Understanding the Past, Building the Future: Health Care – from Xerox HR Insights Blog

I’m very excited to share a post from my employer related to the past and future of healthcare.

To celebrate our 100th anniversary, the consulting practice leaders from the UK, Canada, and the United States were asked the following three questions:

  • How have things changed in their fields in the past 100 years?
  • What are the biggest challenges they – and their clients – are about to face?
  • What’s the most exciting thing they speculate is coming along?

My friend and global health practice leader, Hope Manion, wrote a piece for this and she was kind enough to mention me.  She and I discussed some of these topics prior to her writing her piece – I’m pleased to have helped!

What’s Transparent Is This – Engagement Is Missing

Last week, The Journal of the American Medical Association (JAMA) released the results of a price and transparency study.

Though I do not have access to the full study, I read the brief excerpt including this:

Conclusions and Relevance:  Among employees at 2 large companies, offering a price transparency tool was not associated with lower health care spending. The tool was used by only a small percentage of eligible employees.

Anyone else have a “whoa” moment after reading this? (I’m guessing it will only be the health care geeks out there who have this moment.)

With the continued rise of high deductible plans and the push towards consumer directed health (where a member/patient takes a more active role in shopping for and consuming health care services), the need for a cost and transparency solution was a market need eventually met by a number of organizations.

Coupled with the exchange phenomenon – both private and public – and it appeared the market would be drawn to such tools in droves.  But as this study shows, people are not using the tools.

Should we be surprised at this conclusion? No, we shouldn’t.

We can push transparency and we can offer incentives. We can conduct payment reform and change how we pay for healthcare. We can insure the entire country and set up national work groups to look at quality, efficiency and costs. And perhaps tools and services will be brought to the market to help in these areas.

But if the patient doesn’t get engaged, then you may (still) see a consumer make a poor decision by not questioning a referral to a particular doctor or hospital. You may (still) see a patient select the lowest quality, highest cost hospital for a particular condition.

Engagement has been missing – and it appears it still is. Until we have an engaged health care consumer, price and transparency tools (along with anything else brought to market) will continue to see low utilization.

Health Care, Entrepreneurs, & Integration

For the better part of the last 20 years, I’ve worked in some area or another of the U.S. health care system – an industry in dire need of some changes.

I am regularly reminded of the challenges this country faces related to health care – high costs, coverage for the uninsured, reducing waste and fraud, transparency and quality – the list goes on and on.

Luckily, there are wonderful health care startups and entrepreneurs who are doing their best to find solutions, disrupt the system [insert your favorite buzz word here].  I’ve met more than a few of them and I’m regularly inspired and encouraged.

But then reality sets in and I ask the question that sometimes keeps me up at night…

How is it all integrated?

Without integration and coordination, its like we’re all trying to move a giant boulder…but we’re pushing from different sides and not accomplishing much.

I have attended “demo days” for Rock Health, Healthbox, and recently TiE ScaleUp – all in the Boston area.  The health care startups always have great concepts and ideas and some have since thrived.

But how much has the overall system been improved or impacted?

Some would argue that the silos in health care drive a lot of the challenges that exist in health care.  I tend to agree, but I’m not sure how much of it is attributed to the lack of integration. My sense is a lot of problems and challenges could be solved if the integration and coordination puzzle was solved.

Systems that are tied more closely together can better understand what each area is doing and, as a result, align business practices for the best possible outcome for the patient and/or member.

To revisit my previous example – push the boulder in the same spot in the same direction at the same time – create a system that truly works.

This poses a challenge to all the clever entrepreneurs and startupy folks out there – how to create a health care PLATFORM that allows integration across ALL aspects of the health care continuum – insurance, care delivery, electronic medical records, data integration, medication adherence, wellness and well-being, predictive analytics…the list goes on and on.

To the entrepreneurs out there who have a fire in their belly related to the health care space: the gauntlet has been thrown down. Let’s see whatcha got…

Public Exchanges, Private Exchanges – Friends? Enemies? Frenemies?

