Seven Things Managed Care Can Learn from Other Industries

“Southwest Airlines has excelled at envisioning potential changes in their industry and then determining how they would successfully respond to them with tremendous success. Their responses to 9/11 as well as how they handled a significant rise in aviation fuel prices are legendary in their industry. We do far too little of this type of planning in healthcare despite the fact that our future is always a wide range of possible scenarios.”

Don Hall, MPH, is principal of DeltaSigma LLC, a consulting practice specializing in strategic problem solving for managed care organizations. He most recently served as president and chief executive officer of a nonprofit, provider-sponsored health plan.

“The retail market and related patient/member education are still relatively new to the healthcare sector and we could learn a great deal from other industries and companies who have excelled in this regard.”

Douglas L. Chaet, FACHE is chief managed care officer, Sentara Healthcare, and chairman, American Association of Integrated Healthcare Delivery Systems.

“We need to have better cost accounting across the healthcare continuum.”

Perry Cohen, PharmD, is chief executive officer of The Pharmacy Group and the TPG family of companies, which provides services to associations, healthcare and information technology organizations, payers and pharmaceutical companies.

“We can learn a lot from the banking industry when it comes to these critical tools which could help healthcare organizations effectively lower operating costs, improve coordination, personalize customer care and service, and inject a much greater social context into the healthcare experience.”

David Calabrese, RPh, MHP, is senior vice president and chief pharmacy officer at OptumRx, a pharmacy benefits firm that provides pharmacy care services for more than 65 million lives nationally.

“Other industries are so much better at being consumer-centric. We get way too involved in the complicated ‘delivery’ and we don't really understand how consumers view and want from healthcare.”

Amy Shin is the CEO of Health Plan of San Joaquin, a not-for-profit plan serving 350,000 Medicaid members in San Joaquin and Stanislaus counties of California. Amy has 20 years of progressive Medicare, Medicaid, and commercial managed care leadership experience.

“Managed Care needs to view the entire business as a process and begin to seek quality improvement in each step in the process.  This model has led to significant productivity gains in many industries.”

David Schmidt is president of the TPG International Health Academy, which hosts trade/study missions around the world for U.S. healthcare executives. He also provides strategic consulting to health plans and health systems.

“We can learn from Uber and Lyft when it comes to this skill. Healthcare needs to learn how to transform its cost structure from the sharing economy that matches dynamic demand with fixed supply.  On the fixed supply side, the health industry needs to think beyond just beds and exam rooms and include expertise that can be delivered virtually, like translation services, dependency services, pharmacist services, and behavioral health services.”

Dennis Schmuland, MD, is chief health strategy officer, U.S. Health & Life Sciences division of Microsoft Corp., where he is responsible for setting the company’s strategy and overseeing solutions for the managed care industry.