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Maximize Value April 21, 2016

Webinar: Views on Barriers & Progress Toward New Front Door to Health

Senior Editor, Oliver Wyman

During the April 12 Consumer+ New Front Doors webinar (replay above), the fourth in a series sponsored by Oliver Wyman and Foley & Lardner LLP, top executives representing a variety of technology-driven health solutions shared their points of view on the legal and regulatory issues involved in changing front doors to healthcare. The participants also discussed the opportunities and risks that will emerge as incumbents and new entrants strive to deliver entirely new levels of choice, convenience, quality, and value to healthcare consumers. Participants included Gabe Drapos, Chief of Staff, Oscar Insurance; Neil A. Solomon, MD, FACP, Co-Founder and Chief Medical Officer, MedZed; and Rachel Zeldin, PhD, Head of Network Partnerships, Collective Health. Oliver Wyman Partner Sam Glick co-moderated the discussion with Alexis Bortniker, Senior Counsel, Health Care, Foley & Lardner LLP. Highlights:

Sam Glick, Oliver Wyman: Glick provided a snapshot of the current landscape and overview of trends shaping today’s opportunities. He began by noting that last year was the first year the average, commercially insured consumer was in a high-deductible health plan. “It means that after many years of talking about shopping in healthcare, they now have an incentive to do that,” Glick said. Historical thinking has been that once you shift costs to consumers, give them tools to shop, and educate them on the price of different care sites and procedures, they will make good decisions to bring down costs. “But the data shows us that that is not what is happening,” he said. Instead, as costs get shifted onto consumers, they tend to reduce spending; and rather than shopping or learning about lower cost sites of care, they avoid care altogether. Their mix of care doesn’t change, Glick explained, but their utilization drops. That highlights the gap in currently available health information and transparency tools, but also demonstrates the need for accessible, affordable new-front-door solutions.

Glick also provided data from a recent Oliver Wyman survey on consumers’ use of alternative sites of care. The research found that all segments are finding more convenient ways to engage with healthcare; and that once consumers use the new front door, they are more likely to use it again. On the flip side, consumers who had visited a traditional doctor’s office in the past were less likely to go again. “New sites of care create loyalty, old sites destroy it,” Glick commented, and that highlights broad opportunity for new-front-door solutions. “The cost-shifting to patients, expansion of access due to ACA, interest across segments, new types of way of engaging, and general trend of consumerism creates a kind of consumer bill of rights,” Glick concluded. “We should be able to deliver more affordable, accessible, simplified, better care.”

Gabe Drapos, Oscar Insurance: On how new-front-door solutions can achieve the “triple aim” of improving quality and satisfaction, improving health, and reducing cost, Drapos noted that Oscar provides telemedicine free for all members. In reviewing its upper respiratory telemedicine calls, Oscar found that 90 percent of members had conditions successfully treated via telemedicine, meaning no follow-up claim. “They got what they needed via telemedicine. That lowers costs for everybody,” he said. And on the patient-experience/quality-satisfaction goal, he noted that effective tools help get people the right information at the right time. Equipping both members and consumer-facing staff with advanced tools and information can improve the overall experience.

Neil A. Solomon, MedZed: According to Solomon, hesitation on the part of provider-led organizations is one of the current barriers to adoption of new solutions, as these organizations tend to be among the slowest to embrace new solutions. “Physicians typically tend to be relatively conservative in their decision making. Even if there is a business opportunity, there tends to be a long decision-making process, and that’s a challenge to innovating in the healthcare system,” he said. He noted, however, that another, often more-successful path is to go directly to large employers that are managing the benefits of their employees. On achieving the triple aim, Solomon explained that a solution like MedZed, which brings medical, behavioral and social services care to vulnerable patients where they are, can help consumers stay healthy and reduce utilization. He also noted that what often drags down quality and satisfaction scores is there are many patients who simply fall off a providers’ radar because they don’t come in and can’t be tracked down. “Those are MedZed patients,” he said. “We can help close those care gaps … and improve quality and patient experience.”

Rachel Zeldin, Collective Health: Zeldin noted that it is important that advanced solutions be available to all health populations, agnostic of the payer. “Regardless of who is funding your healthcare, you need better information to help you make healthcare decisions,” she said. She also noted that the triple aim can be achieved by going all the way back to plan design. Collective Health works with employers to design communications that improve benefit literacy and that help members navigate the system. The company also helps employers design plans that take into account how “members aren’t necessarily going to act rationally,” she said. “It’s hard to manage a high-deductible plan. So coming up with plans that allow members to make good decisions for physical health and financial health” is important, she explained.

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