Health Plans of the Future: Out With Complexity, In With Simplicity

emids recently hosted the SFO Healthcare Summit in San Francisco where thought leaders from the industry gathered to discuss several of the trending topics in today’s healthcare space. This regionalized event, and the precursor to our Healthcare Summit this November in Nashville, allowed me to connect with other healthcare executives and discuss the most important issues facing us today.

The theme of the SFO Healthcare Summit “Health Plans of the Future: Growing the Old or In With the New?” proved to not only evoke open and lively conversations, but also enlightened us on the many concerns still plaguing our industry as we continue on the digital transformation journey. As new tools and technologies are changing the landscape on how healthcare is provided, the primary focus remains, as it should, on the healthcare consumer.

SFO Summit panelist experts included moderator Dr. Ashwini Zenooz, SVP and General Manager, Global Healthcare and Life Sciences, Salesforce; Calvin Chock, Chief Product Officer, Clover Health; Sami Inkinen, CEO and co-founder at Virta Health and Megan Callahan, VP, Healthcare, Lyft Business.

The panelists’ diverse backgrounds and significant expertise in their specific areas provided an excellent mix of knowledge and insight for discussion topics.

Here is what was on their minds, broken down into four parts:

  • Consumer Experience
  • Patient Access
  • Social Determinants of Health (SDOH)
  • Simplifying the System

“There is a lot of focus on consumerism, which means you have to have access to the right information for the best plan member experience and patient empowerment.”

 Dr. Ashwini Zenooz, SVP and General Manager, Global Healthcare and Life Sciences, Salesforce

Part 1: Consumer Experience

When we think of the consumer experience, there is a significant emphasis on simplification.

Inkinen knows this firsthand as the leader of the healthcare company Virta Health, which  provides the first clinically proven treatment that safely and sustainably reverses type 2 diabetes without the risks, costs, or side effects of medications or surgery. Says Inkinen, “We work with employers and health plans that cover the cost of treatment, because they save money by reversing type 2 diabetes. The future, eventually, will be such that consumers are fully empowered.”

Another topic we discussed was the importance of providers having a comprehensive overview of a patient’s healthcare history. “Our goal is to provide a very holistic view of patients’ records, because healthcare data is fragmented. It is very challenging to connect multiple sources, lab data, genomic data, EMR data and specialist data,” says Chock. “So we try to build a complete record. This then presents enough information to the provider to give them a total view of the patient’s health and the patient will ultimately have better care. This approach simply leads to overall better healthcare.”

“The next wave is to make data portable.” Calvin Chock, Chief Product Officer, Clover Health

Part 2: Patient Access

We discussed the importance of consumers having control of their healthcare data and history. “People can elect another medical plan and then transfer it. So now it’s not a health-plan-owned source of information. It’s not EMR-source-owned information. The patient has control over what they have and what they would like to do with it. This really puts the empowerment with patients,” says Chock, who defines solutions to improve treatment of Clover Health’s Medicare Advantage members and Provider CDI.

“I think when we talk about patient and member empowerment, it’s about the ability to access the information,” adds Zenooz, who previously served as the Chief Medical Officer at the Department of Veteran Affairs overseeing the national EHR modernization program. “We, as consumers, have had access, but each of us will need the appropriate amount of information and data, so we can care for people, and we want to be able to exchange it.”

“I think what you’re getting at is having a tool to evaluate a personalized experience that requires getting a whole view of that patient. Consumers have to evaluate all the services being offered across different plans, and even across different payers in different plans. This is a major gap that needs to be filled. We’re still probably several years away from having data fully exchanged.”

In the end, we agreed it all comes down to data transparency. Says Zenooz, “Things are coming together with new consolidations and mergers. It’s happening in other spaces like retail. We talk about transparency of data. There’s also a component of transparency in pricing. When we’re looking at these mergers, things are changing in the space. They’re changing for the health plans and for the providers, and we’re seeing requests for even more transparency.”

