Can Insurance Companies Rescue the Health Care System?

January 5, 2015 DATAMARK

The U.S. health care system is broken. The question is, who will fix it?

Sukanya Soderland, a health and life sciences partner in the Oliver Wyman management consulting firm, believes health insurance companies have the power to transform the industry by acting as a bridge of sorts between the entities they work with every day: physicians and consumers.

She made her case recently in a guest blog post on the Harvard Business Review web site. Here’s a quick roundup of her proposed solutions:

Payers should act as true partners to value-based providers: Payers can help providers who are following a pay-for-value economic model succeed by sharing data, analytics and management support. Payers can partner with the best of these “fee-for-value” organizations, using them as service providers for competitively priced insurance products.

Payers should offer options for low-cost, convenient care: Payers can partner with urgent-care clinics and innovative tele-health providers, offering customers a number of inexpensive and convenient destinations for minor conditions.

Payers should cover new wellness and prevention-oriented treatments: An example is Aetna, which offers yoga training to thousands of its employees, helping improve productivity by 69 minutes a week, resulting in an 11:1 ROI.

Payers should explode the PPO model: Instead of preferred provider organizations, health insurers can offer customized coverage that gives consumers choices based on their lifestyles and risk levels. Consumers can choose coaching programs, contract length and incentive structures in an a la carte model.

Payers should sell convenience and personalized service: Soderland argues that given consumers new purchasing power in public and private exchanges, healthcare insurers should respond by making the healthcare experience more convenient, with online appointment scheduling and a variety of information tools to make data and reviews transparent and easy to find.

Payers should power healthy behavior change: Health insurers can offer programs to help change people’s unhealthy lifestyles, taking advantage of new technologies such as wearable monitors and the latest research on behavioral science.

Payers should serve as the bridge between new tools and consumers: Health insurers can tap analytics to help pair consumers with the best programs suited for them. Examples of these type of customer-engagement programs include WellTok and Rally Health.


The post Can Insurance Companies Rescue the Health Care System? appeared first on Outsourcing Insights.

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