HCEG. What Should Be Keeping Health Care Executives up at Night? 2019 AHIP Consumer Experience & Digital Health Forum Dr. Esteban López, MD, MBA, Ian K. Gordon, Consumer Experience, Digital Health. Social Determinants of Health. SDOH. Health Plans.

Highlights of 2019 AHIP Consumer Experience & Digital Health Forum

By | AHIP, HCEG Top 10, Conferences, Social Determinants of Health, Consumer Experience | One Comment

Consumer Experience has been a high-ranking item on HCEG’s Top 10 list of challenges, issues, and opportunities facing healthcare leaders over the last decade.  And last week, 500+ healthcare industry professionals gathered in Chicago at the 2019 AHIP Consumer Experience & Digital Health Forum to present and discuss the importance of the healthcare consumer experience and various approaches to leveraging digital health platforms and tools to effect an improved consumer experience.

In this post, we’ll share some highlights from AHIP’s Consumer Experience & Digital Health Forum including:

Look forward to 2020 and more information and insight shared by healthcare industry leaders, innovators, and change-makers improving healthcare and health delivery.

What Should Be Keeping Health Care Executives up at Night?

As costs continue to rise, more financial responsibility is shifted to individuals, and non-traditional companies disrupt the traditional healthcare space, executives and industry leaders are under tremendous pressure to transform their organizations due to the challenge of providing coverage for healthcare services offering reasonable outcomes at a fair price.

Check out this blog post to learn more about the following topics addressed by three health industry leaders: Ian K. Gordon, Dr. Esteban Lopez, and Ferris Taylor:

• How challenges, issues, & opportunities have evolved over the last few years
• How they’re transforming and innovating their organizations
• What excites them about the future for health care
• How health plans help support health care consumer’s
• How socioeconomic status and social determinants of health impact health plans
• The role of health plans in addressing the social determinants of health and what work they’re doing
• What they’re doing right and what do they need to do better
• What them up at night with respect to the policy actions or industry trends

How Technology Innovation Will Play a Critical Role in Prevention

In the session titled “How Technology Innovation Will Play a Critical Role in Prevention” at last week’s 2019 AHIP Consumer Experience & Digital Health Forum in Chicago, a gaggle of industry leaders, innovators and change-makers shared their thoughts and ideas on the critical role new innovations in technology will play in preventing serious injuries among the fastest-growing demographic—aging Boomers.

Neel Mehta from Honor moderated a panel consisting of Bryan Adams of Best Buy Health, Dr. Ari Melmed, MD of Kaiser Permanente Colorado, Rajeev Ronanki from Anthem, and Faraz Shafiq of Cambia Health Solutions. The panel shared their take and experiences on the following:

• Latest innovations that can help keep older adults healthy and safe in their homes
• The impact technology might have on the social determinants of health
• How these technology innovations can result in better outcomes for well-being

Read this post for Highlights on How Technology Innovation Will Play a Critical Role in Prevention of Accidents and Disease

Creating Impactful Member Enrollment Correspondence

HCEG member Sheri Johnson, AVP of Member Enrollment and Billing joined fellow UCare AVP of Customer Service Julie Feirtag presented how their company utilized a cross-functional approach to update member enrollment-related correspondence to improve member engagement and experience, drive member action and support the customer service team.

See this sample of select slides on how Sheri and Julie orchestrated a team to define and employ simple language and standard templates to transform enrollment-related letters into actionable, easy-to-understand correspondence. And check out a few of the specific processes used, steps taken, changes made, and outcomes achieved they shared in their session.

Connect with Healthcare Industry Executives, Leaders, Innovators & Change-Makers

We’ll be sharing more from last week’s AHIP CDF in the coming weeks. For more information, insight, and ideas on healthcare innovation and the transformation of healthcare, subscribe to our eNewsletter and consider becoming a member of the HealthCare Executive Group.

