Local beer and healthcare payer economics

Nurse in doctor's office

Recently, I had the opportunity to visit a healthcare customer in Grand Rapids, Michigan. Over an especially tasty local stout, we talked about all he and his team has done with my organization’s enterprise content management product and all that is yet to be done.

In true Michigander fashion, when I asked for his involvement in a payer community effort, he casually offered, “Yes, but it has to be about payer macroeconomics. I’m not interested in the small stuff.”

I mentally filed that to chew on during the following morning’s drive home.

Of course, it was March 1 in Michigan and I had a two-and-a-half hour drive so, there must be a snowstorm. As I followed a snow plow down the interstate, I had plenty of time to ruminate on the big picture of payer macroeconomics. Here are some of my thoughts from that drive.

What is payer macroeconomics really about? Here’s the gist: 

     1. It’s about wellness and prevention

Many of us focus on shaving a third of a cent off the cost of adjudicating a suspended claim, but the real money is in eliminating the claim in the first place. Your goal is to figure out these questions: How can we automate wellness? What does that even look like?

     2. It’s about dinner

Some of the best medicine we take is food. But like any good medicine, too much can poison us.

So why doesn’t my insurer cook me dinner? It’s cheaper than treating diabetes. If they can’t send a chef to my door each night, how about teaching me and my family about what and how to cook. How about a workflow for meal planning?

     3. It’s about my journey, NOT your systems

IT, healthcare software, hardware and expensive gadgets should ONLY serve to support a holistic approach to making me your least-expensive member ever. As a member, most payer systems and processes make me dizzy. There is almost no transparency and little real-time feedback.

In contrast, when I buy a book on Amazon, they send me a text at every important moment in my package’s journey. Why is that different when that journey is about my healthcare?

     4. It’s REALLY about me

As a member paying a not-so-insignificant part of my paycheck for health insurance, why am I treated like I am in the cheap seats? I have no useful information available to me from my insurance company on a regular basis (other than an EOB), there is little proactive information to keep me well and my provider knows almost nothing about me.

For example, do you think my provider sent me a text this morning after I hauled myself out of bed and swam 1200 meters? (There is still time for a text.)

But that’s not all. Here’s my beer-infused list of payer macroeconomic issues:

     1. Payers should reduce prices

Yep. If Walmart, Amazon or McDonald’s offered health insurance right now, you would be out of business. If you were competing with McDonald’s, you would be selling $24 Big Macs.

You need to be insanely frugal about administrative costs. Medicare is cheaper than you. That’s right, even the federal government can deliver payer services cheaper than you. Your IT partners need to be hip-to hip with you slashing away at costs.

     2. Payers are a member’s Sherpa

Create the Amazon of Health Insurance. Keep me informed.

Lead me, as your member, through a wellness journey where you, the payer, are the Sherpa. Keep me safe and healthy like a good Sherpa does. Point out the right things to eat along the way and what things to do to prepare to the trek ahead.

     3. Payers should live in glass houses

I should be able to look in from your front window and see right through your entire company. Information, especially my health information, should find me and talk to me… intelligently. If I ever have a question, there should be a human who gives a hoot and can give an answer that makes sense to other humans.

     4. Payers should be madly in love with my doctor

My general practitioner is amazing. He is kind. I really like him. Make his life easier so that he can focus on my care (with you) and not have to focus about deductibles, bundling and fighting arcane, pre-historic rules that keep him from keeping me or making me well.

You are both on my team, act like it.

So… That is my rant on payer macroeconomics. That’s what we should be talking about. Let’s get to work.

If you have had an excellent, locally brewed stout recently or if you have some thoughts on payer macroeconomics, please comment.

* This blog post was originally published on Pulse.

Mike Hurley

Mike Hurley is the industry manager for Health Insurance at Hyland, helping health insurance organizations transform business processes that drive value for members, providers and employees. Mike works with current and prospective customers to use our award-winning product, OnBase, to drive business transformation. He is also responsible for our high-value, high-impact health insurance solutions, the like Mobile Medicare Enrollment Solution for OnBase. Prior to joining Hyland, he was the founder and president of Swim Lane Software, LLC. Hurley founded Swim Lane in 2007 to create a solution that leveraged Software as a Service (SaaS) technology to automate the processing and adjudication of Medicare Claims through unique use Business Process Management (BPM) and Business Rules Management Systems (BRMS) technologies. Preceding Swim Lane, he founded Green Square in 1997 as a national consulting practice that connected technology with business strategy. As a boutique services firm, Green Square was aimed at driving stakeholder value at over 25 BlueCross BlueShield plans in the U.S. Prior to Green Square, Hurley founded Avalon Technologies, Inc., an award-winning systems integrator focused on Enterprise Content Management (ECM), workflow and Optical Character Recognition (OCR) technologies.

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