With healthcare's trillion dollar disruption underway and private insurance being the single biggest chunk of healthcare spending, benefits consultants have a big challenge ahead of them. Particularly since the status quo of health benefits is performing so poorly. This is a key reason why business coalitions are organizing their annual conferences around the Health Rosetta. Since the article on the Florida Health Care Coalition published, I've had several benefits consultancies and third-party administrators (TPAs) ask me to speak at their meetings.
In those talks, I outline how the Health Rosetta is the blueprint for what wise healthcare purchasers should follow to maximize the benefit to their constituents. Whether it's a public entity in the UK or private companies in the U.S., there's a movement towards wiser healthcare purchasing. The 95 Theses for the New Health Ecosystem provides the guiding principles for how winning organizations across the entire health ecosystem will approach the overhauled health ecosystem and deliver the components of the Health Rosetta. Contributors to the 95 Theses include household names such as Bill Gates while others are well-known industry figures such as Dr. Eric Topol, Susannah Fox, Jonathan Bush, and Esther Dyson. Others are not broadly known figures yet are doing extraordinary work in their fields. They include people such as Dr. Tom Delbanco, John Wilbanks, Lygeia Ricciardi, John Grohol, Jan Oldenburg, Shannon Brownlee, Dr. Bryan Vartabedian, Dr. Clay Johnston, Dr. Rushika Fernandopulle and many others whose thinking will shape the industry for years to come.
Leonard Kish and I have spent the last 18 months curating thinking from many of the most forward-looking minds in healthcare. We've been flattered that some have compared the 95 Theses for a New Health Ecosystem to the Cluetrain Manifesto. In fact, it was the Cluetrain Manifesto that was our inspiration. For those unfamiliar with the quirkily named Cluetrain Manifesto, it was hugely influential the development of the commercial Internet when it was published in the late 90s. It remains relevant 17 years later.
11 Rules for Success in the Future Health Ecosystem
I've selected the guiding principles from the 95 Theses that are most applicable to benefits consultants/advisors to guide their clients. I must acknowledge the input we received from the following people on these particular theses:
- Jim Millaway, President and Innovation Lead The Zero Card; Benefits Consultant, HUB International; Chairman of the Board of WellOk, the Northeast Oklahoma Business Group on Health and a member organization of the National Business Coalition on Health
- Dave Sanders, MD, Co-founder & CEO ZOOM+
- Stanley Schwartz, MD, President and CEO WellOK, The Northeastern Oklahoma Business Coalition on Health
- Garrison Bliss, MD and Owner at BlissMD, Founder of the Direct Primary Care movement
These individuals are behind some of the most innovative health benefits in the last 20 years highlighted in the following articles:
- The Silver Bullet To Solving Healthcare's Most Vexing Problem
- Largest Nonprofit Health System Heads Toward Fully Transparent Pricing
- Economists Have No Idea How Hard It Is To Be A Healthcare Consumer
- I've Seen The Future Of Healthcare. I Like What I See.
- A No-Wait ER At 1/10th The Cost And Half The Time
- The Amazing Power Of Deflationary Economics For Health
- Patient Engagement, Negaclaims Can Reposition Health Insurance
- Health Insurance's $4.4 Billion Bunker Buster
In the coming weeks, we'll publish the essays from the individuals mentioned above that expand on the individual theses. The section the thesis is associated with is bolded along with any preamble in that section of the 95 Theses.
Economics and Transparency
14. Individuals have the right to know how much care will cost before receiving care, both out of pocket and covered. When there is unpredictable complexity (not caused by medical error which shouldn’t be charged for at all), individuals should be informed of the most likely ranges.
New Health Plans, New Health Benefits
80. Fee for service is dying. Transition now in every way you can.
81. The dirty secret of health plans is that higher care costs have, counterintuitively, led to greater profits for the plans. This is changing. Winning health plans will capitalize on the opportunity to fundamentally rethink plan design to be optimized for the fee-for-value era.
82. Catalyzing patient engagement will lead to better care and a more competitive offering.
83. The next dirty secret of health plans is that they are money managers. The longer they hold on to money, the more they make. Employers and unions are driving the next wave of healthcare innovation, protecting their employees/members.
84. Rather than reflexively denying claims and building up a mountain of ill will, insurance companies should invest resources in protecting their member’s financial security.
85. Customers will, in effect, “self-deny” their own claims. A new metric for success is the “Negaclaim” — an unnecessary claim avoided. This isn’t about denying care. Just as energy consumers aren’t interested in kilowatt hours, individuals aren’t interested in health claims — they want health restored and diseases prevented. Garrison Bliss, MD
86. When individuals are fully educated on the trade-offs associated with interventions, they generally choose the less invasive approach.
87. The ACA defined “essential benefits” but there will be a corollary about rights to “essential access” as part of coverage. Any modern health plan offering will include virtual visits, transparent price info, updated provider directory, same day e-mail response, next day test results, etc. — all imminently doable with today’s modern technology.
88. As the second or third biggest expense after payroll, CFOs & CEOs are failing in their fiduciary responsibility by being overly passive in how they procure health benefits. A rethought healthcare purchasing plan drives direct, financial returns but most importantly enables your valued employees to do what they desire — realize their full potential.
89. Genomics information and testing will be key components of personalized medications, tailored to provide the best dose/response relationship in each patient. Because of their importance, these tests and genomic information must be covered by health plans and insurance.
Upcoming travel/speaking schedule present opportunities to get on Dave's speaking calendar:
- Week of March 28: Washington DC
- Week of April 4: Montreal, Chicago
- Week of April 25: Orlando
- Week of June 13: New York City
- Week of July 4: Toronto
- Week of July 25: Montana
- Week of September 19: Northern Europe