Blog : Health care Reform

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

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

 

Join me at AHIP’s Consumer Experience Forum, Nov. 19-20

Join me at AHIP’s Consumer Experience Forum, Nov. 19-20

In today’s retail world of health insurance, are you taking advantage of opportunities to engage with and provide exceptional service to your customers and potential customers?

I encourage you to join me in Phoenix next month at AHIP’s  Consumer Experience Forum, Nov. 19-20 (www.ahip.org/Conferences/CEFThreeNov2014) to discuss this and more. The Forum brings together thought leaders from plans, researchers, consultants and leading companies to help you optimize your strategy for converting consumers into customers for life. I’m pleased to be moderating this conference, and I can tell you from experience that it will be a highly engaging and informative event.

I hope to see you there. Use promo code LK14KR  to receive a discounted rate. You can learn more and register here: www.ahip.org/Conferences/CEFThreeNov2014.

 

To your health,

The Team at imagine.GO

p.s. the code gets you $50 off – I make nothing on it – I just want to see you there.

 

modelH – Health Model Co-Creation Forum (part 1)

modelH – Health Model Co-Creation Forum (part 1)

Hello to all. I am working on a new project I am calling modelH  This project is a dynamic collaboration between me, Innovation Excellence, Batterii, and a bunch of great healthcare thinkers.

Batterii’s CoCreation® Platform powers this project, and my Business Model Method for Collaborative Healthcare Innovation guides it. Innovation Excellence’s worldwide Community of disruptive innovators fuels it.

Our goal is to create a business model canvas specifically designed to generate and evaluate healthcare business models that can create positive consumption experiences, improve care delivery, and align and control costs.  We then want to use our framework to co-create and test some innovative healthcare business models. The results will be compiled in a book to be released in 2014.

modelH - Health Model Co-Creation Forum
modelH – Health Model Co-Creation Forum

What is the problem we are trying to solve?

The American healthcare “ecosystem” in its basic form operates along 3 themes: care consumption, care delivery, and care financing. These domains are interdependent points of interaction along a value chain of healthcare. To impact one point, you really impact them all. Make no mistake – healthcare is a business! The problem is that very few people create business models that are considerate of all three points of view – and certainly no one has come up with a framework to make this easier.

Also, across the value chain of healthcare, there are four key stakeholders: patients, providers, payers, and purveyors. To put it in simple terms, the party who consumes the product of healthcare (the “patient”) is usually not the one who pays for it, or at least not most of it. The party that pays for it (the “payer”) is best served when it is not used, and is therefore motivated to push for less of it. Furthermore, the parties that deliver it (the “provider”), and the parties that support its delivery (the “purveyor”), are not aligned to place realistic boundaries on its cost, thus forcing the system into bankruptcy. Due to its divided nature, the ecosystem is overrun with inefficiencies and creates dis-incentives across themes and between stakeholders so that each maximizes their own value, often at the expense of the others.

But the system is not so much broken as made up of working parts not working together. Our diagnosis of the problem is a misalignment of the ecosystem’s building blocks. Our prescription is to reset these building blocks into a better working order. The outcome will be a healthy and aligned ecosystem that is both market-driven and cost conscious.

There is no better time to try and fix the healthcare system than amidst the current environment of reform. The team behind the modelH CoCreation Forum feels that a collaborative and systematic approach is the only means to overcome the interconnectivity barriers that exist to get past where others have failed. We have the means to accomplish this collaboration though Batterii’s CoCreation® Platform. We have the right approach for how to systemically validate a healthcare-specific business model through Kevin Riley’s Business Model Method for Collaborative Healthcare Innovation.  And through Innovation Excellence and our own networks, we have access to a community of radical innovators with representation across all key stakeholders, as well as business model experts, ready to engage with us in this year-long project.

This is where you come in! But before we ask you to get involved, let’s talk more about how we can solve this problem – together.

So, step up to the plate an get involved.

 

To your health,

The Team at imagine.GO

 

Can a Legacy Health Plan Innovate?

Can a Legacy Health Plan Innovate?

Can a traditional, low risk corporate culture stimulate innovation to stay ahead of the curve? I believe they can. If culture eats strategy for breakfast, innovation has to be part of the digestif at the very least.

But how can health insurers innovate and become more flexible in a heavily regulated market? They need to develop an organizational culture that prioritizes innovation and ties it to the organization’s strategic direction.

Creating a Culture of Innovation for Health Plans

The intent of innovation within an organization is to transform the core models and marketplaces (incremental innovation) as well as disrupt the core model  (disruptive innovation).

You can see an extended version of the talk I will be giving in the Slideshare below.

