ChangeNow4Health

What Can be Done?

Integration and Cooperation.

summary

Health benefits companies must integrate products and services, aligning them more to the evolving needs of consumers. They must cooperate by embracing competitors and encouraging customers.

The Need for Integration

Health benefits companies need to integrate finance, product, clinical care and consumer education. This integration parallels an emerging paradigm of thinking about health and health care. In the 20th Century, people were most concerned with the absence of illness. In the 21st Century, the focus is more holistic. People are more concerned about looking and feeling well.

Further, people want things simpler and easier. Interacting with the health care system can be difficult and perplexing for them. One-stop shopping and telecommunications bundling provide useful examples of the typical consumer mindset.

Integration will provide maximum consumer value and will support health benefits company’s inevitable new role as the centerpieces in emerging health care delivery systems. It’s up to health benefits companies to make this happen. The message should be eminently clear by now: Health benefits companies must get efficient and cooperate better. They must cooperate to enhance standardization and electronic connectivity. This will lead to greater value for the entire benefits sector and, most importantly, better health care for members.

Key Obstacles

Insurers need to address three primary obstacles:

• The belief that nothing will really happen in our lifetimes
• The view that nothing can be attacked quickly.
• The “I’d step up, but no one else will” syndrome.

But the answers are clear. Health benefits companies need to embrace competitors and encourage consumers.

Embrace Competitors

To start with, health benefits companies must find opportunities to cooperate with competitors. ATM cards work anywhere in the world because the banking industry realized that cooperation would yield efficiency and consumer value. Rivals cooperated and created a common system. Modest proprietary efficiency gains were leveraged into a major revenue and profit generator industry-wide. Such cooperation (leading to standardization and increased connectivity) can also work for the health care sector, with the consumer being the big winner.

Availity is an excellent example of a change the health care sector can make right now. A standardized, online real-time claims interface, Availity was developed by Humana in conjunction with Blue Cross Blue Shield of Florida. More than 400 million transactions will be processed by Availity this year. And the system is being expanded to four new states in the next few months. A nationwide roll-out of this system would greatly enhance provider connectivity and require insurers to cooperate in new ways. This reform endeavor should be adopted—today.

Encourage Consumers

Anomalies of the third-party payer system have, to date, shielded consumers from the realities of the marketplace. But now people are paying more through high-deductible health plans and other forms of cost-sharing. They’re not crazy. In return for their investment, they’ll seek and demand the value they’ve come to expect in other aspects of their purchasing lives.

One of the best things health benefits companies can do for them is drive integration toward a total solution. For consumers, solutions are pivotal. In health care, people have to hunt to find pieces of solutions as best they can. But they want integrated, standardized offerings that make their lives better and easier.

Corporate value based on tangible assets such as land, buildings, machinery and equipment is long gone. Today, we define value through intangibles; processes, knowledge and human capital. Increasingly, those intangible assets differentiate winning companies and lead to solutions for consumers.