We are clearly in an intense healthcare era with risks that include major regulation uncertainties, managing population health and pressure to continue reducing costs. Healthcare leaders will need a range of skills to navigate these complex times. Flexibility is important, but one characteristic long prized in Silicon Valley is useful now—being bold. They need fearlessness. Of course, plans need compelling strategies, continued growth, strong relationships, and effective operations with good outcomes and profitability as deliverables. However, today’s pressures have created a volatility for survival for some organizations and require dramatic pivots for others. Successful plans will need to capitalize on this chaos by harnessing a convergence of clinical, behavioral, social, and environmental factors for people.
With that, leaders must be fearless in doing at least four things:
1. Articulate clear strategic options and have comfort with ambiguity
There has not been a recent time when leaders needed more comfort with ambiguity and complexity than now. Strategy has become a game of three-dimensional chess. Effective leaders must think, speak and act clearly while bringing the organization forward with highly engaged teams. Regardless of the exact shape of national healthcare legislation, cost pressures will continue. Leaders must also address strategic relationships, physician alignment, labor shortages, and effectively innovate. Plans must adjust their business models and steer away from only clinical thinking. Relying just on claims payment and making coverage determinations is not enough value added for long-term positioning and growth. Even care coordination as once known is passé. A broader, more inclusive view and talent portfolio is required to ensure success now and in the future.
2. Build more inclusion among top leadership ranks
To add new perspectives, seize opportunities, reduce expense, and address unmet needs that can be monetized, leaders need more inclusive C-suite teams. If change moves at the speed of trust, then plans will gain from diverse senior executive teams that are creative and infuse their unique perspectives into changing markets. Leaders must leverage both empathy and insight for business solutions with more diverse customer bases. These micro-insights pay off and can get scaled for big rewards. It makes strong business sense and holds enormous potential upside for organizations.
3. Use data effectively and collaborate well with traditional and non-traditional partners
Having a command of data as intelligence is a critical leadership competency for health plans. Plans must continuously design and disrupt digital platforms as an essential component of their business model. This requires collaborating with both traditional and new partners. Many do not do this well and especially in real time. To improve results, organizations need effective partners that share a data-driven focus. Leaders must build optimal collaborations that overcome natural apprehensions and trust deserts on new partnerships, too. This is particularly true in calculating partnering with potential competitive substitutes such as ACO’s and other delivery alternatives which includes weaving in social determinants.
4. Intersect social determinants into clinical care delivery models
The industry is abuzz that only 20% of health outcomes result from what plans spend on nearly 70% of their medical expense. It’s stunning to consider that for the bulk of most people’s lives, 80% of their health outcomes will not come from hospitals, physicians or drugs. The majority of outcomes come from social determinants which are usually not covered. Plans and providers will struggle to reduce expense especially for complex populations until coherent strategies that intersect care delivery and social determinants are hard-wired for prevention and cost avoidance. This model will require partner alignment and innovative payment. Here again, leaders need the vision to connect these dots across disciplines and ensure that this convergence produces meaningful results based on data, insight and execution.
So, who’s ready to be bold?
John Mathewson was previously interim CEO for the DC Primary Care Association and has led health plan, hospital, and home care organizations. He is active on boards for multiple business and national industry organizations and his career includes roles with CIGNA, Kaiser Permanente and Prudential. He is also an editorial advisor to Managed Healthcare Executive.