologists that don’t have healthcare experience.  It’s refreshing in some ways but utterly terrifying in others.  I have found a lot of value bringing in experienced leadership (and advisors) that has been on the “inside”, understands the buying behavior, and can help navigate with added credibility.

Get very, very, very targeted with your application.  We all want to be a “platform” company or that’s what gets the investors excited, right?  You earn your way into being a platform. Companies should start out solving a very specific, targeted problem that they understand very clearly how to overcome the process obstacles to deliver value quickly.  Start-ups can ill afford to apply their technology too liberally when the real problem that needs to be solved is navigating some very specific use cases.

Technology certainly lubricates business development, marketing, PR, and speaking engagements.  People get excited, intrigued and inquisitive.  But we need to be careful that consumer digital health is not innovating its way beyond the problem that really needs to be solved and thus finds itself “too early” and unable to showcase its potential.

Posted on October 8, 2016 12:10 AM


Improving Health Without Healthcare

By Russell Benaroya

Healthcare is not about an insurance claim, a lab result or a medication. We think it is though because that is the healthcare we read about in the news and experience in our pocketbooks. We criticize healthcare when it doesn’t work for us and applaud it when it saves our bacon. But healthcare is just the result of individual decisions we’ve made, actions we’ve taken and accidents and genetic makeups that we can’t avoid. We can’t expect to save healthcare by trying to restructure the result. We have to impact the formula.

If we wait for the insurance claim or the lab results or the prescription medication to give us a signal of the health of an individual that needs care services for prevention then we are, by definition, too late. What if there is no medical claim and this individual either chooses not to access healthcare services, delays care, or is not well informed about his/her options? The better we can understand what is happening in the life of an individual the better able we are to reach out, build a relationship around prevention, and avoid high cost healthcare.

We built Tandem , a technology that helps health plans and employers align the right health actions to the right individuals, to motivate people to take preventive actions in order to improve their health and reduce the cost of healthcare on their pocketbooks. By delivering focused, targeted offers that are specifically designed to indicate the next most appropriate health action, individuals can act with a well informed and clear purpose.

The LexisNexis® Socieoeconomic Health Score is an integral part of Tandem because it helps our customers better tailor the right health actions to the right people. Medical history is often not available or is insufficient to trigger the right health actions.  However we know that an individual’s socioeconomic environment has high correlations with depression, substance abuse, hospital readmissions and medication adherence to name a few.   In a world where our personal data seems to be used to influence us to do things that aren’t that healthy the work we do with LexisNexis Health Care is different. 

Today we are using the LexisNexis Socioeconomic Health Score to help provide individuals with personalized roadmaps of health that can change healthcare from focusing on the results to focusing on the formula. We are helping our customers build better relationships and concentrating efforts on the people that will benefit most from a service or an intervention. Together we are redefining healthcare, not for the institutions that consume 20% of our GDP but for the individuals who are making smarter decisions to live their healthiest life.

Russell Benaroya is Co-Founder and CEO of EveryMove, a pioneer in consumer engagement. Through their product, Tandem,  they work with health plans and self-funded employers to drive specific health actions among specific members to meet specific near term business goals. He may be reached at Russell@EveryMove.com.

Posted on September 29, 2016 03:03 PM


How Marketing Can Save Healthcare

By Russell Benaroya

Marketing and healthcare in the same sentence can kind of make people feel a little squeamish.  There is something seemingly uncomfortable for health insurance to market to people based on health related information gathered through medical claims data.  There is also a perception that people don’t want to be marketed to about their health.  I think both of these statements are false perceptions we must debunk if we truly believe in putting the consumer at the center of their health. 

Goodbye Member Abrasion!

Have you heard of this term, “member abrasion”?  Member abrasion basically means that health insurance plans don’t want to piss off their members by bombarding them with communications that get annoying.  Many health plans, as a result, don’t experiment because they fear member abrasion.  They also believe that their net promoter scores are so low they don’t want to do anything that might make them worse.  But herein lies the opportunity.  It can’t get much worse so why not change what you’re doing and lean in?  Of course we don’t want to piss off a member (that’s just basic logic) but we live in a marketing world and I can’t think of one company that I feel has “abraded” me.  I am capable of deleting emails and not thinking anything of it. 

If I believed in abrasion I would say that it comes by sending out highly repetitive communications through the same channel. That gets annoying.  But similar communications through multiple channels or different communications through the same channel is not going to trigger the member abrasion concern.  Can we please stop using member abrasion as an excuse for why marketing in healthcare is so sensitive and challenging?  Phew, okay.  Let’s move on.

Back to Basics

Engaging people to become better equipped to manage their health is so ready-made for marketing it makes me giddy.  Marketing is not selling.  Marketing is about developing a demand for your product and fulfilling the needs and interests of the customer.   It might be best captured in the the famous 4 P’s (what’s the product; what’s the priceor value; how will it reach the customer’s place; and how will it be promoted).  Health plans are struggling to engage consumers in their health because the fundamental 4P’s aren’t being prioritized. 

But what would it look like if marketing did take center stage within a health plan, where there was a commitment to member marketing and a belief that customers actually would like to be marketed to because they are so healthcare illiterate they don’t know what they should be doing. 

Product – Let’s redefine the healthcare product to be more than just a health insurance policy.  If it’s important that the consumer take certain actions to reduce the need to trigger that policy the product should come with something that would be enjoyable to market, like free visits, screenings or new services being promoted.  And I’m suggesting that these actually get marketed with the intent that health plans actually want these services getting used by certain of their customers.

