specific trend has really caught your attention regarding its
potential impact on the business of healthcare in 2014?"
Founder/CEO of Center of Health Engagement
The trend of resistance and
confusion across the health care system and payers has been
stunning this year. There have been positive steps forward,
such as the incentives to physicians for PQRS reporting and
the removal of copays/deductibles for prevention screenings,
and there will be a longer time period for producing
meaningful use (MU2) and receiving incentives for MU2. There
have been some incredible mistakes, the largest of which is
the ACA website launch in October.
But I've spent a
lot of time speaking with and for doctors and associated
clinicians, consultants/brokers, small to medium employers,
and Medicare beneficiaries. It was a revelation to learn how
many did not know there were incentives to install EHRs, to
report outcomes and criteria for measures, and more. There
has been an enormous amount of misinformation in the broker
community about penalties, delays, and private exchange
opportunities for their clients. The single clients--CEOs of
small businesses, senior citizens on Medicare--are quite
uninformed about changes and, more importantly, perceived
changes that they are hearing from news outlets and from
I'd like to detail the rapid IT expansion
and the bubbling of consumer price advocacy, but these have
not been so loud as the confusion/resistance that has
enveloped the communities outside of the large metro areas
and especially the Northeast and California. The rest of the
country is clamoring for accurate, objective, data-driven
Epstein Becker & Green, P.C.
I have been struck by the trend
among group plans to impose beneficiary responsibility in
the form of high deductibles and limiting payment to
so-called "reference prices". There has been some moderation
in health care spending recently. It is common for that
moderation to be attributed to the Affordable Care Act. I
would however speculate that the cumulative impact of these
coverage and payment limitations is more likely to be
responsible for the slow down than the ACA itself.
Not only are these trends remarkable for their impact on
costs but for they are notable for their potential to cause
consumers to engage directly with providers over price.
Health policy wonks have long sought to engage the consumer
in health care purchasing decisions. The refashioning of
coverage and new payment limitations, as the trend
accelerates, may spur competitive provider responses. Those
responses might actually drive more system reengineering
than the now limited federal governmental efforts around
value based purchasing.
Principal, KBM Group
Customer Experience. Picking one
trend from what's ahead in 2014 is a challenge: Obamacare
2.0, Paying for Quality, Digital Disruption or Socialnomics.
But, I have to go with customer experience. This is the year
when payers and providers need to stop talking about being
customer focused and actually start delivering personalized,
relevant and multi-channel consumer interactions. Superior
customer experience (aka UX) is no longer an option. With
benefit standardization, provider network parity, price
transparency and regulatory constraints commoditizing
markets and neutralizing brands...what's left?
2014 healthcare marketplace defined by personal
responsibility, it's the consumer's obligation to deal with
intimidating financial and clinical decisions. If we ask
customers to step-up and take control of their healthcare
destiny they need to be engaged. The only way to accomplish
this is through a customer experience that respects the
complete customer journey - from prospect to participant to
promoter - each built on a foundation of trust, empowerment
Like it of not the retailization of
healthcare means consumers are in control: budgeting
benefits, choosing providers, and navigating care options.
As a result they're talking about you, reviewing you, price
checking you, and recommending you...or not! Today's customer
has an abundance of choice and it's up to them to determine
your value and what your brand stands for; or they will take
their money and spend it elsewhere. However, as much as
they're in control, remember, customer experience
encompasses every aspect of a consumer's interaction with
your company's services, products and people.... the sum total
of everything they see, hear, feel and experience as part of
their dealings with your company. And that's something you
can control! How well do your brand touchpoints resonate
with your customers' needs, drive engagement and promote
How do healthcare companies deliver superior
customer experience? It won't be easy. Annual consumer
surveys by J.D. Power and Forrester consistency rank health
insurers far below other sectors when it comes to a few
basic customer questions: Do they meet my needs? Are they
easy to deal with? Would I recommend them to a friend? The
current state of healthcare customer communications needs an
overhaul. There's redundant and siloed messaging, no
personalization, and very little measurement. Turning around
healthcare's UX will be driven by customer insights that
allow you to know your customer, create relevant content
delivered through relevant channels, deploy
cross-organization satisfaction metrics, and most
importantly, have champions for your customers' experience
that reside in the C-Suite.
