#whccic John Kaegi BCBSFL

Real time notes from WHCC innovation congress

Emerging Marketing Implications:
– Adapt B-C Marketing Model
– Sustain Customer Base
– Curb Medical Cost Inflation

Adjacent products employ existing capacity to deliver familiar “jobs to be done”
– Logical brand extension

Consumer needs are paramount in a retail market
– Jobs to be done:
1. Stay Well
2. Episodic/Get Well
3. Maintain Health

40% behavior
15% Social Circumstance
10% Inadequate Health Care
5% Environmental Causes
30% Genetic disposition

“No nation can afford to focus only on sickness” – Prathap C. Reddy, India Hospital System


#whccic Alex Akers, Microsoft – Supplemental Products and Value Propositions for Emerging Individual Consumers

Real Time Notes from WHCC Innovation Congress

Alex Akers, Health Plan Strategist, Microsoft

1. The Cell Phone is the platform
2. Telemedicine matters
3. The best way to engage consumers is for them to have fun
4. Social Media may matter
Vision for consumer engagement:

“Mobile could be a game changer, but only for those who get in the game”
Self care is the fastest growing category in the Apple Apps Store.

Humana Sensei App is a virtual dietician app that works across desktop and mobile.

Weight Watchers: Members that attended meetings AND used tWeight Watchers Mobile lost 50% more weight.

Facebook: 300M users
50% active logon each day.

#whccic Karen Kocher of Cigna

Realt time notes from WHCC Innovation Congress

Check out the Global Knowledge Exchange Network for sharing best health practices from around the world.

The Health Care industry is still in the mode of push in Social Media.

CIGNA are doing proactive scanning of Twitter to detect issues people are having issues with – not just Cigna related.

CIGNA data triggered actions:
– Public health and wellness education
– Enhanced Award winning EOB
– Customer Champion program- 24×7 Service
– “Word We Use”

Companies measure the wrong things and congratulate yourselves on those wrong things.

CIGNAs ALignment Continuum

– Awareness – i am aware of
– Understanding – I understand
– Relevance – It is relevant to me
– New Behaviors – I do things differently because of this knowledge.

Cigna’s Public education program reflects the health care landscape which is dominated by the reform issue.
– Improved business performance
– Educate important stakeholders
– Position as customer advocate

Reducing out of pocket cost generates most interest. People also want to know how to navigate the health care system.
35-54 age group is rapidly adopting Social Media. It is already dominant medium in 18-24 age group.

In social media Cigna learned that people will invest up to 5 minutes. Keep things short!
Why Water? Campaign. Learn and Earn program

youTube channel. Doc Rock videos are most popular.

#whccic John Bigalke – Deloitte talking on Innovation and Creativity – survive and prosper in an uncertain health economy

More real-time notes from World Health Care Congress Innovation Congress

John Bigalke: People define innovation differently.

What does Innovation mean given where Health Care is in its life cycle.

Innovation and Creativity – A Recipe to Survive and Prosper in an uncertain health economy

AND should be OR – survival is very different mindset from prospering.

Economy should be the 3 E’s Economy, Environment and Ecosystem.

Think Differently!

John showed organizational characteristics with two halves of the life cycle [Editor Note: I think he missed the 3rd half – The declining period]

Innovation is trying something people have not done before.

A disruptive innovator has nothing to lose. Once they get a market they have something to lose. Then they reach the drive to sustain/tweak/survive. The core of the HealthCare industry is in the sustain mode.

– HealthCare is Stagnant
– ROI is difficult to measure
– Focus is on the legacy needs of the constituents
– Unable to influence the behavior of others in the system

Elements of Reform: More than the congressional legislation
There is already reform taking place at the state level. ICD-10 is underway. ARRA is kicking in.
Private employers are pushing initiatives (Editor: eg. Dossia)
Medicare implementing Episodic payments in 2013.

