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Employer innovation, block chain and the rise of the narrow network

Notes from the Healthcare Revolution

Every once in a while in this business, you come across an employer who is willing to think way outside the box about their benefits programs. I recently collaborated with one of these employers, NCH Corporation, to present at the Healthcare Revolution conference in Orlando.  This conference is one of the largest annual healthcare innovation and networking conferences in the country, with more than 2,000 attendees.

NCH is an 8,500-employee company that sells industrial, commercial, and institutional maintenance products. Their benefits leader and I discussed the difference between benefits innovation and healthcare innovation. These are two distinct things that are often used interchangeably. In the case of NCH—benefits innovation means taking big risks to solve health care trend with little or no cost shifting to their members. To accomplish this NCH lets their HR/Benefits team push the envelope a bit. Their team has successfully managed their plan to zero trend for several years in a row. This list isn’t exhaustive, but here are three key ways they did it:

  1. They moved from a traditional PPO to “EPO” model with no out-of-network coverage
  2. They created a tiered network (varying plan design based on Tier 1 physicians vs. Tier 2).
  3. They rolled out a narrow, high performance network with Imagine Health, and they are aggressively pursuing a national ACO/narrow network for 2020 rollout.

It was fun to share the wisdom of NCH’s experience with hundreds of other employers.

While in Orlando, I also attended sessions on block chain and artificial intelligence (A.I.), which I first explored a few weeks back while studying the healthcare system in Portugal. I’ll admit, these concepts can seem very technical and confusing, but the possibilities with them seem to be endless. A panel of experts including Microsoft’s David Go Houlding and Grapevine World’s Wernhard Berger  gave us a much clearer understanding of where blockchain and A.I. can help, and—perhaps more importantly—where they CANNOT help.

Block chain/A.I.  involves data sets being able to talk to each other and share information, but without the human element involved and no data actually being handed over from one party to another. In the case of highly sensitive and detailed health care information, this technology is a potential game changer. It will maintain a multi-party accessible “ledger” record for clinicians and institutions to access. The catch? The transactional costs are still prohibitively high for industries like health care that have many thousands of transactions per day; and HIPAA will still prevent free sharing of information between disparate/non-connected systems. However, the vision of reducing/removing clinical errors and redundant data entry procedures is within reach – and could unlock a significant amount of efficiency in an area where it is desperately needed. The most important element—privacy—will still remain. Block chain WILL NOT change or release HIPAA constrictions – since most of the issues here involve an otherwise disconnected system. It’s important to note: much of this is still theory and will be determined in future…but after what I saw at the Healthcare Revolution conference, it seems the future is promising.

Perhaps my biggest takeaway from the conference is the growing use of the narrow network to manage costs and improve quality. This idea is on its way to becoming mainstream again and the PPO as we know it today will soon be a thing of the past. But have no fear—in its place you won’t find the HMO plans of yesteryear.

Bind Health, a new company with large seed funding from United Health Group, has an extremely interesting value proposition that could significantly accelerate the changes to supply side/access. All the executives at Bind Health come from Definity Health, which was acquired by United in the early 2000s. Its leaders are disruptive by their nature and they know the healthcare space well.  The platform drives members to high quality, lower cost providers by mandating engagement, and varying member cost share based on the care chosen. The platform also has a unique “variable/custom insurance on demand” function. More here on Bind Health. If you’re interested in more details about the annual Healthcare Revolution conference, check that out here.

 

 

 

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