 

To your health,

The Team at imagine.GO

 

Power to the Patient

Power to the Patient

Retail health— from convenient care clinics in drugstores to the emerging insurance exchanges mandated by healthcare reform—has the potential to reshape the provider and payer markets. Health plans are taking a position by investing in technology, assisting members with price and quality transparency, and developing innovative care networks that broaden member access. This webinar in brief is about how consumer-directed healthcare empowers “shoppers” by providing them with information about price and treatment options so that they can pursue cost-saving opportunities. As a result, a growing number of managed care organizations are adding retail health stores and clinics within their networks. Consumers want convenience in their health care options, which is right in line with retail channels offer.

PANEL DISCUSSION: Power to the Patient: Technology and Networks that Support Consumerism

I will be giving a talk on Tuesday, February 26, 2013, at 1:30 – 2:45 in Arlington, VA at the 6th Annual Consumer-Directed Healthcare Forum.

Here we will discuss how consumer-directed healthcare (at its best) empowers consumer-providing information about price, quality and treatment options; offering network options and incentives, including access to low-cost self-care and retail healthcare; and providing tools, technology and interventions that help consumers make the best choices possible. I will provide insights on the evolution of retail healthcare and learn what’s coming next.

You can see an extended version of the talk I will be giving in the Slideshare below.

To your health,

The Team at imagine.GO

 

New Webinar on Retail Health

New Webinar on Retail Health

Retail Health and the Future of Health Insurance

I invite you to attend a webinar I will present this week on The Implications of Retail Health and The Future of Health Insurance on Tuesday, January 8, 2013, from 2:00 PM – 3:15 PM ET.

Retail health— from convenient care clinics in drugstores to the emerging insurance exchanges mandated by healthcare reform—has the potential to reshape the provider and payer markets. Health plans are taking a position by investing in technology, assisting members with price and quality transparency, and developing innovative care networks that broaden member access.

This webinar, in brief, is about how consumer-directed healthcare empowers “shoppers” by providing them with information about price and treatment options so that they can pursue cost-saving opportunities. As a result, a growing number of managed care organizations are adding retail health stores and clinics within their networks. Consumers want convenience in their health care options, which is right in line with retail channels.

The Evolution of Retail Health

What You Will Learn

This webinar will outline how you can best position your organization for success via retail health.

  • We will explore the origins and evolution of retail healthcare with an eye toward emerging trends that will impact your business.
  • I hope to show you how retail health coupled with consumerism can impact member behaviors—improving quality and cost.
  • We will also look at the impact of retail clinics on member access, costs, and quality.
  • Finally, we will examine how plans might formulate a retail health strategy to encompass market-based initiatives coupled with reform-driven mandates.

I hope to see you there.

To your health,

The Team at imagine.GO

Postscript

Here is the deck on SlideShare.

What Can Health Plans Learn from Retail?

What Can Health Plans Learn from Retail?

Podcast on Retail Health and Its Future

Listen to a podcast I gave where I discussed why health plans have a lot to learn from retailers. In this discussion, we cover many topics related to retail health, its evolution and its trajectory. We also discuss some upcoming talks I am giving.

What You Will Learn

  • This drive towards consumerism is spanning all industries – how are health plans reacting?
  • How can plans continue to attract and retain members in a competitive marketplace?
  • What are some of the key takeaways that attendees can look forward to this March?

Sketch Video

To your health

The Team at imagine.GO

 

Maximize Consumer Engagement via Technology

Maximize Consumer Engagement via Technology

Maximizing Member Engagement Through Technology

In the spirit of the Christmas season, I will be (re)giving a talk entitled Maximizing Member Engagement through Technology. This will take place on December 19th at 2:00 pm ET.

This webinar will cover a variety of efforts to connect with consumers in the marketplace, and how to use technology properly as both a channel and an experience. I gave this same talk this summer and it was so well received I was asked if I would do it again.

The Internet has transformed the way healthcare is managed and delivered. It significantly reduces costs, builds strong relationships with customers, and allows for tailoring of message on a faster delivery channel. As such, the question is not who is searching for health info online, but rather “who isn’t”?

My basic premise of this talk is that technology should serve as a means to help educate, navigate, plan, motivate and choose from suitable solutions for health care needs, anticipated and otherwise. If this sounds informative to you, or perhaps helpful to your own work – please join me.

What You Will Learn

During this webinar you will explore how a leading health plan developed these best practices and learn:

  • Optimize member engagement through technology.
  • Maximize the potential of retail health.
  • Increase member engagement through direct consumer marketing.

The webinar availability is guaranteed only to the first 250 registrations so if you are interested please register by clicking here.

To your health,

The Team at imagine.GO

 

3 Ingredients for Health Innovation

3 Ingredients for Health Innovation

Healthcare Innovation Require Three Things

For well over the past decade I have made innovative healthcare companies my home. In that time, I have developed a simple litmus test to determine if the company I am working with is ready, willing, and able to create breakthrough innovation. Let’s call it my “3-legged Stool of Innovation Readiness.”  Like any three- legged stool, it cannot stand on only one or two legs – it takes all three.

