Patient Engagement

Foundation for Growth

Invest in fundamentals and growth to move forward

Scarcity mindset is toxic to you and companies. It is a result of something lacking in your life that causes you to do things for short term relief rather than taking actions that provide long term benefit.

I had several exchanges with colleagues recently and scarcity mindset came up in every exchange whether the topic was foreign investment or potential business partners taking information for their own gain. When people feel their job or survival is threatened they tend to protect their turf with short sited decisions.

It’s hard to make any meaningful progress in business when people are protecting their turf because it limits their ability to think creatively and resourcefully. People need a certain level of support to shift their mindset to growth. It’s why leading edge companies provide employees with continual learning opportunities and benefits that support health and wellbeing.

Processes will be automated and jobs will be eliminated. As leaders we need to be thinking ahead, making investments in people and supporting their transition in the workforce. There is always something better when people can imagine their role in a brighter future.

Reframing mistakes, screw ups and failure all have a seemingly negative impact but they are not all the same and shouldn’t be treated the same way.

Screw Ups are just simple mistakes that happen even though you normally get whatever it is right. Don’t beat yourself up over a screw up. Just make amends and move on.

Failure is a necessary part of growth. If you try something new and it doesn’t work as expected, don’t get caught up in negative self talk. Grow from the experience and achieve something even better.

Representation matters. You might not agree with what was done in the past but when you see opportunity, you can change the future.

A few years ago, colleagues questioned my decision to work with a certain client. Admittedly, that client operated with business practices that were definitely questionable in terms of ethics, but that were not illegal. I had even struggled with the decision at the time because the practices didn’t fit with my own moral code of conduct and later wondered if I made a mistake.

However, watching the interview with Bozoma Saint John, Chief Brand Officer for Uber her words confirmed for me that I made the right decision. Accepting the client didn’t mean that I condoned their past business practices. Rather I saw the opportunity at the time to move the client forward in a way that created a win for everyone.

Some health plans have been developing narrow networks that are economically credentialing some providers out of their networks for past behaviors. Unfortunately, no one really wins with that strategy because patients value choice and penalizing providers usually forces more consolidation which drives up the cost of healthcare.

No one can change the past. We have to look for the opportunities to correct past wrongs and move forward in a way that serves everyone’s best interests.

You don’t have to cheat to win. Healthcare is a tough business but investments in the fundamentals pay off over time and ready your organization for the future.

1. Market Assessment: Assess your value to the patient population you serve in terms of the 3 P’s of marketing: product [your service], place and price.

2. Invest in your People: Too often healthcare companies only provide required training to professionals. They forget that every single person within the organization affects the overall patient experience. Leading edge companies that routinely invest in their people perform 45% better than their competitors.

3. Automate all Routine Processing: Streamlining and automating processes increases accuracy, increases cash flow and enhances the experience for healthcare consumers [patients] by giving them more control. Training investments make it easier for people to transition up or out of the organization when the time comes.

4. Manage your Contracts: Use data from your market assessment to negotiate ‘fair value” rates with commercial payers and mange those contracts. 3–5% annual increases may not seem like much but when you compound it over time, it adds up.

Laying the foundation takes some upfront work and investment but the pay off is long term financial success.

More change ahead is likely as patients demand more transparency and become sophisticated healthcare consumers.

Reference pricing offers way to engage healthcare consumers that allows for more choice and full access to providers. What is it?

The allowed amount for a specific service is limited to a defined contribution or in other words, a flat amount for a specific service. If a more expensive provider is chosen, the employee/patient has to pay the difference. The employee receives the full benefit when treated by low cost providers.

A reference price gives employees/patients more control over the entire experience in terms of their providers [facility and physicians], setting, implants, drugs etc. which is what most people want. The challenge is the lack of pricing transparency.

The prices available to most patients now are estimates based on historical claims data. The data fails to reflect real time market changes resulting from consolidation, new contracts and new technology or services. The only way to get accurate prices is from the providers involved and the health plan contracts with those providers.

We have standard transaction sets for authorization and claims submission but for some reason we’re not using them to facilitate estimates. The question is why not? Current revenue cycle costs exceed $52 Billion annually and do little to serve the healthcare consumer.

