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Value-Based Contracting Strategies From All The Large Payers

Value-Based Contracting Strategies From All The Large Payers

Kevin Riley will be moderating a panel of accountable care experts this week at the 2016 FLAACOs Conference. Our session, Value-Based Contracting Strategies From All The Large Payers, asks the big questions from big thinkers at UnitedHealthcare, CIGNA, Florida Blue, and Aetna.

We see this topic as one of the four pillars of innovation, that is driving modern healthcare in the United States.

  1. Remove the inefficiencies in the system that create waste and allow for fraud.
  2. Continue to drive the onus for an individual’s health to the consumer.
  3. Change risk-sharing models to better incentivize providers.
  4. Move care from high-cost to low-cost venues.

The intent of ACOs is to move away from the traditional pay-for-service model to one that better aligns care with the holistic needs of the patient all within a more affordable cost structure. If you want to quickly learn about what an ACO is and how an organisation can benefit from becoming one – check out the Game of ACO from the National Council for Behavioral Health.

The Game of ACO

The session is Friday, October 14, 10:30 am – 11:30 am, right after the Key Note. The event is held at the Omni Orlando Resort Champions Gate. We hope to see you there.

Facilitator:

Kevin Riley, imagine.GO, kevin@imaginego.com

Panelists:
Andy Marino, Florida Blue, andy.marino@floridablue.com

Michelle Copenhaver, Aetna, CopenhaverM@AETNA.com

Ruth Fricke, United Healthcare, Ruth.Fricke@uhc.com 

Mike Howell, CIGNA, Michael.Howell@Cigna.com

FLACCOS 2016

imagine.GO provides rapid product innovation for healthcare companies using our proprietary delivery methodology modelH. We speak and write quite a bit about value-based healthcare models.  You can read more here:

to your health,

The Team at imagine.GO

Innovation or Innovation Theater?

Innovation or Innovation Theater?

Most Innovation Efforts Yield Poor ROI

“But when I have drilled down into the work the so-called innovation labs were actually doing day-to-day, I have discovered that it is actually the innovation managers that “don’t get innovation” It turns out your boss was right to shut down your lab and here are five reasons why.” Forbes, Tendayi Viki

We try and stay pretty positive about innovation and disruption – after all, it is what we do for a living. However, I saw this article recently, and it struck a chord with our entire team.

Five Reasons Your Boss Was Right To Shut Down Your Innovation Lab

From the article, we agree with the author’s points about:

  1. Most people working innovation labs tend to conflate innovation with creativity.
  2. A lot of innovation labs are working on projects that are not aligned with the parent company’s strategic goals.
  3. Innovation labs need to have a strategic focus.
  4. The job of an innovation manager is not to imitate the outcomes of innovative companies (i.e. ping pong tables and bean bags), but to understand and implement innovation practices to create one.
  5. After many years, most innovation labs have to demonstrate impact.
NYU Tandon School of Engineering, CITE Game Innovation Lab

How Do You Know If Your Innovation Effort Needs Disrupting?

I am proud that (before it was all the rage) I was one of the 1st Chief Innovation Officers in healthcare.   As part of a $12-billion-dollar machine that had been running pretty much the same way for 75 years, I certainly found the task daunting.  Coming from the startup world, where I had successfully helped launch national healthcare disruptors like RediClinic and The Little Clinic, it was a shock to the system (mine and theirs). That journey is food for another story. However, my time there changed me in a very positive way, and I am certainly pleased with the results.

I mention it, however, because the article above made me realize what I could not verbalize but was feeling – most corporate innovation programs are little more than “innovation as theater.”  Even with best intentions, many of them have missed their purpose, which is to disrupt. Instead, many innovation managers busy themselves (and burden others) with the non-essential work.

We decided to add in a few self-check questions that we believe all innovation managers should ask themselves. And if the answer is “Yes” (please be honest here) to most of them – then you probably need to rethink your innovation efforts.

  • Is your Innovation Lab more than walking distance for more than 95% of your employee base?If so, bad idea. Innovation is for anyone who can contribute – incrementally or significantly. Who are we to think innovation only lies with a small team? This approach is a sure fire way of creating the “us vs. them” scenario.
  • Do less than half of your “market ready” innovation projects get adopted by the core business?If so, then you are probably innovating for yourself. If no one wants or can use your best work, then you are not aligned with the work of the “core.” Remember, it is the big machine that pays for your experiments (and expresso machine and bean bags). You have to be meaningful to them if you want your work to take root in the market and grow.
  • Do you spend more time at innovation conferences than producing successful “market ready” innovation projects? This one should be obvious. No one can tell you what will disrupt your business better than you. That is what you are paid to do.  As fast as you can, learn the basics of minimum viable product development and agile methodology – and get busy disrupting.  If you want some help learning or doing – call us because this is what we do best.

Well, that is what we think at least.  But hey, we could be wrong. Let us know one way or the other.