The growth of both public exchanges and private exchanges in the past few years has been quite remarkable.  For the sake of definitions, public exchanges include federal and state based exchanges established by the Affordable Care Act. Private exchanges, in this blog post, will be used to cover large, benefit consulting exchanges that serve the enterprise employer space (think 5000 employees and above).

While working at a state-based exchange, I recall attending an information session held by a large consultant private exchange organization.  The folks from the consulting firm seemed surprised by my attendance and asked why a fella from a public exchange was there.

Considering the fact that these public exchanges serve very large employers while public exchanges serve individuals and small businesses (currently defined as 50 Full Time Equivalents -FTEs- or less), I didn’t quite see why my attendance was being called into question. Can’t a health care geek get his geek on by attending an evening session to learn about private exchanges?

[The answer is yes, but you have to read to the bottom to find out why…]

Of course, that was more than a few years ago.  The landscape has changed. The view of both private and public exchanges has changed.  Private exchanges continue to grow leaps and bounds.  Public exchanges seem to be getting their legs under them after struggling mightily for a few years.  And you know what else has changed?  The ability for public and private partnerships to demonstrate that they can work.

Consider this – any benefits broker or consultant worth their salt knows that solutions for active, full time employees is good for their employer clients. But what about other employees like pre-65 retirees and part-time employees?  Hint: solutions that provide services for those “other” employees are ALSO good for employers.

It just so happens that private exchanges can fill a gap here.  Forward thinking folks identified this gap and have pursued collaboration and cooperation with both the federal public exchange and a number of state-based public exchanges. In fact, when I was working for a state-based exchange, I set up a collaboration with two of the large private exchanges that involved warm-transfers from their exchange to the state exchange to facilitate enrollment.

What does this mean?  For an employer with full time, part time, and pre-65 retirees, it means a one-stop shop for them.  These employers use the private exchange as a solution for all of their populations. Since the private exchange has a partnership – typically through a vendor partner – with the public exchange – voila.  One-stop shop.

Oh, and that private exchange story I shared above – the one that questioned my attendance because I was working for a public exchange?  I now work for them.

First Class Ticket and the Importance of Health

Happy New Year to all!

To help set some perspective for 2016, I thought I’d write about an experience from a few months back…

This summer I was at the airport getting ready to board a plane after being on vacation for a week. While boarding the plane, I was waiting in the aisle in the first class cabin while others ahead of me stored their overhead bags.

Though I wasn’t trying to eavesdrop, I overheard one side of a phone conversation from a person sitting in first class. He was a man in his mid to late 40s, tall and slender – generally in good health from an outward appearance standpoint. However he was sharing with the person on the other end of the phone that the doctor’s aren’t sure what’s wrong and that he has to go back for monthly monitoring. Mentioned Sloan Kettering which makes me believe it could be rather serious in nature – perhaps cancer related.

I’m not sharing this to break any HIPAA rules or to speculate on someone’s medical state. I’m sharing because we often get caught up in life – job, work, family challenges, money, etc.  We don’t often place enough focus and attention on our health and well being. We take for granted our health and stress about things that – in the grand scheme of things – just aren’t worth stressing about.

This experience help set some perspective for me – a person sitting in first class, looking fairly healthy to the eye at first glance, could be facing a terrible illness with an unclear outcome.  My hope is that he will be OK.

As we begin a new year, let’s remember this: health affects everyone.  Though we can’t always control what happens from a  health perspective, perhaps the importance of health and taking care of yourself should be higher on the old priority list than it sometimes is.

So if you’re looking for a resolution for 2016, why not this:  make health and well being a priority.

Wishing you and yours the very best in 2016. Happy New Year!


Private Exchanges are Booming…Now What?

Employers are selecting private exchanges. Defined contribution achieved. Employees are signing up – and buying down. Savings all around. Private exchanges = success.


Well, let’s not celebrate just yet…

If the move to private exchanges is simply a cost shifting play where employers set contribution levels and employees select lower cost, higher deductible plans, then I suppose you can break out the party hats, confetti, and horns.  We’re well on our way.

But if the move to private exchanges is more about better outcomes, health improvement, better decision making, higher quality providers, patient engagement, wellness, and well-being – then we’ve got some work to do.

More to come soon…