Prevention. How Technology Innovation Will Play a Critical Role in Prevention. 2019 AHIP Consumer Experience & Digital Health Forum. Neel Mehta. Honor. Bryan Adams. Best Buy Health. Dr. Ari Melmed, MD. Kaiser Permanente Colorado. Rajeev Ronanki. Anthem. Faraz Shafiq. Cambia Health Solutions. social determinants of health. SDOH

How Technology Innovation Will Play a Critical Role in Prevention (of Accidents & Disease)

By | AHIP, Conferences, Population Health, Social Determinants of Health, Consumer Experience | One Comment

In the session titled “How Technology Innovation Will Play a Critical Role in Prevention” at last week’s 2019 AHIP Consumer Experience & Digital Health Forum in Chicago, a gaggle of industry leaders, innovators and change-makers shared their thoughts and ideas on the critical role new innovations in technology will play in prevention (of accidents & disease) among the fastest-growing demographic—aging Boomers joining original Medicare and Medicare Advantage programs at the rate of 10,000 new beneficiaries a day.

Neel Mehta from Honor moderated a panel consisting of Bryan Adams of Best Buy Health, Dr. Ari Melmed, MD of Kaiser Permanente Colorado, Rajeev Ronanki from Anthem, and Faraz Shafiq of Cambia Health Solutions. The panel shared their take and experiences on the following:

  • Latest innovations that can help keep older adults healthy and safe in their homes
  • The impact technology might have on the social determinants of health
  • How these technology innovations can result in better outcomes for well-being

The remainder of this post shares a few highlights from the session. Access all recordings mentioned in this blog post here.

Highlights on How Technology Innovation Will Play a Critical Role in Prevention

The following are some of the questions that moderator Neel Mehta presented to the panel and some panelist responses to those questions. You can listen to the entire recording – admittedly not of the best quality but still enlightening – here. Specific starting and ending points in the recording are noted below and link to the audio recordings.

Q1: How do health plans support caregivers? (02:24 – 04:30)

Fariz Shafiq: On average, caregivers provide 32 hours a week of unpaid caregiving, essentially a full-time, unpaid job imposing a financial and emotional impact on the caregiver. As a health plan, we recognize that caregiving is an extremely important service. Fariz shared how his organization equips caregivers best:

  • Help with scheduling appointments and checking the efficiency of patient schedules
  • Reconciling medications
  • Help with understanding and paying bills

Rajeev Ronacki: Keeping on top of local resources is a real challenge. We provide members and patients digital apps and help identify and connect members and patients with community-based orgs that can assist them. And we provide an online marketplace where members and patients can also self-serve.

Tech and Touch Must Be Balanced for Innovative Prevention of Accidents & Disease

Q2: The elderly caregiver population, whether it’s home care, provider or family member, are difficult to reach and engage with, regardless of whether they are tech-savvy or not. What are some of the ways you reach this population? (06:45-08:47)

Prevention. How Technology Innovation Will Play a Critical Role in Prevention. 2019 AHIP Consumer Experience & Digital Health Forum. Tech vs. Touch. Wearables. Telehealth. Social determinants of health. SDOH

Bryan Adams: Everything starts with balancing the tech vs. touch concept. We want to leverage technology into the home and surround that with robust services. This will ultimately move the needle not only for the healthcare consumer but also for the healthcare system as a whole.

We have ‘healthcare caring centers’ staffed by people encouraged and trained to have a high level of empathy interaction. Mostly telephonic relationships that establish and nurture a tech vs. touch relationship with the senior.

Q3: One of the things that is appealing to tech innovation in healthcare is Artificial Intelligence. What do you think in your perspective as a provider is the role of the healthcare provider in respect to AI? (08:53-12:53)

Dr. Ari Melmed: It’s a new time for providers and physicians. The role of the provider is to partner with the patient and to address their concerns. To get them the right answers. The amount of information available to everyone online is overwhelming. Staying up to date as a physician nowadays only takes 21 hours a day.