Price – What is value of health screening, an immunization or a primary care wellness visit?  What about signing up for health coaching, using telehealth, or accessing second opinion services?  It’s hard to market a service if the health plan doesn’t know the value of the thing they are marketing.  But let’s assume it has real business value (which it does) then the price or value might come in the form of an incentive to encourage a member to take action.   Even more interesting is that the value of that incentive could be (and should be) different based on the value of that specific consumer engaging in it (example:  a chronic utilizer of emergency room services is more valuable to steer to telehealth than someone who has never stepped foot in an emergency room).

Place – Place is about distribution.  Where will consumer engagement be marketed.  Here’s the deal – not every member is created equally for a health plan.  There are certain people managing chronic conditions that are more important than those that are healthy and active.  Where do these people show up?  How do they want to be communicated to? 

Promotion – The strategy to promote consumer engagement is where health insurance plans need to embrace marketing automation.  Getting a 360 degree view of their member will help determine the most appropriate touchpoints and places to engage that align with the interests and needs of like consumers.   

Marketing has been undervalued at health insurance plans for too long.  Today, marketing may be the most important function to driving consumer engagement and bending the cost curve.  Consumers don’t risk becoming abraded.  They risk being so unsure of what to do that their health suffers. 

As we stare into the abyss of the future of healthcare in America, it’s hard to agree where we go from here.  So much of our work is spent putting band-aids on fundamental structural problems that we don’t have time to see that we can build a bridge to the other side.

Posted on September 26, 2016 04:00 PM


EveryMove Adds to its Clinical Advisory Board

By Russell Benaroya

Today EveryMove is being called on to bring its member engagement capabilities into more clinical areas of healthcare.  Why?  Because the people that benefit the most from taking the right health actions are those who are managing a health condition.  Our experience in building technology solutions that delight consumers to engage with their health is what makes us well positioned to continue making a bigger impact across the health spectrum.  Our goal in building our new product, Tandem, was to provide customers the flexibility to drive targeted health actions to serve both the well and chronically ill.  

In order to best serve our customers desiring more clinical related health actions we are excited to announce that Christopher Mathews, MD has joined our clinical advisory board.  Dr. Mathews is currently the Senior Vice President and Chief Medical Officer of Zeomega, one of the premier population health platforms that helps health plans and care delivery organizations deliver a better and more personalized care experience for individuals. Prior to Zeomega, Dr. Mathews was the SVP and Chief Medical Officer at Community Health Plan.  Community Health Plan is a well known managed care company that has demonstrated success in delivering quality care at a reasonable cost.  

As a member of the advisory group, Dr. Mathews will play an important role in supporting Tandem to define the health actions that will yield the greatest benefit for the individual and the sponsoring organization (health plan or self funded employer).  Our job is to take those actions and build them into a Tandem Offer that encourages an individual to take action for their health!

We are excited to welcome Christopher Mathews to the team!  

Posted on September 15, 2016 08:43 PM


Health and Well-Being as a Competitive Advantage -- Invitation to Work Room

By Russell Benaroya

There are few people I have met that are as interesting and captivating as Andrew Sykes.  Every conversation I have had with Andrew has helped me better understand, well… people… and how to build experiences that can actually engage people to improve their health and quality of life.  It’s through what Andrew calls the science of habits

As the founder of a product called Tandem which helps employers and health plans engage individuals to take specific health actions, I’ve had a lot to gain from the science of habits.  That’s why I’m so excited that Andrew has decided to take his knowledge to a broader audience with a program he is launching called Work Room. 

Recruiting top talent to organizations is hard.  Keeping people operating at their best once they have joined is critical!  Often times employees aren’t able to give their best at work because other areas of their life create stress and anxiety, or just plain get in the way.  Many employers have taken an active role in helping improve the well-being of employees because they know that healthier employees leads to more productive employees and reduces healthcare costs.  But the question is how?  Solutions today to engage employees around well-being have been inconclusive at best.  Yet there is data that shows that engaged employees do indeed work better and cost less.  That’s not the issue.  The challenge is implementation - putting strategies and tactics in place that can help employers and their employees reap these benefits.  This is what Work Room is all about and why we're excited to be a part of it.  

Work Room is a 3-day interactive workshop to help employers become “employers of choice” by investing in the health, happiness and security of their employees.  It is about giving an employer a competitive advantage with the take home tools and techniques that can make a difference quickly.  It is about building confidence and motivation to critically assess solutions that claim to activate employees but typically under deliver on results.  It is about acknowledging that every employee is different and your desired actions for them should be aligned with their interests, capabilities and motivations.

On October 4-6 in Seattle, WA, Andrew Sykes is presenting Work Room, a transformational series aimed at organizational leaders that believe the health and well-being of their employees should be a strategic advantage. They are organizing Work Room in partnership with Vivacity, a wellbeing and productivity consulting company.  We are excited to be presenting Tandem at the conference on October 6th to show how we apply some of Andrew’s strategies in a digital solution for employees.

You can learn more at www.findworkroom.com and register at: www.workroomseattle.eventbrite.com.  If you are interested in the workshop and would like to inquire with me about a discount, please do so.  You can reach me at russell@everymove.com.  I’d love to have you attend and not miss experiencing the impact of Andrew Sykes on your organization.

Posted on September 14, 2016 03:36 PM


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