throughout the customer lifecycle must create a value
exchange through an integrated communication stream that
deepens engagement and improves loyalty. And in healthcare,
unlike transactional retail markets, loyalty needs to focus
on interactions (vs. transactions) with an ability to
leverage individual motivators as well as emotional and
rational drivers of customer behavior. The payoff is not
only better customer retention and LifeTime Value, but a
healthcare customer experience differentiated by
personalization and most importantly, one that produces
Better Health Technologies, LLC
"Narrow networks" is the specific trend catching my
attention - one that has been grossly mis-characterized in
the press. The topic has generated headlines in the
Washington Post, the Wall Street Journal, CNN, AP, USA
Today, and numerous regional news outlets.
has gained visibility as a result of the "narrow" provider
directories being offered in the Federal and state health
insurance exchanges. The plans typically do not include all
the providers in a geographic region, particularly ones that
are highest cost, e.g., academic medical centers. These
narrow networks often are priced 10-25% below networks
offering a broad selection of care providers.
how the issue of "narrow networks" has been mis-characterized
in the popular press:
• Health plans are
the bad guys in creating narrow networks.
The narrow networks have been created by health plans
offering low ball prices to doctors and hospitals. Price is
the predominant factor being considered by health plans.
• Narrow networks are inherently bad. They limit
patient choice of providers and sometimes force patients to
change long standing relationships with doctors and
• Excluded doctors and hospitals
are outraged; some are suing to be included and/or promoting
legislation to prevent their future exclusion.
issue of narrow networks actually isn't new - it's been
around for over two decades... but the issue will look much
different in the future. Here's how I'm hoping a more
educated press will begin to reposition the issue that I'm
relabeling as "Patient-Provider Value Networks":
• Provider networks increasingly will be created and
operated by providers themselves. Think about it. Medicare
ACOs, commercial AC-Like initiatives between plans and
providers, clinical integration networks, bundled payment
initiatives, capitation arrangements - all of these are
forms of "narrow networks".
• Price will be
only one factor in broader Patient-Provider Value Networks.
Yes, in the past price has been a primary differentiator in
putting together provider directories. Surveys have shown
that for many consumers price is the primary factor in
selection of a health plan. But...the so-called narrow
networks haven't been true networks; the word "network"
implies a prior relationship, coordination, common systems
and policies - not just lists of providers that have
haphazardly put on a sheet of paper or a website.
• Patient-Provider Value Networks offer many
advantages. In the future, quality, care coordination,
patient experience will increasingly take front-center stage
in creating true networks. Consumers will recognize that
there are many tradeoffs that must be considered in their
• Competition among providers will
shift and will be based on quality, cost, patient
satisfaction. The press and public will realize that
specific providers being excluded from health plans is a
healthy result of a more competitive, transparent health
care system. Some people will still want the broadest choice
possible - and that's OK, but it will have a price tag
Chief Strategy Officer
public focus has been on the opening of the Exchanges this
year, attention will quickly shift to the employer-provided
benefits segment, where the vast majority of the population
obtains their health coverage. According to a report
published by Families USA in November, nearly 19 out of 20
of Americans under age 65 will not be seeking coverage in
the individual market. Most of those will be obtaining their
coverage through an employer.
the impending approach of January 1, 2014, the one-year
reprieve from employer reporting and penalty enforcement
under the Affordable Care Act (ACA) is quickly evaporating.
So the time has come for employers to get serious about how
they plan to handle the data collection and recordkeeping
tasks that are not far ahead.
have to be able to translate their more conventional
employee classifications and benefit eligibility definitions
to determine which employees fit the two definitions that
matter in the ACA: Full Time Employees (FTEs) working 30+
hours a week, and Not Full Time Employees (NFTEs) , working
less than 30 hours a week. It will not always be easy to
make the distinction especially in industries with a lot of
variable scheduling or seasonal peak periods.
dollars at stake are significant, and we have been
encouraging our clients to use 2014 to analyze their
workforce, assess their systems and evaluate their policies
and procedures to ensure they are ready for the ACA
requirements to go live.
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