Faraz Shafiq: Computers are helping doctors getting better at diagnoses. Healthcare is so complex and the volume of information so great and often so nuanced that AI-powered assistance is needed.  (10:42-12:09)

RELATED: How Cambia Health Solutions is Leveraging Artificial Intelligence in Healthcare Space

Using Technology & Data to Understand Social Determinants of Health

Q4: I have found that on the medical side there’s a mountain of data. And on the social side there’s a huge and growing amount of data. How can technology support the understanding of how social and community health factors influence outcomes? (13:10 – 15:00)Prevention. How Technology Innovation Will Play a Critical Role in Prevention. 2019 AHIP Consumer Experience & Digital Health Forum. Tech vs. Touch. Wearables. Telehealth. Social determinants of health. SDOH

Rajeev Ronacki: I think the question is what do we do about it? How do we react to it? How do we make it more democratized?

Listen to more of Rajeev’s response here.

Q5: What are some of the challenges in integrating data, making it uniform, and making it ‘analyzable?’ (15:33-19:18)

Rajeev Ronacki: Roughly 80% of the work we need to do on any AI initiative is data prep: obtaining the data, looking at the quality of data, cleansing and integrating it, creating standards for uniformity. There’s nothing secret about it.

Listen to other responses to this question here.

Brick & Mortar Bring Human Interaction and Touch to Accident & Disease Prevention

Prevention. How Technology Innovation Will Play a Critical Role in Prevention. 2019 AHIP Consumer Experience & Digital Health Forum. Tech vs. Touch. Wearables. Telehealth. Social determinants of health. SDOH. Brick and Mortar

Q6: What unique value do brick and mortar companies bring to healthcare? (20:20 – 23:20)

Bryan Adams: Brick and mortar locations enable the touch component of the critical need to balance technology and human touch/interaction mentioned before. This is particularly important for the senior population.

Being entrenched in the neighborhood and being involved with community care initiatives helps us to better understand and capture social determinants of health unique to that area and then take that information and make it actionable. At our company, we’re giving thought on how to leverage our Geek Squad (20,000 people) and over 1200 retail outlets to engage with health plan members and to advance preventive care.

Q7: If telehealth has not yet reached into the home it is gaining a footprint in places like Best Buy, Walmart, and Walgreens. Are you seeing brick and mortar playing a part in expanding the reach of telehealth? (23:40 – 25:20)

Dr. Ari Melmed: Yes. And there are different ways of thinking about telehealth like onsite work clinics which are playing an important role, schools are developing innovative programs, remote clinics are interfacing with centralized, specialized services.

Q8: How has the Medicare market shifted in trying to support senior’s health?  (25:24 – 28:50)

Rajeev Ronacki: Increasingly there’s a consumer preference to do things in the home – particularly in the transition to and from the hospital.

Using TV’s and sensors and voice-assistance to deliver the care that’s needed. I would venture to say that 60-70% of the care that doesn’t need active intervention can be provided in the home. The question is how to deliver it in a way that makes sense.

Bryan Adams: Medicare Advantage as a whole has become a hub of innovation and we’re excited about SSBCI and opening up the ability to address social determinants. (27:31 – 28:38)

Can Technology Address 50% of Preventive Health Measures?

Q9: As Rajeev mentioned, with the right technology 60-70% of the care that doesn’t need active intervention can be provided in the home. What will it take to get to widespread adoption of the minimum technology infrastructure needed to address 50% of preventive medicine? (28:50 – 32:13)

Rajeev Ronacki: Some sort of super simple, USB-type device that’s widely adopted by consumers. Installation and implementation need to be simplified and cost-effective.

