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Healthcare truly not ready for the future


Among the list of changes that consumers simply are not ready to face is value-based purchasing and reduced care based on evidence

We’re going to have to increase our tolerance for serving up half-baked products in the healthcare industry. It makes me cringe to think about it, but I don’t know that we have much choice.

Either get in there and start marketing your best attempts at individual, small-business and Medicare-dual products or lose out on opportunities. Policy rules don’t allow much time for refinement, so we’ll have to forgive ourselves for making mistakes, knowing that the market truly isn’t ready for most of the changes.

For example, consumers aren’t ready for value-based decision making. Their passivity and resistance to change will work against even the best programs.
Here’s my list of things consumers aren’t ready for:

◾ Shopping for coverage on exchanges--There’s a lot of uncertainty about the effectiveness of and funding for navigators who are supposed to help consumers shop. Even if the selection process goes smoothly, understanding benefits, networks and limitations will baffle most consumers after they sign up.

◾ Choosing low-cost, high-quality providers--Accenture recently reported that 70% of consumers who are worried about costs aren’t willing to change providers even if it saves money.

◾ Planning ahead for future healthcare expenses and high deductibles--According to the Department of Commerce, the personal savings rate is around 3.5%. However, consider the rise in healthcare premiums as a percentage of income: from 12% in 2001, to 23% last year, and a projected 30% of income by 2023. Saving for future out-of-pocket healthcare expenses seems impossible when the rise in premiums alone eats up a family’s overall attempt to save.

◾ Less care, based on evidence--Ask any physician whether his or her patients are ready to forgo care. They’re not.

◾ Personal responsibility, including the individual mandate--Some consumers will begrudgingly pay the penalty rather than buy coverage simply out of principle. They don’t want any government telling them they have to buy something.

Your laundry list

For the industry stakeholders, the challenges are equally rough. Here’s my list of things the industry isn’t ready for:

◾ B-to-C marketing of health plans--The only exception so far seems to be California. The exchange board is moving forward with the Covered California brand, and a county Medi-Cal office has a wonderful, visual ad campaign featuring “uncovered”--as in naked!--people.

◾ Customer service--Health coverage is extremely confusing for most members because of industry jargon, exceptions and unique situations not spelled out in benefit materials. Your service agents must be prepared for the unique questions, not just the average member looking for a provider. Empower agents to resolve member questions on the first call.

◾ Leveraging comprehensive clinical information--Few plans can handle big data. Most will need to set small targets for data synthesis and grow slowly from there. The key to big data is connecting the dots to arrive at an information-based strategy.

◾ ICD-10--The deadline is October 1, 2014. Payers need to be able to accept ICD-9 and ICD-10 at the same time until those old claims are through the process. Providers are woefully unprepared, so ICD-9 will have a long, painful halflife.  MHE

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