Blog : Innovation in Healthcare

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.


Kevin Riley, imagine.GO,

Andy Marino, Florida Blue,

Michelle Copenhaver, Aetna,

Ruth Fricke, United Healthcare, 

Mike Howell, CIGNA,


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


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


Here is the deck on SlideShare.

Healthcare Must Care About Customers

Healthcare Must Care About Customers

Customer Intimacy in Healthcare

Health care companies need to care more about just their consumers. As such, the time for health plans to make a commitment to the market discipline of Customer Intimacy is here.

Managing the commitment to consumerism remains the greatest challenge for insurance plans and providers as reform era health care changes the landscape from a wholesale orientation to a retail one.The Discipline of Market Leaders: Choose Your Customers, Narrow Your Focus, Dominate Your Market

Keep in mind, that retail is NOT equivalent to consumerism. This point seems to get lost in the rush to the individual/exchange market.  Let me explain. Wikipedia defines retail as” the sale of goods and services from individuals or businesses to the end-user.” Therefore, insurance has been “sold” to the employer on behalf of the consumer, through an extended and inefficient value chain involving many “resellers” (read brokers and 3rd party agents).

On the other hand, customer intimacy (or consumerism) is defined best by Michael Treacy and Fred Wiersema in their seminal business book “The Discipline of Market Leaders.”  In it, they explain the need to have an ever-refining understanding of the consumer in order to place products and services within their value model.  So simply put, retail is positioning products in front of consumers; consumerism is understanding what is perceived as valuable before placing it in front of the consumer.

See the difference? Being retail without knowing your customer and understanding what they perceive as valuable is not a recipe for success. Just ask K-mart.

Do Health Insures Want to Be Intel or Dell?

Intel or DellSo how do health care companies, insurance plans and hospitals build health-related relationships with individual consumers? If other industries that have undergone a similar retail transition provide any insight, the competitive landscape of America’s health system will be reshaped dramatically over the next five years. There is one problem that stands out in my mind. In the health care consumer’s purview, when it comes to the insurer and the doctor, who gets to be Dell and who is Intel?

In my question, I use Dell as the consumer brand that creates the actual consumer-facing product. I use Intel as the tool that powers that consumer product and actually provides lift to the Dell brand.

So back to my question, does an insurance plan want to be Dell or Intel – meaning, do they want to be the reason for the “purchase” or do they want to power the purchase and boost the satisfaction with it? If insurers see themselves as the ones that consumers should turn to in order to solve their health care knowledge gap – we may see troubled times ahead as the care practitioner tries to do the same.

Plans likely face significant branding hurdles in their attempts to win the hearts and (premium) dollars of individual consumers. I say this based on consumers’ negative perceptions of insurance.

Instead, should the insurer focus on powering the provider conversations? This may better serve the consumer value model and fit within the competency of the plan.

However, will providers even take this mantle on? Something to think about for another day.

To your health,

The Team at imagine.GO