Collection Risk is a real problem for healthcare providers especially when patients are underinsured. Who should pay for the collection risk?

Policy benefits are assigned to the provider when care is provided. Assignment of benefit was meant to protect the provider from patients who fail to remit insurance payments made for their care.

The problem now is that providers may or may not get paid even when they have been assigned the benefits. In many cases, the first dollars under many policies are now due from the patient not the commercial payer.

There are new solutions to help providers collect from patients but it’s adding more time and effort to the process. Many small retailers cringe at the thought of a credit card transaction fee which is a drop in the bucket compared to the cost of collection in healthcare. Even with the new tools and increased effort, collection risk is increasing because patients don’t have the money to pay or just don’t pay.

Should insurers selling the policies and/or companies providing the policies be required to reinsure the underinsured? Technology being used to help people select policies can probably also predict the reinsurance need. So should premium dollars be set aside to cover the collection risk?

Gravity Problems: Watching “ObamaCare” twist in the political winds has not been easy especially for those directly impacted by the changes.

I have started reading a new book called Designing your Life. It breaks life down into 4 aspects: Work, Play, Love and Health and uses a metering like system to help you evaluate what areas are working and what areas need improvement. I like the simplicity of the framework.

One idea that has stuck with me is “gravity problems” and the fact that you can’t change gravity. You have to work with gravity or work around it to achieve whatever it is that you want. Gravity problems can be environmental, circumstance related or even political.

So tackle the problems that you can solve, change your tact on some and prepare for others that are likely in the future.

Innovation: Companies that want to innovate and perform better need to accept that failure is part of the process. The learnings are as valuable as the result if you allow people to harness the insights into doing or creating something better.

Not everyone is prepared or willing to take on the risk to chart a new path or create a new product. So people willing to take the risk should be rewarded not punished when they fail especially when they can explain and act on their learnings.

Innovation is about experiments. The very nature of experiment is about trial and error. The concept of innovation gets lost when people make huge bets that don’t pan out. Don’t make a huge bet until you know what works.

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About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.

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The Benefit Gap

Purchasing health insurance is kind of like purchasing a specialty light bulb. There are more bulb options than you can ever imagine. Standing in front of the wall of bulbs once you’re at the store, you’ve probably realized that it’s next to impossible to pick the right bulb without knowing the model and wattage needed.

If you’ve used an exchange or picked your insurance from a bunch of policy summarizes, you probably felt that same overwhelming feeling as standing in front of the wall of bulb options and likely thought there has to be a better way.

Exchange and Brokers:
Exchanges and brokers narrow the options so that you only have to look at part of the wall. The problem is that the criteria used to narrow the options basically tell you which policies you can afford but not necessarily which plans are best for you.

Income, age and location are the primary criteria being used to filter the options on the exchanges. Age is a risk adjustment to help insurers price the policies, income addresses your ability to pay for health insurance and location provides all of insurance policies offered in your city. In other words, it’s like seeing only the bulbs that you can afford to buy but they may or may not fit your light.

Healthcare Jargon:
Model numbers and wattage don’t help if you don’t the model and wattage needed. Similarly, the use of healthcare acronyms don’t help you pick a policy when you don’t understand what the acronyms mean.

Exchanges and policy summarizes are littered with healthcare acronyms such as HSA, PPO, HMO and EPA. Some of the acronyms have been around for a while but how they are being used is changing and evolving within the healthcare industry and those newly covered probably don’t have a clue what they mean. The problem is that all of the acronyms affect the cost of healthcare and impact the consumer experience.

Comparable Plans: 
How do you pick a bulb when you don’t know the model and wattage? Chances are you guess. You pick the new bulb from your memory of the old bulb and take it home to try it out. That’s kind of what people do when picking health insurance. They use past experience to find a policy like their old one or a better one if the last one didn’t meet their needs. 

However, the only thing comparable about the plans now are the names and the benefit terms included. Some benefit terms specify a copay or rate of coinsurance and others set a maximum benefit. Consequently, there is no mathematical way to know which term provides the better benefit.

Few people are able to figure out which benefit is better because it takes a lot of work just to get the information needed to do it. So most people guess and hope for the best. Needless to say, emotions flare when they figure out their guess was not so great because unlike a light bulb, they’re stuck with the policy for an entire year.

