Blog : Retail Health

How to Explain Healthcare Reform to Your Customer

How to Explain Healthcare Reform to Your Customer

This is a tale of two customer conversations about healthcare reform. The first is conducted by an insurer and the second by a large consumer financial services company.  Guess which one tells a better story. Here is a hint, not the health insurer. This article is not about picking on one or the other. It is about trying to uncover why healthcare companies have such a hard time communicating about their industry in a manner that is simple, clear, and effective. I set out to make a fair and honest comparison, and was actually disappointed in how bad the insurer got it.

H&R Block Reform Conversation Header

Why Communication is so important to Win Health Insurance Business

The battle for healthcare communication must be fought and won. As we head into the first enrollment period under the new Affordable Care Act (ACA), most small businesses do not have a clear or accurate understanding of what will be required of them to “play.”

This is a problem. I advocate that small businesses have the most change thrust upon them, and make up the market that is most competitive in the health insurance landscape.

I am not talking about the U.S. Small Business Administration’s (SBA) definition of a small business, which includes operations with up to $7 million in revenue or 500 employees. I am talking about the ACA definition of a small business – those with 50 employees and under, which includes most of the businesses in the country.  To put this in perspective, according to the to the most current U.S. census data, companies with 9 employees or less make up 95% of small businesses.

Provisions in the new law present difficult new decisions regarding healthcare benefits for companies of this size. Some employers must cover insurance for their staff or face a penalty. Some employers are exempt from having to buy insurance for their employees. Some can even be subsidized.  Here are some examples:

  • A small business with 50 full-time equivalent employees is required to provide coverage for employees who average 30+ hours a week, or a penalty will be applied.
  • A small business with less than 25 employees that pays average annual wages under $50,000 may qualify for a small business tax credit of up to 35% (up to 25% for non-profits) to offset the cost of insurance.
  • A small businesses may be eligible to use the new Small Business Health Option Program (SHOP) Exchanges to pick a plan they want their employees to enroll in. In 2014, the employer selects the plans, and employees choose from the selected options. In 2015, this changes to the employers selecting an actuarial value level and the employees selecting any plan in that range.

 

Infographic on Employer Understanding of Healthcare Reform

Source: Docstoc

So you would think Health Plans would be beating the streets to get the message out to all small employers.  It stands to reason that the Health Plan that does the best job of explaining healthcare reform and its implications on small businesses (thus taking a burden of information off of the small business owner) will probably be the plan that the employer selects for his employees in 2014. Assuming the Plan does a good job in 2014, there is a strong chance that the employees will keep that same Plan Carrier in 2015 and beyond. Yet, according to the infographic above, more than half of the exempt small businesses do not understand the basics of the equation. Who will win this business? The ones that does the best job explaining it!

2013 a critical year to compete for the small business health insurance.

But, healthcare reform affects more than just small businesses. It affects many individuals who are not on employer insurance roles as well.  To put this in perspective, according to the World Bank the total US workforce numbers a little more than 158 million.  By 2015 there will be 70 million independent 1099 contractors. That means that almost 50% of the US workforce will be an independent worker by 2015.  What are insurers plans to win this growth market?

2014 is critical year to compete for the under 65 consumer market.

What is Considered Good Communication?

H&R Block understands this cause and affect and has already started its communications to both groups. After filing my taxes this year, I was prompted to engage with the following interactive explanation of how the new healthcare reform law will affect me and my taxes. I made a quick video of what I thought were the highlights.

You can try it for yourself here: http://www.hrblock.com/healthcare/#.UWbNVSvzYm7

Now juxtapose this to a more comprehensive and confusing explanation by a major insurer. I was not prompted in the course of another action as I was with H&R Block, so I did what we all do to learn – I started with a Google search. This page is what came back, so I clicked the top result.

CIGNA Explains Healthcare Reform

As I was trying to make sense of the overwhelming amount of information, unprompted CIGNA asked ME how to make THEIR website better.   This survey was unbelievable to me. They actually interrupted a bad experience to make it worse.