Prevention. Preventive Medicine. Primary Care. Care Coordination. SSBCI. Medicare Advantage. How Technology Innovation Will Play a Critical Role in Prevention. 2019 AHIP Consumer Experience & Digital Health Forum. Tech vs. Touch. Wearables. Telehealth. Social determinants of health. SDOH. Brick and Mortar

Listen here from more on how technology in the home may address 50% of preventative medicine.

Q10: Are there any examples of technologies that are starting to scratch the surface of being pretty easy to use? (33:35 – 38:50)

Rajeev Ronacki: Wireless sensors and other devices are becoming increasingly sophisticated and easy to use.

Bryan Adams: Passive devices that operate in the background and do not require the member/patient to do anything special or change any behavior. Devices that measure ADL’s and allow the member/patient to keep living their life without any special attention.

Dr. Ari Melmed: Devices that provide feedback on a real-time basis to drive behavior change. Tools to extract information from medical records and help the physician more quickly understand salient aspects of the patient.

Connect with Healthcare Industry Executives, Leaders, Innovators & Change-Makers

For more information, insight, and ideas on healthcare innovation and the transformation of healthcare, subscribe to our eNewsletter and consider becoming a member of the HealthCare Executive Group.

2019 AHIP Consumer Experience & Digital Health Forum. Healthcare Consumer Experience. 2020 HCEG Top 10 list of challenges, issues, and opportunities facing healthcare executives in 2020. health plans, health systems, providers. Healthcare Predictions & Trends for 2020. HCEG. HealthCare Executive Group.

Healthcare ‘Costs & Transparency’ and ‘Consumer Experience’ – Top of Mind for 2020 & Beyond

By | AHIP, Conferences, Consumer Experience | No Comments

‘Costs & Transparency’ and ‘Consumer Experience’ are ranked in the two top spots on the 2020 HCEG Top 10 list of challenges, issues, and opportunities facing healthcare executives in 2020. These two areas of focus for health plans, health systems, and providers – risk-bearing or otherwise – are also frequently referenced on the various lists of ‘Healthcare Predictions & Trends for 2020.’

Rising Costs & Increasing Patient Responsibility for Payment Drive Focus

In a presentation at this week’s 2019 WEDI Winter Conference, Dan Mendelson Founder of Avalere shared some eye-opening facts and statistics that underscore why “Cost & Transparency” is ranked as the top issue facing HCEG member organizations.

  • 84% of consumers believe drug prices are unreasonable
  • 2019 AHIP Consumer Experience & Digital Health Forum. Costs & Transparency. 2020 HCEG Top 10 list of challenges, issues, and opportunities facing healthcare executives in 2020. health plans, health systems, providers. Healthcare Predictions & Trends for 2020. HCEG. HealthCare Executive Group.40% of Americans have saved enough to cover a $1,000 emergency
  • 57% of employees are offered a high deductible plan
  • $13K Average employee health benefit cost
  • Affordability is #1 issue for Democrats (45%) & Republicans (30%)

Higher premiums, higher deductibles, increasing co-insurance, and surprise medical billing are four trends that really took off about a decade ago and show no signs of slowing down. See more presentations from the 2019 WEDI Winter Conference here.

Strategies to Improve Transparency and Lower Costs

This time of year all the experts, thought leaders and prognosticators are making their predictions about 2020 and beyond. And Cost, Transparency, and Consumer Experience are frequently referenced items on those lists. The following are some of the more detailed predictions, strategies, and tactics to address the growth of medical and pharmaceutical costs and improve transparency and access.

  • Simplify explanation of benefits communications and simplify terminology
  • Provide members and patients with data that is understandable and usable in a secure and private manner
  • Making data available for review by independent 3rd parties
  • Merge clinical, financial, and operational data with CRM insights to enable greater transparency and enhance customer experience
  • Deploy and support ‘Local Market Relationship Liaisons
  • Develop a culture of transparency to more openly share information on the following:
    • Medical and pharmaceutical pricing
    • Payments and incentives offered to physicians for prescribing drugs
    • Results of clinical trials

All of the above demands the convergence of digital health technology with human needs and wants in a trust-based, member/patient-centered model supporting and balancing person-to-person engagement.