 

To your health,

The Team at imagine.GO

imagine.GO helped Dell Healthcare design & launch CRM+

imagine.GO helped Dell Healthcare design & launch CRM+

Dell Healthcare hired imagine.GO to design and launch a CRM solution for health insurance companies.

Dell Healthcare is one of the largest Healthcare Technology Services providers in the world. They provide the people, processes, and technology to help health plans and large health care providers create the healthcare of the future.

The goal of this project was to define the ideal approach for implementing Salesforce.com as a CRM solution for health insurance companies.  We used our 15+ years of implementation experience to not just design and build a technical solution, but also define the best way to implement it for Dell and its health care clients. Our work included how to set client expectations, how to make key design decisions, the best way to set up user roles, and our expert recommendations for customizations to the core Salesforce system.

Our final product produced solutions for health insurance lead management, sales, onboarding, service, and even care management. A high-level view of a few of the features in the solution are shown in the images below.

imagine.GO provides Salesforce CRM implementation services for healthcare companies using our proprietary delivery methodology (Decision Driven CRM Design). We also develop our own Healthcare Applications, currently available on the AppExchange.

to your health,

The Team at imagine.GO

imagine.GO to Present at Dreamforce 2016

imagine.GO to Present at Dreamforce 2016

We have been busy this year helping companies launch new healthcare products.  We have been doing some killer work on the Salesforce.com  platform for one of our clients CareCentrix. CareCentrix is the leader in managing patients from high-cost hospital settings into the comfort and safety of their homes. For 20 years, they have worked with payors and providers to create programs that improve quality and lower costs via patient care in the home.  We love this client because they are serious about our triple aim of creating real value in healthcare. To us, “value” is measured in:

  • Improved consumer experience yielding an informed decision maker aligned to their risk and reward;
  • Increased access to necessary care through an engaged delivery system; and
  • Reduced aggregate cost of care, with a market-driven, balanced incentive and reward model.

Speaking of Salesforce, we had planned to skip Dreamforce this year – but our partners there convinced me otherwise.  

So…

Dreamforce

We are presenting in the Dream Theater on our Health Cloud implementation and our client (CareCentrix) is on one of the main stages.

 

We are set to speak at Thursday, October 6, 12:15 PM – 12:40 PM and the Moscone South, Industry Partner Theater.

Our presentation is titled: Using Health Cloud to Shift Patient Care to the Home

Annual healthcare costs are $3.0 trillion. A solution is to move care from high-cost arenas into lower cost one. imagine.GO is a health-focused innovation consultancy that also develops applications for the AppExchange. Come and see our solution enabling healthcare delivery in the home using Health Cloud and Communities.

Please use this link to enroll in our session:

https://success.salesforce.com/Sessions#/session/a2q3A000000BMDrQAO 

best wishes, 

Kevin

How to Get Started with CX at Your Healthcare Company

How to Get Started with CX at Your Healthcare Company

CX is all the rage these days. It seems that most of it is couched in theoretical theory and “potential” value creation. To be clear, we think it definitely has its purpose. In fact, it is core to our modelH approach. But, we are weary of anything that cannot be implemented in an Agile fashion.

In a McKinsey survey of senior executives, 90% said customer experience (CX) is one of the CEO’s top 3 priorities. This fact is due to increasing customer expectations in an evolving digital marketplace. Customers expect more, better and faster – and they expect you to know and fix your process problems. McKinsey research indicates that for every 10-point up in customer satisfaction, companies increase their revenues by 2 to 3%. Gains come from increasing wallet share (more product purchases) and lower churn rates (fewer customers leave). Satisfaction is correlated to operational or infrastructure-related factors. These include price, transparency, cycle times, product features, and use of digital channels.

distorted-office-hall

We take for granted that the result of a great CX discipline produces customer action (behavior change), satisfaction (customer happiness), and attraction (brand loyalty).  As a result, your employees will be able to understand how their work impacts the member’s experience – and establish a baseline for all future CX endeavors.

Though this seems straightforward, implementing a customer experience discipline within a company is difficult. So how do you begin?

Well, even the longest journey begins with a single first step. Experience is something that can be designed, implemented and measured. In healthcare, favorable experiences can make a difference between healthy/profitable customers and unhealthy/expensive ones. A better experience comes from orchestrating a customer’s journey across channels. Experiential design starts with recognizing and prioritizing your (i.e. your customer’s) most important “touches” so you can optimize the operational factors that drive them. For health plans, the inventory of touches includes your member as well as your providers.

We recommend you start with defining (in a minimally viable way) how the discipline of Customer Experience (CX) will work at your company. Although CX eventually encompasses all of your company’s touchpoints and communications, synchronized across channels to achieve maximum customer activation and brand awareness – we are asking you to just spend a day outlining the basics and assigning responsibility for them. Just do enough to define your most important first CX project(s) and get someone assigned to the task. Then see where it goes from there – and keep it Agile.