CIGNA Values My Opinion

And to boot, the dialog that I did not want and had to click to get rid of had errors on the page. Look n the upper left corner and notice the infamous “image not found” image. And to really go over the top, CIGNA gave me instructions on something I did not ask for and did not want, which put the burden on me. I was not here to help them with their website – I was hear to help myself learn about healthcare reform and somehow I am now roped into giving them my feedback. But even that was not easy. Take a look at the actual instructions they gave me – “When you click “Yes, I would”, another browser window will open for the survey. Please return to your open Cigna.com window, complete your visit, and then return to the survey window. All input you provide is strictly confidential.”

I had to go somewhere else, to do something I did not want to do, to help CIGNA, and then they had the brass to ask me to return to the page I was confused on in the first place to complete the business I was here for – absolutely unbelievable!!!

CIGNA H&R Block Reform Conversation

When will the insurance companies get it right? If H&R Block can do it, I expect them to be able to as well.

To your health,

The Team at imagine.GO

 

How to Send a Personalized Bill to Your Customer

How to Send a Personalized Bill to Your Customer

I just received a new bill from AT&T – and get this – it was a personalized video of my charges.  Yes, that is correct, a video.  It was my actual bill, with my actual charges explained.  And it was cool. I watched it three times and then recorded it and made a video to share. Here is the short video I made of my experience:

An Old Dog with Some Cool New Tricks

To be sure, I am not a raving fan of AT&T but I respect their product offering, and they seem to be getting much better at customer service. In truth, their coverage where I live at the beach in Florida is terrible. But, for the most part, they are pretty spectacular anywhere else I travel for work.  I pay around $130 to $150 every month for their services. I know and trust and rely on their product.  But, historically speaking I have had two issues with their product – at least from the arena of understanding my bill charges and getting someone one the phone to help me get answers.   I can sympathize as they have a lot of customers to deal with daily. However, I am still the customer, and I pay them close to $1500 per year. I have the right to expect better.  Such is life.

I have upgraded my phone and service several times in the life of my relationship with AT&T. Invariably, I am always confused at the one-off charges I see on the bill and in many cases, I have had the need to call and clarify what they were. I dread this scenario because I know it will be several trips through their telephone prompt system, then saying the same thing to at least three reps that have a somewhat less than mastery of English.  One month ago, I upgraded my iPhone to the new 5 (my relationship with Apple is a story in itself, and someday I may let you know about it).

So imagine my surprise when I received an email from AT&T with a link asking me to watch a video about my new bill. The call to action was clear and the broadcast email was well done, so I obliged. It took me to a page at the AT&T site where I saw a video that explained my most recent bill, in clear detail – even the one off charge. It was very well done, and it was tailored just for me.  I can still get access to the regular online or printed bill as well – but I feel no need to now.

AT&T Video Bill Email

How did they do it? I am not so naïve to think AT&T chose to invest resources in the AV department to create a video just for me – so I have to assume this was done by some smart new vendor that can tie into their systems and use list data to create custom videos. Whatever the reason, the result was that I understood the bill, and I did not feel a need to call AT&T – this saving them the transaction cost.  I have to assume the economics are for the mass/custom video versus the support line.  Furthermore, they saved me aggravation and got me talking in a positive light about AT&T. Nice work.

AT&T Video Bill

One other thing, because this is new technology and a new experience (I am sure they tested it quite a bit), AT&T was smart enough to ask me some survey questions at the end to see what I thought about it. Thus, validating their efforts. Again, nice work.

AT&T Video Bill with Questions

If My Phone Provider Can Do It, Why Can’t My Healthcare?

As I said, I spend approximately $130 with my phone provider each month. By contrast, I spend $400 with my health insurance provider.  As bad as my old phone bill was, by contrast, it is like a new Harry Potter novel (FYI I love Harry Potter books) compared to the bill I get from my insurance company. Or should I say, the “THIS IS NOT A BILL” I get from my health plan.  Take a look at a sample Explanation of Benefits (EOB) below.