RELATED: “People Hate Shopping for Health Insurance”

Consumer Experience: Balancing Person-to-Person Engagement with Technology

Over the past five years, Consumer Experience has ranked in the #2 spot on HCEG’s Top 10 list four times. HCEG defines Consumer Experience as “Understanding, addressing and assuring that all consumer interactions and outcomes are easy, convenient, timely, streamlined, and cohesive so that health fits naturally into the ‘life flow’ of every individual’s, family’s and community’s daily activities.

As with ‘Costs & Transparency,” many of the lists of predictions and trends for 2020 and beyond include Consumer Experience as a prominently ranked item. The following are some ideas, strategies, and tactics healthcare organizations may consider to improve the healthcare consumer experience:2019 AHIP Consumer Experience & Digital Health Forum. Healthcare Consumer Experience. 2020 HCEG Top 10 list of challenges, issues, and opportunities facing healthcare executives in 2020. health plans, health systems, providers. Healthcare Predictions & Trends for 2020. HCEG. HealthCare Executive Group.

  • Offer personalized mobile apps to leverage user-centric relevant notifications
  • Utilize blockchain technology to create a transparent and tamper-proof ledger of all member/patient transactions
  • Invest in member enrollment and patient recruitment programs
  • Service members and patients where they are outside the four walls of your office, hospital or practice
  • Chatbots for self-service and scaling member/patient interactions
  • Virtual reality providing an immersive experience for members and patients. A virtual tour of a health facility, demonstrating an example procedure and helping patients cope with pain are some examples

RELATED: Did CMS Just Declare 2021 ‘The Year of the Consumer?’

Offering a personal experience when it comes to healthcare is vital and today’s healthcare organizations must focus on utilizing digital health technologies to enhance and advance the experience of the healthcare consumer. Given the entry and disruption from non-traditional players like Amazon who’ve set the standard for consumer expectations, not doing so will surely result in extinction.

More on Costs, Transparency, and Healthcare Consumer Experience

Next week HCEG members and select sponsor partners will be presenting at the 2019 AHIP Consumer Experience & Digital Health Forum in Chicago. HCEG Executive Director Ferris Taylor and Ian Gordon, Former Sr VP & COO 2019 AHIP Consumer Experience & Digital Health Forum. Costs & Transparency. Healthcare Consumer Experience. 2020 HCEG Top 10 list of challenges, issues, and opportunities facing healthcare executives in 2020. health plans, health systems, providers. Healthcare Predictions & Trends for 2020. HCEG. HealthCare Executive Group.of Regence, will be presenting What Should Be Keeping Health Care Executives up at Night? They’ll share more ideas, strategies, and tactics healthcare organizations can use to improve the healthcare consumer experience. Learn more here.

HCEG member Sheri Johnson, AVP of Member Enrollment and Billing at UCare will present Creating Impactful Member Enrollment Correspondence on December 10th at 3:15 pm. Learn more here.

And Mark Nathan, CEO & Founder of HCEG sponsor partner Zipari, Inc. will present Revolutionizing Consumer Experience With a Single Platform Built for Health Insurance on December 10th at 4:10 pm. Learn more here.

Join senior healthcare leaders and line-of-business executives and leave Chicago with guidance for managing the implications that reducing costs, improving transparency, and enhancing consumer experience portends for your IT investment priorities and implementation strategies.

Time for Healthcare to be Top of Wallet

By | HCEG Top 10, Consumer Experience
unnamed (2)

Adam Nelson – Vice President at NTT DATA, Inc

You may have seen on television commercials that a particular retail and credit card bank wants to know, What’s in your wallet? This question and the drive toward being top of wallet is a customer relationship management (CRM) theme that the financial industry has been focused on for decades. The intent is to drive consumers to use their credit card the most and become your bank for other services, from checking and savings accounts to auto and home loans. So, open your wallet and take a look inside. What do you see? Is it American Express, Target, or Capital One? Is it your driver’s license? Regardless of what card you see first, one thing is for certain, it was not your healthcare insurance card.

