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Innovation will help you survive major changes


According to several presenters at the recent America's Health Insurance Plans Institute, coordination, communication and challenges are now the industry's driving forces.

You know you can't wait until your organization is teetering on the brink of disaster before you think about reinventing yourself-particularly as you size up the more than 60 major regulatory deadlines that are headed your way in the next decade.

According to several of the presenters at last month's America's Health Insurance Plans (AHIP) Institute, coordination, communication and challenges are now the industry's driving forces. Many presenters insisted that plans will not be able to reform healthcare if they can't first reform their own businesses.

"We have to give people a sense that they can have confidence through change," said former President Bill Clinton, a keynote speaker at the event, talking about plans' role in serving their members.

"I agree with you that we should have done more on cost containment," he said.

Former Senate Majority Leader Bill Frist, MD, called the use of reconciliation to pass the new law "a huge mistake" and "antagonistic to half of America," warning that plans now need to become resources for the industry at large.

"It will be your job to pull people together, not politicians-they're out of it now," Frist told attendees.

New organizations will begin to emerge to fill the gaps that payers and providers aren't able to overcome-and they'll want their cut of the savings to boot. For example, care coordination, provider quality ratings and financial management for members are just beginning to reach the market, and traditional players haven't quite figured out the best practices just yet. Be prepared to work with even more outside sources.


Challenge is both a verb and a noun. While trying to mitigate the threats of change, challenge your own thinking and add reinvention to your list of core competencies. Don't assume your organization is resistant to change and attempt to retrofit your past business into the new landscape.

Only a few plans have started to negotiate provider reimbursement based on quality and gain sharing, but that type of innovation will increasingly become the rule rather than the exception. Quality care and rewarding the practice of evidence-based medicine is one area in which you can begin to innovate now. It's not out of reach.

What about transparency? Where can you innovate? If you're instantly resistant to the idea of "revealing" your proprietary data, realize that new organizations are already using explanation of benefit statements from your members to create a transparent resource on healthcare-service pricing, arranged by insurer. The information is already out there.

You've probably started to coordinate your community's healthcare framework in local health information exchange organizations, and it appears that most of the alliances are going well so far. That's a great starting point for other cooperative efforts.

If ever there was a time to coordinate, communicate and challenge yourself, it's now. Considering that going out of business might be the only alternative, perhaps change is not so bad after all.

Julie Miller is editor-in-chief of MANAGED HEALTHCARE EXECUTIVE. She can be reached at julie.miller@advanstar.com

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