4 tiers of investment going on:

1. Health IT (1. e-prescribing 2.fraud detection 3.. administrative simplification 4. care coordination)
2. Comparitive effectiveness (personalized medicine, bundled payments,3. Primary Care 2.0
4. Consumerism

Check out deloitte.com and check out industry landscape. A complex diagram that maps drivers, obstacles and enablers and this creates convergence opportunities.


– risk
– embedded interests

The key elements of reform are:
1. Consumerism
2. Comparaitive Effectiveness
3. Coordination of Care
4. Health Care IT

Expanding the horizons of care:
– Medical Tourism
– Retail Clinics
– Remote Monitoring/Smart Homes
– Mobile Technology
– Virtual Visits

States will have to change. They are dealing with many different issues that are inter connected.
The Wellness view “Wholistic”The most appropriate conversations happen at the point of care. Accountable Care Organizations are emerging and will be influential.
Data is a gold mine. The greatest asset that is not on the payer’s balance sheet.Social Media – progressive organizations are embracing social media. Most in the industry have an inside-out view. But Web 2.0 is about the engaged individual.

The iPhone as the newest competitor. [Editor: amen to that – Africa runs rings around us in the use of SMS Text on the simplest phones.

The future requires us to be flexible. in order to handle uncertainty.

#whccic – Results of a consumer centric benchmarking survey from William Boyles

More real time notes from WHCC Innovation Congress.

The Market pressure has reached the point where health plan financial performance depends on the ability to innovate.

There is no clear standard of best practice and there is no clear view of whether the industry is spending more on new products.

feedback from the audience: Need a better set of questions. Innovation is not just the big changes but also a lot of smaller innovations.

Innovation focus:

CDH 70%
Web Self-Service 58%
All Inclusive PHRs 50%
Web-based office visits 50%
Provider Patient email 42%
Gift Cards/Rewards 30%
Plan designs/copays 25%
E-broker web sites: 15%
Social Networking: 5%

#whccic The Convergence of Group and Individual markets

Real time notes from WHCC – Innovation Congress

Rob Panepinto, Managing Director, Client Practice Group at Connextions Health

A tactical look at the transformation from B-to-B to a B-to-C model.

“Reform will just be an accelerator – the market will reform regardless.” Employment-based coverage will continue to decline.
Triggers to change:
1. Job or Benefit Loss
2. Aged out ( >18 >65)
3. Group Plan opt-out
4. Early Retirement

Member Transition Best Practices:
1. Develop Right product, at right time to right members
2. Targeted outreach campaigns
3. Multi-channel web buying support for consumers (web, chat, text)

If you develop pre-approved products as part of retention efforts how do you handle brokers in that context.

[Editor’s Note:] what do the Cell Companies do with brokers when they upsell?

What can be implemented today:
<65 Perspective – 
– Timing of access to disenrolling members
– Target the Right customers (pre-screening and auto or rapid underwriting)
– COBRA (Provide consulting support to help members make the right selection)
– Provide support and education

With Aging Up Dependents: 
– You sell to both Kids and Parents
– These invincibles are underwritten by the parents in event of a catastrophe

In small business sector where Group coverage is declined:
– Offer individual products

Michael Cho, Founder and Chief Strategist at DestinationRx

Group Retirees needs are different. They are angry at loss of coverage. 
This group is typically in the higher income bracket and are active Internet users.

The Plan knows what the retiree has used on the group plan. This puts you in the position to be able to tailor a plan to meet their needs very effectively. These are savvy buyers. Don’t sell on Premium. They understand total Cost of Ownership. They look for lowest overall cost.

The upcoming reform legislation will impose a similar buying experience on the proposed exchanges. People will be able to see estimated total annual costs and not just the premium.

#whccic BCBSMN and American Well – innovative delivery models for accessible and affordable care

More real time notes from the WHCC Innovation Congress.

This session has MaryAnn Stump SVP, Chief Strategy and Innovation Officer from BCBS Minnesota and Roy Schoenberg, CEO of American Well talking about new delivery models that leverage the Internet to deliver accessible, affordable, Quality care.

