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Posted by on Oct 17, 2016 in Uncategorized | 0 comments

Solving the Next “Problem” in Health Insurance Exchanges

Solving the Next “Problem” in Health Insurance Exchanges

Private exchange adoption is on the rise. Accenture projects by the end of 2016, 12 million employees will enroll through private exchanges, and that number will double in 2017[1]. What kind of technologies and products are being developed to aid the consumer in purchasing insurance on an exchange, and what does the future of exchanges look like? Matthew Mellor, Strenuus’ Chief Executive Officer, participated on a panel at The 2016 Private Exchanges Conference for the Private Exchanges 2.0: Technologies and Products Evolving the Consumer Experience session to help answer that question. Along with Mr. Mellor, Julie Donahue, Business Development, PinnacleCare; and Tate McDaniel, Senior Vice President, Engagement Solutions, Change Healthcare participated in the session, answering questions around health care innovations that support consumer engagement, diagnostics, and care delivery to improve the consumer health care and exchange experience.

Below is a brief summary of some of the key questions Mr. Mellor addressed:

What are the new things you are doing to solve the next problems in health care consumerism?

We have been putting a lot of emphasis around the “millennial problem.” We offer great tools to help consumers find the right network based on physicians they currently visit and hospitals to which they want to go. Our clients tell us this is great, but we need to help consumers find a network when they don’t already have a doctor, as is the situation with many millennials out there.

Obviously, we have a lot of great tools payors use to understand network dynamics. How do we scale these tools for just one person? How do we figure out the right network for an individual person and tailor it to a specific demographic?

It is time to set the stage so our clients can layer a whole new level of intelligence on top of looking up providers in a directory. What if choosing a plan isn’t just about the number of pediatricians or allergists, or low cost hospitals, but it shifts to the best pediatricians, best allergists, and highest quality of care?

We can provide the ingredients in the overall plan recipe, but we will not own the recipe. We want to empower the benefits consultant companies to use their expertise to dictate the criteria. They know what is important to their clients. We want to give benefit consultants the information they need to build the tools that work best for them and their clients.

How do you fit into consumerism?

There is a natural tendency to equate health care consumerism to the shopping experience, but it is unequivocally different. We are all on individual health care journeys. Each one is different, and we are usually reluctant participants on that journey. Many times we are being forced to look for a doctor because of a health issue. At Strenuus, we want to help take some of the anxiety out of the decision process. We try to surface data so it is meaningful and insightful. It is about getting the right information in front of consumers when they need it most.

We need to be there when a consumer needs help. What happens when an individual enrolls in a health plan and their doctor is no longer in-network? That consumer most likely will need a new doctor. When they log in to their employee portal, they will see a message, “Your preferred provider is not in the Healthy Start PPO network. Here is a list of providers in network that match your individual needs.” Having access to big, robust data is valuable only if we can put it in the hands of consumers when and where they need it and in a way that makes sense.

What is the next big frontier? What will we be focusing our energy on 5 years from now?

There is going to be a shift to focusing on physician engagement, the same way we’re looking at consumer engagement today. We need to turn our attention to the other half of the equation. What tools and information do the physicians need to practice better? How can we get physicians more fully engaged in the overall health of their patient population—not just treating diseases? Right now, it is a volume game—it’s all about how many patients can get through the door. We need to shift toward the right incentives for high-quality care, not toward the number of patients seen.

[1] https://www.accenture.com/us-en/insight-private-health-insurance-exchange-annual-enrollment

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