Category: Health plans

Whatever happened to consumer directed health plans?

published date
October 8th, 2018 by
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A sad story for consumers

“Consumer directed health plans” were all the rage in the mid 2000s. The big idea was that if patients had ‘skin in the game’ in the form of greater financial participation in the cost of their care, they would use their well honed shopping skills to find the best deals and thereby drive costs down and value up. Employers embraced the idea, since it could reduce their costs and keep employees happy.

There was a general acknowledgment that patients would need better information and tools to transform into consumers, and there was plenty of optimism that these would be made available.

But now as Kaiser Health News reports (High-Deductible Health Pans Fall From Grace In Employer-Sponsored Coverage) employers are going back to more traditional plans.  There are a few interesting things to note:

  • No one uses the term “consumer directed” anymore. There’s an acknowledgment that this term became a euphemism for cost-shifting
  • Employers tweaking health insurance offerings is not going to solve the healthcare cost problem in this country
  • Employees don’t like the plans and in a tight labor market employers have to abandon them

Kaiser reports that:

Because lots of medical treatment is unplanned, hospitals and doctors proved to be much less “shoppable” than experts predicted. Workers found price-comparison tools hard to use.

Not all “experts” jumped on the consumer directed bandwagon. Back in 2007 I attended the World Health Care Congress where I heard people gushing about the benefits of consumer directed plans. They used employer sponsored 401(k) plans as a model of how employees would take responsibility once offered compelling products, information and customer service from companies like Fidelity and Vanguard.

But as I pointed out at the time in “What if the consumer can’t hack it?” employees had actually done poorly with 401(k)’s, investing too little, choosing low return investments, concentrating their holdings in their own company’s stock, etc. As I wrote:

In my view, 401(k)s are a lot simpler for employees to understand than health care. In a 401(k) you can make one or two decisions and then be on auto-pilot. For example, just contributing the maximum amount and picking a target-date retirement fund is about all that’s really needed. Results can be easily and objectively measured over time and compared with benchmarks. We’ll never be able to do that in health care.

I don’t totally discount the 401(K) analogy but we should at least acknowledge that the 401(k) experience has been far from perfect and that health care is going to be a harder nut to crack.

Looks like I was right.

By healthcare business consultant David E. Williams, president of Health Business Group.

 

Nurse triage lines 3.0. Podcast with AxisPoint Health

published date
July 20th, 2018 by
Anne VanBronkhorst, SVP of AxisPoint Health

Nurse triage lines have gone through three phases of evolution. In phase 1 they were implemented to ‘check the box’  for member education, phase 2 brought “demand management” to keep patients out of the emergency room, and now in phase 3 health plans are creating a gateway to innovative programs and services.

In this podcast interview, AxisPoint Health SVP, Anne VanBronkhorst and I discuss:

  • (0:14) Why payers offer nurse triage lines in the first place
  • (1:37) What kinds of issues they handle and how popular they are
  • (2:50) How payers measure success
  • (3:56) How to stand out in a crowded field
  • (4:58) Examples of innovative services for which nurse lines are a gateway
  • (6:00) The role of telehealth as a replacement or complement
  • (6:53) What results AxisPoint Health is seeing with its customer base
  • (8:10) The definition of emergency department “redirection rate”

By healthcare business consultant David E. Williams, president of Health Business Group.

Preparing for value based payments. Podcast interview with MediQuire CEO Emily Chen

published date
June 18th, 2018 by
MediQuire CEO Emily Chen

Despite all the noise and dysfunction on healthcare in Washington, DC, the move toward value based payments is continuing apace. But providers and payers continue to straddle the fee-for-service and value-based worlds, slowing and complicating the transition.

MediQuire helps providers and payers measure, improve and get financial reward for improvements in performance and patient outcomes. In this podcast interview, CEO Emily Chen and I discuss:

  • The current state of affairs in value-based payment
  • How the value-based movement has changed (or not) since the new administration arrived in office
  • The key capabilities needed for success
  • How MediQuire helps
  • What the future holds

By healthcare business consultant David E. Williams, president of Health Business Group.

Massachusetts healthcare turmoil: I’m quoted in the Boston Globe, Herald and CEO Magazine

published date
June 13th, 2018 by

I’m always happy to speak with the press to provide my take on healthcare business and policy. In the last few days I’ve been quoted in a few outlets:

Today’s Boston Globe: In a sudden departure, Harvard Pilgrim CEO resigns amid questions about his behavior

Harvard Pilgrim and Partners each said Tuesday that Schultz’s resignation does not affect their discussions about a possible merger.

But David E. Williams, a Boston health care consultant, predicted the leadership change at Harvard Pilgrim would slow any other major moves by the insurer.

“I think it reduces the chance that a deal will happen, especially in the near term,” Williams said. “The Harvard Pilgrim board can’t deal with two major things at once. Partners will want to wait and see if something else shakes out at Harvard Pilgrim.”

Today’s Boston Herald: Harvard Pilgrim CEO resigns over ‘behavior’

Neither Schultz nor a company spokeswoman would comment on the nature of his behavior, or whether he is receiving any severance payments.

“I think the board is likely to be sensitive to that topic here,” said David Williams, president of Health Business Group. “Any expense is going to be borne in some ways by the customer.”

Yesterday’s Boston Globe: Beth Israel and Lahey say they want to learn from missteps in earlier merger

Beth Israel Deaconess and Lahey do seem to have much in common. Both have flagship medical centers and a network of community hospitals. Both are considered high-quality, and they have lower costs compared with the region’s largest hospital network, Partners HealthCare. On their own, both have struggled to compete with Partners, which includes the renowned Massachusetts General and Brigham and Women’s hospitals.

“There’s a decent amount of compatibility and similarity,” said David E. Williams, president of Health Business Group, a Boston consulting firm. “BI and Lahey spent a lot of time getting to know one another and making sure that this is a good fit.”

The current edition of Chief Executive: Athenahealth CEO Jonathan Bush resigns: Avoiding a similar fate

In both cases, Sonnenfeld says the boards didn’t have the fortitude to stand up to the attacks. David E. Williams, president, Health Business Group in Boston, similarly seen this scenario play out before where a founding CEO is ousted by investors.

“It actually usually happens at an earlier stage than what you’re seeing here. What’s so noticeable here is that [the CEO] has been involved with the company for a long time and is a large publicly-traded company,” Williams says.


By healthcare business consultant David E. Williams, president of Health Business Group.

 

 

Partners/Harvard Pilgrim merger madness: I’m quoted in the Boston Globe

published date
May 9th, 2018 by
Beast of the East?

I just finished my post (Partners and Harvard Pilgrim aren’t really going to merge are they?) when I got a call from the Boston Globe asking about the same topic.

I’m quoted on the front page today (Experts puzzle over Partners-Harvard Pilgrim merger talks) and am happy to see I’m not the only one that is struggling to see the logic behind such a combination.

Here’s what I said:

“My guess is that regulators would not like this,” said David E. Williams, president of the Boston consulting firm Health Business Group. “There’s no compelling logic for a merger here. There would be a lot of resistance to it.”

Williams said he doesn’t see a good business reason for a merger since Partners and Harvard Pilgrim, one of the largest health insurers in Massachusetts, could choose to work together more closely while remaining independent.

I’m pretty sure the idea of a merger won’t get very far. Stay tuned.


By healthcare business consultant David E. Williams, president of Health Business Group.