Category: Health plans

Simplify Healthcare CEO Mohammed Vaid on helping health plans with administrative automation (podcast)

published date
April 23rd, 2018 by
Simplify Healthcare CEO Mohammed Vaid

The average consumer might not know it, but health plans are often mired in complexity and inefficiency as they struggle to configure and deploy new offerings. A surprising number of plans rely on spreadsheet-based systems to manage their plan benefit packages —  a surefire formula for driving up labor costs and making errors. Some have spent tens of millions of dollars trying and failing to automate theses processes.

In this podcast interview, Simplify Healthcare CEO Mohammed Vaid shared his perspective on this problem and its solution.

  • (0:14) What are some of the main inefficiencies you see with health plans?
  • (3:44) Are these problems widely recognized within the plans?
  • (5:08) Have they become more of an issue recently?
  • (7:12) What approaches have been taken to address these problems?
  • (10:12) What are the more promising ways to address these issues, perhaps starting with benefits?
  • (12:12) To what extent have such enlightened solutions been implmented? Are there success stories out there?
  • (14:10) Tell me about Simplify Healthcare and how your company gets involved. What’s the experience like for a customer?

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

Tufts Health Plan CEO Tom Croswell on value based care (podcast)

published date
March 5th, 2018 by

 

Tufts Health Plan CEO Tom Croswell is a veteran of the health plan world. I sat down with him recently to discuss value based care, collaboration, diversity and how Tufts tries to set itself apart in a crowded market. Tufts is best known for serving Massachusetts but is also expanding into neighboring states. It has a joint venture in New Hampshire and just announced its entry into Connecticut in partnership with Hartford HealthCare.

Overview:

  • (0:08) What’s the outlook for value based care? Have the attacks on Obamacare taken a toll?
  • (1:15) Tufts got started in a value based way. Say more about that history.
  • (3:55) You talked about partnering. Who are the partners? How do you work with them?
  • (5:29) Do health plans need to take an adversarial role with providers? Does your collaborative approach actually work?
  • (7:42) Does collaboration just work in Eastern Massachusetts? Or can it work more universally, including your new market of Connecticut?
  • (8:59) Let me ask you about a couple of other buzzwords: diversity and inclusion. What do those words mean to you?
  • (11:02) Are there particular things you do at Tufts on diversity and inclusion related to your own workforce?
  • (12:36) Can you measure the impact of your policies and activities?
  • (13:54) Are you optimistic or pessimistic about 2018?
  • (15:00) How do you think about differentiating Tufts Health Plan from all the other strong players out there?


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

What Amazon can’t do

published date
February 13th, 2018 by
Watch out below!

Now that Amazon and its partners JP Morgan Chase and Berkshire Hathaway have decided to tackle healthcare for their employees, everyone  is tossing out ideas for what they might do to solve the system’s myriad problems.  I count myself among those lobbing in suggestions, with my emphasis on making the system more patient-oriented.

Two letter writers in the Wall Street Journal have interesting ideas about what the partnership should do, but ultimately they are misguided.

Fred Hyde, MD, JD, MBA thinks the team should take advantage of association health plan (AHP) rules to beat up providers over pricing, pointing the finger at “monopoly pricing by larger health systems” and prescribing reference pricing or a Dutch auction for the procurement of hospital care. He points to ERISA as a great liberator for larger companies and thinks  AHPs could be the answer for smaller businesses.

Well, all three partners already can take advantage of ERISA and that hasn’t really helped them. There’s also no particular reason to think providers are going to give the companies lower prices just for the heck of it.

Robert E. Mittelstaedt Jr., Emeritus Dean from Arizona State University, thinks full price transparency is going to be the answer, “forcing patients to make economic decisions” and pushing government to allow providers to compete on price. In my experience providers don’t want to compete on price and sick patients and their families are not well positioned to shop for most healthcare, especially the expensive and emergency stuff like cancer treatment and trauma care.

The writer says the partnership is “no different” than the history of Kaiser Permanente. In that case why not have all employees join Kaiser? After all there is already Kaiser Permanente Washington, based near Amazon’s headquarters, the former Group Health Cooperative. These plans are no panacea.