The financial industry knows how to create stickiness with its consumers attract them young via their first savings or checking account (pre-collegiate years) and then give them a credit card when they turn 18. They, then have a profitable consumer for life, which averages between 14 – 22 years in the banking industry and spans auto and home loan up-sell opportunity. However, for a healthcare insurance company, consumer stickiness, or top of wallet mindset, has been traditionally based on a once a year enrollment event or a quick scan of an Explanation of Benefits letter after a preventive or acute event (annual exam or hospital visit). This depicts an extreme lack of stickiness with a healthcare consumer, which the health plan desperately needs to have, but never considered prior to the healthcare event or as a primary focus on health management and wellness programs.

This last concept is an interesting one diet plans emerged in the 60’s with Weight Watchers, followed by Atkins in the 70’s, evolved to the 80’s era of Let’s Get Physicalgym memberships and where did we end up? With an obesity epidemic in America and abroad popularized by a shift in dining habits (eating out and eating faster), longer working hours (translating into less time for exercise) and a notable upswing in detrimental ingredients like sodium and sugar. All combined, these factors have contributed to an increase in chronic conditions that we all know; diabetes, heart disease, hypertension and the list goes on.

Now, we are entering an era of consumer directed health whereby individuals have more options, yet also want a better experience in what is being distributed as a more self-service model. So, how does a health plan create an ecosystem that is attractive to new customers (price driven), sticky (to increase retention), self-serving (cost effective), and helpful (quality of care with tangible positive outcomes)

Almost every health care insurer has some sense of a program that at the core resembles the start of a digital business similar to how retail has adopted an Omni-channel approach. In this approach, the intent is for the experience to be as similar as possible across any channel, be it in-person, phone, web or mobile, with the most significant outcome being the end state. The single qualifying question should be can the consumer do what they want across all channels; can they try, buy, return and rate and have a positive, familiar experience that drives recurring visits.

With a health plan, the same approach could be used and it is suggested that all the data and channels are in place or available today. The question to ask then is, How easy is it for an employer group or individual member (potential or existing) to shop, buy, use, and understand their benefits and all associated information from financial (FSA, HSA and maximums) to clinical (can I view my own trending lab and radiology results and vitals from multiple doctors) to prescriptions (what kind, how long, what was result) The answer is that while the data does exist, the information is not user friendly to view and therefore, no stickiness is generated between am employer or member and the health plan. In the end and with the push for consumerism, health plans, it could be argued, are almost driving too hard to the hoop for the proverbial silver bullet of a self-service, care-about-my-own-health, and know-what-to-do model.

Push the decision to visit a doctor, or any medical facility (ER, urgent care) based on funds in an HSA too hard and folks might begin to think financially instead of based on health. Shift from a $20 co-pay for a chiropractic visit to a pay-as-you-go until your deductible is met, and folks might not seek out or even research preventive care options. Sweep obesity under the rug because you only visit a doctor once a year for the free visit and there might not be multiple opinions pushing you with the cold, hard truth to change your habits or else. The balance is a fine line yet can be met with a few straightforward lessons drawing from retail, banking, and even some common sense

  1. Ease of Information Make it simple and visually appealing
  2. Person to Person Connection Make it easy to get past IVR and talk to a knowledgeable representative
  3. Interpret my Information Make it fast to view and highlight relevant information to me, typically financials and benefits
  4. Help Consumers Make Decisions help me to find the right healthcare when I need it! Whether the reason is preventive or immediate, think about the consumer experience. If someone calls at 2AM local time, chances are they need a nurse, not an IVR.