Firstly, I find it somewhat ironic that it is called an Explanation of Benefits – as it is neither a benefit nor a good explanation of what I owe. I am not picking on any one plan – I just happened to be able to find a sample EOB for them online. And not wanting to post my own, I had to have something to speak to, so they are the lucky winners. In truth, from what I know and what I have heard, all if not almost all insurance companies are this bad.

Here is what drives me crazy about this document. It gives me more than I need in a poorly laid out manner, so it guarantees my confusion. Thus, resulting in my need to call them. Thus, having to deal with the call center for the insurance company. Thus, ensuring I add anger to my confusion. This repeat cycle is a never-ending loop for million of customers across the country.

When will the health insurance companies get it right? If AT&T can do it, I now expect them can as well.

Explanation of Benefits with Notes

To your health,

The Team at imagine.GO

 

modelH – Health Model Co-Creation Forum (part 4)

modelH – Health Model Co-Creation Forum (part 4)

After reading my 3 earlier posts, I hope we have you convinced that this is a worthwhile effort and that you should join us. By joining the forum – you join the movement to create a better healthcare system.

The solutions for transforming healthcare will come from harnessing diverse ideas from across the ecosystem of healthcare stakeholders. We are inviting individuals inside and outside of the healthcare industry to join us on one platform to ignite conversations and build solutions for new business models within US healthcare.

That means you – yes, you are invited!

When you sign up, you will join other passionate healthcare and innovation professionals to create meaningful change in the US healthcare industry. You will also cultivate new professional relationships, elevate your personal brands and identities, and receive direct attribution in my forthcoming book as permanent proof of the important co-creative role you played.

Please know this is not a marketing scam – we are sincere in our work and care deeply about our goals. Our end result will be a book published in 2014 that you will get to share in the credits for creating.

How to Participate in modelH

Well, first you have to register on the modelH site.  We suggest you read up on the whole project here first – http://bit.ly/modelHForum.

After that, there will be three Phases to the modelH project, which will last through at least March of 2014.

model Business Model Canvas for Healthcare

The three Phases are:

  • 1. CoCreate a healthcare business model generator, called modelH. We will draw from the work of Alexander Osterwalder and Yves Pigneur in their book, “Business Model Generation: A Handbook For Visionaries, Game Changers, and Challengers” to create a new framework for developing health model innovation throughout the remainder of the project. Building the modelH engine is the most critical part of the project, and we’ll be devoting most of our time – 4-5 months – on this module.
  • 2. Generate and evaluate ideas through the modelH engine. Next, we’ll gather your inspiration, insights, and research to develop ideas that can be tested in the modelH engine. These ideas will address our three main areas of concern for healthcare: creating positive consumption experiences, improving the care delivery mechanism, and aligning payments and incentives. If we’ve built modelH correctly, we will be able to produce innovative business models that reflect a new direction for US healthcare. We expect to spend 2-3 months on this module of the project.
  • 3. Validate the health model innovation solutions. The final step is to review our modelH solutions to ensure they are fair, reasonable, and feasible. Once validated, Kevin Riley will be compiling the work into a visual playbook to be published later in 2014. We expect to spend 1-2 months on this module.

This project is a labor of love for all of us and the modelH team is fronting the cost to put all of this together. Our reward is the same as your reward: pride in creating a new path forward for US healthcare. It’s an opportunity to do something meaningful that has the potential to effect change on a system that is in dire need of change and to positively impact the lives of millions of Americans. We’ll also provide attribution to all contributors in the book as proof of the important role you play.

Keep in mind that this is an experimental project, and we expect some bumps along the way. If you encounter troubles, inconsistencies, or simply need clarity on how it all works, kindly let us know so we can improve the process. Also, we will have a firm “no jerks” policy in place within the modelH forum. We want disruptive thinkers, not disruptive individuals. If you are serious about making something that will help all of us create the healthcare system we so desperately need, please join in with a heart and mind for that task. If not, please sit this one out.

So, step up to the plate and get involved.