Roy Schoenberg led off the session. He talked about American Well’s Online Care solution.

Online care is a technology solution that allows patients to be connected with physicians. It is more than just a video chat session. Patients are members. They have a health history. They have benefits. Providers have a relationship with the plan too. The interaction needs to recognize allo of these aspects to the care transaction.

Capture the opportunity of an available provider and match that to patients that require access.

The benefit to – 
Consumers: Immediate access to care from their home
Physicians: Freedom to practice on their own terms.
Payers: shift care home in to the most convenient low cost setting.

The typical referral process involves the consumer in traveling 6 times:
1. To Doctor
2. From Doctor
3. To Specialist
4. From Specialist
5. To Doctor
6. From Doctor

While Physicians practice within state lines. Physicians can refer across and consult across State lines.

In the past 12 months the online care systrm has gone to:

UHG/Optum – National

Gartner projects that by 2013 25% of encounters in US and Europe will take place over the web.

MarryAnn Stump then talked about the experience with Online Care at BCBSMN

“Transforming Care Delivery”

What we are currently doing isn’t working. 

Employers are worried too.

BCBSMN has a number of innovative employers in their region.

What attracted BCBSMN to American Well was:

– A real time approach connecting consumers to providers online
– Live interactions
– Upholds PCP coordination and care continuity
– Offers new practice opportunities and flexibility for health providers
– Delivers increased access and affordability

It allows care to come to people and not force people to go to get care.
BCBSMN started by testing on their own employee base.

The Goal: 24hr affordable access

A typical employee clinic costs about $200k to build.
They recreated the employee clinic as a virtual employee clinic

The PC for access but also some monitoring equipment that is integrated to Microsoft HealthVault

Access is by Video, Telephone or IM texting.
There were challenges in introducing the service in to the day-to-day practice at providers. 

The project is 14 weeks old. so what has been learned:

Over 1100 registered users. 66 visits so far. They bypass the claims system. It is a retail solution. Peak hours are during the work day. They are learning what to recommend when they roll out to other employers. 

Of the 66 visits: 88% replaced an office visit. 9% replaced a retail visit. 9% = other -reflects unmet need for advice from a doctor.
from the Doctors perspective:

52% replaced a retail clinic visit, 27% replaced an office visit, 23% are new uses.

82% said online care is good value. Cost is 45$ and it is subsidizes with $25 making a net cost of $20. Given the harsh winter this has been very popular. 50% of the participants said they learned something new by using online care.
82% said they saved an hour or more by using online care. 18% saved 3 or more hours. 80% said the time saved was during work time.

They engaged with physicians early in the process. This is disruptive technology. The 45$ price was driven by under cutting Minute Clinic but giving access to a doctor. All parties agreed in a multi year agreement to take 20% out of the cost of the transaction.

This is a consumer model. Providers think of the people they serve as patients. The plans think in terms of members. Both have to now think about “Consumers”

The challenge with Minute Clinics is the inbound and outbound data flows. The clinician doesn’t know anything about the consumer. Even if they have to provide the data back to their PCP after the event. In online Care the feed to the PCP is at the option of the Patient. However, the system can provide background to the online physician before the event. Care continuity is a pillar of the system.

The process has a “wrap-up” step that allows the physician to revisit the notes. The system uses rules to attach patient education materials that reflect the decisions made during the visit. 

Milliman looked at Online Care. They looked at Episodic Treatments and looked at potential substitutions. On acute conditions only they looked at a $7PMPM saving in the medicare population. Primary Care, Chronic Care and Follow-up with Physicians.

Online Care is set to become a substitution level of care.  Online care extends Primary Care in a non Bricks and Mortar context. 

Is Online Care mobile: Yes – There is an IVR front-end that can enable use with just a phone. The interface is no where near as rich. AmericanWell is working on an iPhone App. 

[Editor’s Note:] Wow – Think about an iPad version of online care using Chat and voice. All it needs is for the iPad to include a camera.