To provide the math at time of purchase, more information is needed about each insurer’s network. Most insurers have to contract with healthcare providers (physicians, hospitals and others) for services needed by their members. The contracted rates are negotiated and may be different from provider to provider.  For healthcare providers not included in the network, the provider’s charges are needed to calculate the benefit.

The Point:
Healthcare consumerism starts with the selection and purchase of the insurance policy not healthcare services. If consumers don’t purchase the right policy for them, there is friction every time they use their benefits.  

With healthcare costs becoming a bigger part of the consumer budget, we need to make it easy for healthcare consumers to understand what they are purchasing and make better recommendations of policies to serve their needs.

About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success.

Let’s Change the Game

Medical risk is like the hot potato that keeps getting passed around between the government, employers, insurers and providers.  Similar to the hot potato game, whoever ends up holding the medical risk usually looses the game.

The responsibility for managing medical risk includes the responsibility for managing a big pot of money to administer claims. Medical billing and collections, as described by Jonathan Bush, founder and CEO of Athena Health, is one of the stinkiest parts of healthcare that few providers do well. So basically by transferring risk to providers they end up with more of the stinky stuff that they haven’t been able to manage well. That alone give me heartburn because the stinky part is critical for monitoring the overall health of the risk pool and their organization.  However, there is even more to the story.

Risk + Money = the Risk Pool:

Healthcare trends like the aging population and the number of obese and overweight people are the risks that suggest a need for a very large pot of money to pay for healthcare. Unfortunately for providers, all the other players in the hot potato game are basically saying they’re tapped out. So healthcare providers somehow have to figure out a way to do more with less. In other words, they are getting less money than they need to pay all the expected claims. 

Do More with Less:

Many providers are accepting the challenge to do more with less even though it’s never been their strong game. Most have been focused on delivering the care patients want regardless of cost because historically, they have been able to make enough from some patients to cover all the bills for everyone. So at this point no one really knows how to do more with less successfully.

Building regulations, staffing regulations and lack of pricing transparency for medical supplies make it challenging to cut costs that companies in other industries routinely cut. Some savings will be realized if providers share records and reduce the amount of duplicate tests but the bigger savings come from not delivering care at all. Providers have yet to figure out how to say “No” to patients who want medically unnecessary care without getting a bad review and how to get people covered by their risk pool to live healthier lives.

Medically Unnecessary Care:

People who are really sick rarely think care is unnecessary even if a treatment has a very slim chance of working. Who doesn’t like to think they will be the exception to the rule? Isn’t that part of positive thinking? That’s what makes coming up with care guidelines so difficult and hard for providers to adhere to. Saying No or No unless you pay for it upfront is hard for all the players. Insurers did a better job of playing the bad cop because they didn’t have to face their member and tell them the bad news or work with them day-to-day.

What healthcare consumers need to understand is that healthcare insurance doesn’t mean covered for everything and anything. Few healthcare consumers read the fine print of their policies before they need to access the benefits – and unfortunately, that’s when the frustration begins for everyone.

Live Healthier:

There are a lot of people in this country carrying too much fat. Providers tippy toe around the issue by telling patients they are at risk for disease and/or by letting them know their BMI measurement is beyond the healthy range. You can only imagine that some patients don’t really see the problem with a point or two beyond normal and why some patients are not connecting the dots or getting the right message about fat. Fat causes a lot of health problem that are costly to treat and makes it hard for providers to do more with less.

Wearables may help connect the dots for some healthcare consumers. The latest technologies measuring our motivation, movement, sleep and food consumption can help us develop awareness, establish a baseline and monitor metrics during periods of physical change.

The problem with wearables now is that they are not sticky enough without a financial incentive to motivate the healthcare consumers who needs to loose weight and they are addictive for people who are already extremely active. Both groups are problems for healthcare providers trying to do more with less.

The Point:

There are a lot of questions left to be answered about how to make it all work so that providers can do more with less and patients get the care they need and want. It’s going to take some more honest conversations and fresher thinking to change the game.

The one thing we know now is that everyone can help by eating a healthy diet, exercising and living an active life.

About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success.