 

To your health,

The Team at imagine.GO

 

Are Healthcare Companies Focused on their Consumers Needs or their Own Products?

Are Healthcare Companies Focused on their Consumers Needs or their Own Products?

Insurance companies are trying to connect with consumers in the marketplace – but are they focused on the consumers needs or their own products?

I will be speaking at the World Congress 3rd Annual Leadership Summit on Ancillary Products and Voluntary Benefits on March 13-15 in Lake Mary, FL.  Please join me there.

What You Will Learn

During this session you will learn:

  • What is retail health, really?
  • What does a health solution look like?
  • What products are relevant to consumers for their health jobs-to-be-done?
  • Can you server members and non-members alike, simultaneously?

 

To your health,

The Team at imagine.GO

 

Speaking on the Current Landscape of Retail Health

Speaking on the Current Landscape of Retail Health

Assessing the Current Landscape of Retail Health: Opportunities for Revenue, Member Engagement, and Care Coordination through Retail Stores and Urgent Care Clinics

Wednesday, March 13, 2013, 1:00 pm – 4:00 pm in Lake Mary, FL; 5th Annual Leadership Summit on Health Plan Innovation

In the mid 2000’s, there was a disruptive movement in healthcare to build nurse practitioner run clinics within grocery store settings. Retail Health was disrupted again when insurance companies started building retail stores to attract consumers and sell their insurance products. Recently, partnerships between health plans and urgent care centers/retail clinics have spurred even more opportunity for plans to identify options for additional non-emergency services instead of expensive emergency room visits, when appropriate.In this workshop, learn how insurers are exploring this changing dynamic to not only control costs, but also attract new customers and coordinate member care. Key takeaways include:

  • Understanding the purpose and use of a retail storefront
  • Assessing the impact on the plan-member relationship
  • Understanding the payment model for a retail care clinic
  • Assessing the impact on the plan-provider relationship
  • Incorporating retail clinics and urgent care centers into accountable care and changing models

 

This workshop will be split into three distinct sections:

  1. Part 1 – A brief history of retail health and its place in insurance
  2. Part 2 – Case Studies from successful organizations
  3. Part 3 – Open Discussion and Q&A on “The Future of Retail Stores and Clinics for Insurers”

 

To your health,
The Team at imagine.GO

 

Speaking on Technology and Networks that Support Consumerism

Speaking on Technology and Networks that Support Consumerism

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

Tuesday, February 26, 2013 at 1:30 – 2:45 in Arlington, VA 22201; 6th Annual Consumer-Directed Healthcare Forum

Consumer-directed healthcare at its best empowers consumers-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. Finally, you’ll learn the value of providing members access to critical pricing and quality information. Key takeaways include:

  • Learn about demand management programs that educate members on proper utilization of services.
  • Explore trends and development in the availability of price and quality data.
  • Gain insights on the evolution of retail healthcare and learn what’s coming next.

 

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

 

Retail Healthcare and its Implications for the Future of Health Insurance

Retail Healthcare and its Implications for the Future of Health Insurance

Join me as I give a talk on Retail Healthcare and its Implications for the Future of Health Insurance this Tuesday, January 8, 2013 from 2:00 PM – 3:15 PM EST.

Retail healthcare—from convenient care clinics in drugstores to the emerging insurance exchanges mandated by ObamaCare—has the potential to reshape the provider and payer markets in the U.S. Health plans are taking a leading position by investing in exchange technology, assisting members with price and quality information, and developing innovating networks that broader member access. This webinar will outline how you can best position your organization for success in the burgeoning retail healthcare sector.

What You Will Learn

Attend this webinar to:

  • Explore the origins and evolution of retail healthcare with an eye toward emerging trends that will impact your business.
  • Understand how retail healthcare coupled with consumerism can impact member behaviors—improving quality and cost.
  • Assess the impact of retail clinics on member access, costs and quality.
  • Formulate a retail healthcare strategy that encompasses market-based initiatives couples and reform-driven mandates.

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