With the digital experience, consumerism and the ecosystem of data upon us, health plans that thrive will find ways to attract, retain and both qualitatively and quantitatively support their members and customers data is at the core; using it has been a decades old initiative and finally, the business processes and technology exist with suitable price points for health plans to become top of wallet.

NTT DATA welcomes you to read more at The Outsourcing Center in the article, The Shift to a Patient Centric Healthcare Ecosystem: Changing Minds, Medicine and Marketing


Adam Nelson is a Vice President at NTT DATA, Inc. Adam leads the Healthcare and Life Sciences Solution Offerings group focused on productizing service capabilities to bring predictable and relevantbusiness change to clients. Adam’s background in Industrial and Organizational Psychology helps tobring accelerated decision making and behavior change to complex enterprise programs; he has beenpublished and interviewed by Computerworld, Corporate Board Member Magazine, and Oracle’s Profitmagazine on the topics of IT Governance, Compliance, the IT / Business relationship, and Program Management.

Healthcare 2016 Game of Thrones Shift: Consumer is King, Payer is Hero

By | HCEG Top 10, Consumer Experience

2015.09.22 - KingSetting the Stage

For those of you not familiar (or more appropriately heavily addicted binge watchers) with the hit series Game of Thrones on HBO, it is a story about the rise, fall, shifts and drifts of power within and between kingdoms, families and characters in a fictional medieval period. Make no mistake, even with all of the current technology and decades of knowhow available, the current healthcare system and process is feudal and the experience is draconian overly complex, hard to access and navigate, confusing and costly to all stakeholders. Consumers feel like they are being left hanging in the stocks (a medieval punishment device) in the town square when it comes to the current experience and costs associated with their health benefits and related purchases.

The good news, we are on the verge of emerging from this archaic, high resistance to change era into the next golden age of healthcare. E-commerce is the key that ignited change in other major industries (ex. banking and retail) and led to a significant spike in growth, improved experience, better efficiency and reduced costs. E-commerce and medical shopping are poised to have that same impact on healthcare.

Crossing the Gulf of Grief – Consumerism initiative driving healthcare

According to CMS Office of Actuary, of the $2.9 Trillion spent on healthcare in 2013, $381 Billion of that came directly out of consumer’s pockets for expenses other than healthcare premiums. While a significant portion of the $381 Billion was spent on co-pays, an increasing amount was spent on full cost healthcare from credit, debit, cash accounts or HSAs.

Continuing with the Game of Thrones analogy, the up and comers in a kingdom called Mereen are trying to create a better, more equitable society by challenging legacy cultural norms and the existing ruling factions. The citizens of Mereen are separated from the current centers of power think government payers, commercial payers and providers–by the Gulf of Grief. I liken healthcare consumers to the citizens of Mereen. The Mereen citizens are starting to realize their power yet struggling with becoming more self-governed and having increased voice, influence and decision making abilities. Sound familiar

Just like the citizens of Mereen, healthcare consumers will have to cross the complex, confusing and surprising currents of the Gulf of Grief to become sufficiently self-directed with less than exact information and imperfect navigational tools unless E-commerce, medical shopping and retail principles are more widely adopted by payers and providers.

Price, quality and access transparency to support the consumer experience

According to recent studies, 88% of healthcare consumers want to know their out-of-pocket costs before receiving health services. Only 46% of consumers are happy with their CDHP, HDHP benefits. The lack of insight into the true total cost of care pre-service is the #1 point of dissatisfaction among healthcare consumers. These data points above, as well as other indicators, point to an increased need for E-commerce and medical shopping initiatives.

By example, annual enrollment is a huge administrative burden on payers and confusing to most consumers. It makes sense to improve it. In my opinion, a disproportionate amount of resource investment and focus, especially in public and private exchanges, has been placed on enabling online benefit shopping and elections which typically happens 1-time per plan year. Would consumers rather have an online, more retail experience for shopping, comparing and electing their benefits Sure.