As first projects go, we recommend you start with a journey map. A Customer Journey Map is a graphic representation of the journey your prospect/customer takes in relationship to your organization over time and across all touch points.  This tool emphasizes the intersections between your processes, your customer’s jobs-to-be-done, your measures, and your customer’s expectations. If you cannot define the touches, how can you truly prioritize which need fixing first? We recommend you first focus on the “experiences” that move the needle for customers and impact your cost/profit outlook. A few things stand out for prioritization. Digital journeys should be prioritized over manual ones as it easier to “fix” digital than physical. And, McKinsey research shows digital-first journeys produce higher customer-satisfaction scores than traditional journeys. Reducing journey time (the time it takes to complete an individual journey) should be prioritized over adding new features. Customer satisfaction has a higher correlation to “ease-of-use” than “feature rich”. However, keep in mind that there are diminishing payoffs for reducing journey time, so only take it as far as it produces returns.

modelh-consumer-behavior-when-purchasing

imagine.GO specializes in helping companies thrive where consumerism and health care converge. We have helped organizations ranging from fortune-100 companies to startups, quickly define better business models and communicate them to stakeholders. We have implemented our “100 Days to Customer Experience” model for several large health insurance plans and other retail-focused healthcare companies.

Here is the link to the McKinsey article we are referencing (The four pillars of distinctive customer journeys).

To your health,

The Team at imagine.GO

Happy Holidays from imagine.GO 2015

Happy Holidays from imagine.GO 2015

What a phenomenal year we had in 2015. imagine.GO is proud to have worked with some of the biggest names in health care this year – as well as some we believe will be in the not-so-distant future. Look for us to continue to launch innovative solutions into the market as we work with healthcare companies to hone their business models and get to market fast.

We wish you and all of yours a blessed, peaceful, and joyful holiday season.

imagine.GO Holiday Card 2015 part 2

 

To your health,

The Team at imagine.GO

 

McKinsey on Business Model Innovation

McKinsey on Business Model Innovation

It is nice to see McKinsey publish an article on something imagine.GO pioneered in healthcare. The use of business model innovation as a means to drive transformation into new models and new markets – and ultimately disrupt yourself.

“We’re often asked, “Can you keep innovating?” The truth is, I find that the more you innovate, the more you can innovate.” – Adrian Gore is the founder and CEO of Discovery

We pioneered this at GuideWell and since that time, we have worked with many great healthcare companies. We have even had the good fortune to get to work with some of the Discovery team in the U.S. via Humana Vitality.

imagine.GO Clients

 

Our modelH method enables companies, large and small, to quickly generate better business models and communicate them across stakeholders. We apply it to companies that need transformation or want to create new products with real product market fit. We also apply it to start-up concepts to build them into sustainable business models. Here is the article from McKinsey.

You can learn more about our application of business model innovation here.

modelH Methodology

 

To your health,

The Team at imagine.GO

 

2015 Research on Retail Insurance

2015 Research on Retail Insurance

imagine.GO and Deft Research have worked together to co-author a study on the value of retail health insurance stores in the eyes of healthcare consumers. The study can be purchased from imagine.GO or Deft for $5000.

02 Retail Study - 1 in 4

Our study specifically explores:

  • The retail consumer experience through year one of the ACA.
  • Retail design concepts that are most favorable to ACA health plans.
  • Retail location concepts that are most favorable to insurance buyers.
  • Benchmarks related to the decision-making, design, build, and operations of a store.

 

To your health,

The Team at imagine.GO

 

3 Rules for Healthcare Business Building

3 Rules for Healthcare Business Building

We just got back from a week in Boston where we presented at the Health 2.0 and Mad-Pow sponsored HXRefactored Conference. They did a great job with the conference, and we had a good time and met some very cool folks on the cutting edge of health and design. I was honored to be able to present with Matt Holt, Google Ventures, & Henry Ford Innovations at Dollars & Sense: The Business of Healthcare. We each gave perspectives on building healthcare businesses.

My talk focused on three simple rules for building healthcare businesses.  In brief, they are:

1. Make sure your business model has applicability to all parts of the healthcare ecosystem. WHY? Building healthcare business models require understanding the dynamics of the ecosystem. It is very hard to disrupt the players. Make sure you know how your stuff helps their stuff.

2. Make sure your business model speaks to all parts of the healthcare canvas. WHY? Building healthcare business models require understanding the moving parts and then showing how they interact. We think there are more of moving parts that Alex Osterwalder’s 9 (although we love his 9 dearly). That is why we built modelH – a business model canvas designed specifically for healthcare companies to develop and explain their business models.

1. Make sure you business model is more than just a canvas. WHY? Building business model canvases is part of building businesses – but you are a long way from viability with just a canvas. Building healthcare businesses also require more than LEAN & your MVP (but please start with this). This is why our model for building businesses is focused on commercialization from the go.

In summary, know how your model will apply to the healthcare ecosystem, explain how your business model serves all constituents in the multi-sided market (and is believable), and show how you will operationalize your business based on sound decisions.

Here is the deck. Enjoy and let us know how we can make it better.  And if you need help launching your company, contact us.

 

To your health,

The Team at imagine.GO