An externality creating an impetus (Ready)

I have heard that only wet babies like change. While I am sure the part about the babies is true, I am not convinced that most companies are truly resistant to change. The inherent desire is there, which we will talk about next, but without some external force applying pressure, most companies will forgo change to focus on the problems of the here and now. I think of this as needing equal parts carrot (desire) and stick (impetus). However, very few companies are disciplined enough to apply their own stick. Ingredient number one of the three-legged stool is that impetus.

Look at the healthcare industry as an example. With the exception of those services rendered to consumers for direct cash payment (such as Lasik and liposuction), we have seen little change in quality or cost. In fact, many trends seem to point in the opposite direction. Now this is obviously not the entire fault of the healthcare industry – I have always argued that consumers are equally culpable. However like those folks that would rather eat potato chips and sit on the couch instead of getting out and exercising, companies do not often seek out a change in lifestyle – even when, change is necessary.

So along comes some outside force to require that change – The Affordable Care Act. Say what you will about its inability to address the underlying cost issues; Reform has forced the hand of the healthcare industry to do something about the problems at hand. And now that we are past the point of no return, these companies must act or potentially cease to exist.

Without PPACA, I am convinced there would be little or no room for disruptive innovators like myself within the “healthcare industrial complex”. As it turns out, we are now in high demand.

But even with the requirement to change, some companies are not willing to change. Many say they are but are merely paying lip service to that fact. Let’s talk more about that notion.

A real desire to change (Willing)

So the second ingredient is a deep desire or a sincere willingness to embrace change.

I have heard that addicts will not change their lifestyle until they hit bottom and bounce. I am not sure it is that drastic for healthcare companies. But obviously, a company must be willing to make room for new thinking and new thinkers before it can change.

Let’s take a lesson from science here. Consider that adding any catalyst to a mixture creates some reaction. However, most catalysts get used up in the reaction. If you are being asked to both implement a new disruptive idea and create a culture of change readiness (where none exists) at the same time – be forewarned. What I have found is that you do not want to be the straw that breaks the camel’s proverbial back.

What I mean by this is that to realize large-scale sustained change within a large company, you need an established platform for change in place. Staring from a cold stop requires all of your energy to just get the ball rolling, and leaves you no time or resources to implement your new ideas. So, if you find yourself in this scenario, ask yourself if you are primarily a “change agent” or an “innovator.” A change agent is willing to focus on creating the infrastructure required to sustain change and introduce new ideas –which may or may not be their own. This is noble work and requires a full commitment to the long-term culture of the company that one is changing. An innovator, as described in this discussion, is about creating new value and getting new ideas to market fast.

So, if you are primarily an innovator and you are focused on getting your idea to market quickly, without having the luxury of a change platform in place – you will likely meet roadblock after roadblock. And you will become frustrated. And you will want to quit or be asked to as you gain the reputation for not being able to “get anything done.”

So this cautionary tale is for both you the employee and for you the employer. To the employer, I recommend investing time and energy in facilitating change readiness so that you can bring change agents in and they will have success. For you the employee – make sure you know who you are and which role you are being asked to play. This will ensure your happiness and their success.

A means to invest in the future (Able)

So the final ingredient is the hardest to come by – ability. Even with the previous two (assuming they are ready and willing) – a company must be able to change. They must be financially stable enough to commit resources in the form of capital and talent directly to unknown or uncertain outcomes. For a company struggling to stay afloat, or concerned with the cost of upgrading their core “plumbing”, this can be a frightening and unrealistic necessity.

So know the environment you are going into and the one that you are in. If your company is not willing to dedicate at least 1% of their capability budget to innovation/R&D, then you will forever be chasing ideas and never implementing them. Great leaders like AJ Lafley from Procter & Gamble understood the need to invest in radical ideas. Ask your leadership if they are willing to “put their money where their mouth is” – with no strings attached.

A quick note of caution in this respect – if you are promised a budget based on other conditions (like finding savings elsewhere) – you are most likely not going to get it. We all know that overruns and unforeseen circumstances or priorities are common occurrences, and if you budget is relying on the efficiency and generosity of another group – be prepared.

A Final Note

When you find all three of these ingredients in a company – jump on the opportunity. My coming to Florida Blue (the Blue Cross Blue Shield Plan of Florida) in January of 2010 to be their Chief Innovation Officer, was predicated on their alignment with these three requirements for “breakthrough innovation.” As such, we were able to accomplish some amazing things and be counted among leaders in the healthcare payer space in innovation.

And if you are lucky enough to find all three ingredients, it is your job as an innovator and/or change agent to respect and nurture them within the organization. Ensure that you continually and effectively lead the clarion call for the importance and progress of your work. Congratulate your peers and leadership for their commitment to innovation, and remind them of their professional responsibility to advocate for, and push change in your company. Most importantly share in the victories you have created with and because of their sacrifices.

To your health

The Team at imagine.GO