“Health plan providers tell us that transportation is their number one grievance. It really impacts the brand of their health plan and their total member experience. So, they are highly invested in fixing this because it’s a very tangible problem for them.” Megan Callahan, VP, Healthcare, Lyft Business

Part 3: SDOH

Another hot topic was SDOH and what specific add-ons could be made to healthcare plans to help treat the entire individual. Discussion centered around how some organizations are actually reworking their business models to take such issues as identifying consumers with diabetes, or those who may have problems getting to their medical appointments, into consideration when establishing their medical plans. We discussed in depth the lack of ability for many seniors to get to their medical appointments. Callahan says, “We have a business-to-business platform and use that to enable patients to get to their appointments, without even having to use their smartphone. So an account manager, a discharge nurse or any ride agent can identify the need in this transportation gap and call a Lyft ride.” Callahan was hired from McKesson late last year to run Lyft’s growing business transporting patients to medical appointments.

“It’s a very niche part of healthcare and is really interesting, because with all of the groundswell around social determinants of health, transportation is obviously key to almost every single aspect of unlocking health for someone. Not just medical care, but actual health,” she adds.

“I think what we offer is a really humanizing experience and it’s what people are looking for. We work with CareMore, an Anthem subsidiary, and have 98% customer satisfaction. These are seniors, people who you think would have a high degree of resistance to get in a car with a stranger that somebody else calls for them.”

“For years, we’ve just been looking at the medical care component of it, and that is not a game-changing solution. The industry is actually starting to codify it in a certain way. United worked with the AMA to come up with actual codes for social determinants of health. So instead of just having a barrier of care and a care plan, consumers actually have a code and can get referrals to either government or community programs. The physician now actually has a way to follow up on that conversation.”

 “I recently heard the quote, ‘There are only two actors you need in healthcare, the patient and the provider, and everyone else is a middleman.'” Sami Inkinen, CEO and co-founder at Virta Health

Part 4: Simplifying the System

The conversation kept going back to the need to simplify the system for the healthcare consumer. As we know, consumers have been very vocal in their need for plan pricing to be transparent, which is having an impact on how they are choosing their health plans. While a small amount of progress is being made in this area, there is still a long way to go, as our experts shared.

“It all looks very similar and most patients or members don’t know whether it’s good to go with an all-generic prescription plan or a mix of brand and generic. It just doesn’t make any sense to them. They need someone to really decipher each plan and help them make a selection,” says Chock.

It’s clearly not just the price of benefit plans. Says Callahan, “I think even beyond price, there needs to be a certain amount of literacy among consumers when they pick the plans. My mother is older and she’s asked me to help her navigate her Medicare. I should be able to do that. But the amount of time we have to spend doing that, even when everybody in this room is highly knowledgeable, people must be just throwing darts at a board, trying to figure things out.”

“We’ve all read the stories about high deductible health plans and how people really get in over their heads financially because they didn’t understand what they were signing up for. We need to take a step back when we get to transparency, to make sure that people actually understand how insurance works, how it’s priced and the questions they need to ask.”

Inkinen is definitely seeing change. He adds, “When I look at some of the very large health plans, they are either transitioning to providers or integrating vertically, and are concentrating in delivering excellent care and outcomes.”

And now there’s the presence of several retail companies entering the healthcare space. “It’s pretty clear that the retail giants see healthcare as a massive opportunity. Just read the headlines – CVS, Walgreens, Walmart – and what they’re doing,” says Inkinen. He notes that although Virta Health delivers care virtually, they have incentive to be selling and distributing in the retail space. He adds, “For some populations, 30-40% of people are type 2 diabetic, and they walk into these retail stores every day to pick up their insulin.”

The healthcare industry is in a state of flux and change as never seen before. That was evident in our San Francisco conversation, and why we brought this group of industry experts together to share their knowledge and insight. I look forward to adding to, and expanding upon, these conversations at the even larger 6th Annual emids Healthcare Summit in Nashville, and at our regional Summit later this year in New York City.

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Overseeing payer and digital solutions for emids, Dr. Praveen Soti is a physician thought leader and healthcare business and digital innovation executive with more than 18 years of health tech experience across private and public sectors in North America, EMEA and Asia Pacific. Dr. Soti holds an MD and MBA and is an alum of the Stanford Graduate School of Business. He served as a past board chair of the Microsoft Health Users Group. He has been a featured industry speaker at the World Congress, Harvard Patient Safety Colloquium and HIMSS-Microsoft HUG. Be sure to connect with Praveen on LinkedIn.

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