Payers and Health 2.0

Moderated by Brian Klepper, Health 2.0 Advisors

Commentary: Jerry Reeves, Health Innovations; Mohan Nair, Regence Blue Cross Blue Shield; Ingrid Lindberg, Cigna; Nathan A. Moracco, State of Minnesota Management & Budget; Chris Ohman, Kaiser Permanente

Nathan - Supports the 120,000 employer group of Minnesota; incentives for members to seek higher quality of care.

Mohan - Working for the last six years to help understand how the system can change; the system is so broken and lacking significant transparency; everyone is to blame, not just one individual; insurers have to change fast and quick and to respond — but how? Physician and healthcare system – with the consumer – have to make better decisions. Balance medical management with community engagement. The solution is that healthcare is a community asset, and we need to realize that. Consumer has to recognize it is their money, and their future.

Chris - Kaiser is 8.5 million members across 10 states. Finishing touches on enterprise-wide health IT system. Going into clinical care management; also consumer engagement piece. Steps forward include chronic disease management; manage diseases proactively on the physician level. Engagement of the consumer is related; first steps are to have the lesson (scheduling, filling Rxs, etc) — foundation is there. How to bring them together so there is better health and lowering costs – that is the ultimate question.

Linda - Cigna has 8.5 million members domestically. Slogan is to “help customers live better lives.” Transform an “old-school insurance company” into a healthcare service company; the “customer” — not the patient any longer – is the center of everything they do. What do people want from this system? Healthcare needs to be as easily and as accessible to everyone. Facebook, Twitter, SecondLife, etc. are all part of the mix; goal is to be able to have customer to be able to interact with Cigna any way they want.

Jerry - Very tough to get people to concentrate on specific behaviors to leverage change. Concentrates on data to influence that change. Drill into the data that drives costs, and it’s not wrapped around the usual suspects any longer. People with conditions are not getting the things that are life-saving; items are being thrown into the mix that ramp up the cost. Energy must be expended to engage physicians with good decision-making to minimize costs.

Making sense of the data is paramount to leveraging stakeholders and to make incentives to bring them all together. Is this a paradigm shift in healthcare? Yes. The difference is understanding the importance of the customer/consumer. We have to get much more specific/granular with actual incentives and encourage them to do things they wouldn’t normally do.

Look at the alogirithms that bring people to the top and how to we reach them? 77% of the people have no idea what payers do and what healthcare even is. The key is to marry the excitement of the consumers with the data being presented. Frame the recipe to engage the consumer; the logic of entrepreneurs developing these new systems to help these consumers does not take over automatically.

Demos by Quicken Health, The Prevention Plan, Optum Health, and HealthWorldWeb finished the presentation. The Prevention Plan was the standout. The main point was the “data drives change,” but how do we challenge ourselves with finding the things that really engage people to make those changes and think “something is in it for me”?