I’ve heard people quip that the best thing this group of companies could do for their employees is advocate for a single payer system in the US. I think they can do better than that, but it’s actually a better idea than a lot of what’s being discussed.

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

Amazon: Force the healthcare system to become patient-centric

published date
February 6th, 2018 by

The announcement that Amazon will work with JP Morgan Chase and Berkshire Hathaway to create a new healthcare organization for employees has health plans and providers running scared. Initial press coverage has focused on the impact of this group on the market value of CVS, United Healthcare and the like –but how many people really care about that?

CareCentrix CEO John Driscoll has the right idea when he suggests that Amazon should compel provider organizations to put the patient first –for real, not just rhetorically. His three specific suggestions are good ones: mandate self-service scheduling, introduce  a universal patient portal, and improve the quality of provider reviews. As simple and straightforward as those sound, they would require Amazon and its partners to overcome serious resistance. It will be fascinating to watch what happens.

Assuming Amazon can make those basic but challenging changes come to pass, I have two additional, ambitious suggestions to help patients:

  1. Ensure that patients receive clear, consistent, actionable follow-up information when they leave a doctor’s appointment or are discharged from the hospital.
  2. Use the full set of information available about a patient to anticipate their needs and help them navigate the system.

The first idea is a simple one, which should be happening anyway, and occasionally does. The challenge is to get the provider system to care enough about what happens upon discharge and provide the tools, training, information and support to enable more seamless and empowering transitions. I was shocked at how poor the discharge instructions were after my release from the emergency department a few months ago, after I was struck by a car. I received basically nothing and had to count on family and clients in the medical system to help me. I know I’m not the only one who’s had this experience.

The second idea is broader and vaguer, but starts to draw on the expertise of Amazon’s partners who are in the financial services and insurance industries and have a lot of information about their customers. The consortium could help patients chart their financial path through the healthcare system, helping them identify what insurance to select, how much to save in their HSA and FSA, and where and when to get their care. It could be a virtual concierge for patients, relying big data and machine learning to provide insights and continuous improvement.

If these suggestions were implemented they would have a high impact, even though they would not completely transform the system. It seems like about the right level for this group to shoot for. If they try to be bolder they will likely fail.

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

Getting a handle on health insurance data: Podcast with Vericred CEO Mike Levin

published date
January 3rd, 2018 by
Michael_Levin_Vericred_CEO
Mike Levin, Vericred Founder and CEO

A huge ecosystem of technology companies has sprung up with tools to shop for health insurance, search drug coverage, administer HR and benefit plans, make physician appointments and more. They all need accurate, accessible, and detailed data on topics such as health plan design and rates, provider network participation and drug formularies in order to succeed. It’s remarkably difficult and expensive to obtain and maintain the data, and this has created an opportunity for a specialized company —Vericred— to perform the function as a utility for the whole industry.

I’m excited by the opportunity and recently joined the board of Vericred to help guide the company’s growth. In this podcast, I interview founder and CEO Mike Levin about the market and how Vericred is addressing it.

Overview:

  • (0:15) What are some of the key data challenges in the health insurance market?
  • (1:53) Why are these problems so tough? Don’t other industries have similar issues?
  • (6:23) So what’s the problem? With consumerization you have all these new players springing up and health plans just need to work with them, right?
  • (7:40) What are the typical approaches to addressing these problems? Are the problems being solved?
  • (9:16) You talk about “liberating” the data. Doesn’t that scare health plans?
  • (11:11) What does Vericred do to address these issues? Are you gaining traction?
  • (15:03) Who are your customers?
  • (17:10) Are there analogs in other industries or this is a unique beast for healthcare?
  • (18:13) What changed with the passage of Obamacare and emergence of the marketplaces? And what is the impact of recent actions to undermine Obamacare?
  • (20:23) How did you get involved with founding the company? How did it go from concept to implementation?
  • (22:44) What changes do you expect in 2018? How is the company evolving to keep pace?

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