But, do consumers better prefer and need an E-commerce or medical shopping retail solution for how they utilize their benefits over an online enrollment solution Yes, consumers prefer E-commerce and medical shopping over online enrollment is what my informal user experience research shows. If the name of the game is to attract, acquire and retain policyholders for payers and patients for providers, then the benefit utilization experience is the primary area needing investment focus, improvement and automation. Commercial healthcare consumers on average access and utilize their benefits 13 times per year. Using the logic above of 1 enrollment experience versus 13 or more utilization experiences per year, wouldn’t logic indicate that payers and providers should prioritize and focus more resources on E-commerce and medical shopping initiatives.

If this is true, why are a disproportionate amount of payer resources tied up in online enrollment projects The answer is regulation. An online enrollment experience is mandated for public exchange benefits hence the resource prioritization on it. Lesson to be learned, healthcare and many other heavily regulated industries (ex. banking) typically do very little voluntarily in advance of regulation. That is why 9 states have or are considering transparency initiatives. That number is expected to grow. I contend that a transparency tool doesn’t go far enough in meeting the needs and expectations of healthcare consumers. The E-commerce platform will leapfrog traditional transparency tools and modernize traditional provider contracting, claims infrastructure, collections and payment processing which could save the healthcare industry $235 Billion.

Bend the cost curve in both medical and administrative expenses

PwC notes three factors that serve to “deflate” the 2016 medical cost trend: (1) The Affordable Care Act’s looming Cadillac tax on high-priced plans which is accelerating cost-shifting from employers to employees to reduce costs; (2) Greater adoption of virtual care technology that can be more efficient and convenient than traditional medical care; and (3) New health advisors helping to steer consumers to more efficient healthcare.

With respect to 2015, Milliman found the cost of healthcare for a typical American family of four covered by an average employer-sponsored preferred provider organization (PPO) plan is $24,671, up from $23,215 in 2014. The 2015 family costs works out to $2,055 on a monthly basis. Total employee cost (payroll deductions plus out-of-pocket expenses) increased by approximately 43% from 2010 to 2015, while employer costs increased by 32%. Of the $24,671 in total healthcare costs for this typical family, $10,473 is paid by the family, $6,408 through payroll deductions, and $4,065 in out-of-pocket expenses incurred at point of care. Overall, the U.S. healthcare economy is seeing increases in premium rates and drug costs, and decreases coming from efficiencies in virtual care and choosing lower cost options.

The primary drivers of cost reduction in most industries, including healthcare, are automation, competition and multiple or alternative channels of consumption or distribution. According to MDLive, a leading telehealth solution provider, 90% of PCP visits can be addressed by telehealth. SpendWell Health has observed 12 27% lower health service prices by providers participating in E-commerce marketplaces with upfront patient responsibility collections versus traditional network contract fee schedules and collections. An E-commerce or medical shopping solution with embedded telehealth has the potential to impact approximately $101 Billion of U.S. healthcare spend. Using these market principles and applying them to healthcare provides strong supporting evidence for E-commerce or medical shopping with embedded telehealth being one of the best and nearest term approaches to improving consumer experience and bending the cost curve.

About SpendWell Health

SpendWellTM is the leading health care e-commerce solution that empowers insured consumers to shop, compare and buy routine health services at actual prices. SpendWell’s online marketplace integrates benefit plans, removes consumer anxiety about surprise bills with upfront payments, eliminates patient collections risk for providers and reduces administrative inefficiencies and costs for payers. SpendWell transforms the traditional health care model for consumers, providers, employers,health plans and administrators into an online retail experience. SpendWell’s nationwide community of providers includes medical, dental, vision, behavioral health, chiropractic, alternative care, imaging and more. SpendWell is a wholly owned subsidiary of Cambia Health Solutions, Inc. Learn more at CambiaHealth.com. For more information about SpendWell, visit SpendWellHealth.com.