McKinsey Quarterly released an interesting study this week under the moniker, “What Consumers Want in Health Care." The central theme of the publication was the large and growing opportunity for a new type of health care “infomediaries” (who traffic in the flow, enhancement, and interconnectivity of information) to have a large and sustained impact in the transformation of our current system to a next-generation system required to meet the health needs of the future.
A few relevant quotes:
- Retail health consumers constitute a market worth hundreds of billions of dollars annually.
- Currently 116 million consumers have a choice of health insurance (expected to be 151M by 2011).
- Most consumers still do not “shop” for insurance — 74 percent will like purchase from current health insurer.
- People who do “shop” do so during moments of considerable change — and a full 41 percent either considered or changed insurance.
- Most people need additional guidance, education, and advice to make decisions.
- Innovative, cross-industry products that assist with the complex decision making will be highly valued by an influx of consumers eager for options but unsure where to turn.
Mckinsey has published a series of papers on the “retailization” of
health care and the convergence of health and financial sectors as the
transition continues. They are obviously seeing a compelling need for
an organization that can help aggregate data, analyze information, and
provide advisory services back to consumers in a personalized,
I am sure there will be something coming down the pike that will help you crossover to the next generation health care system.
Health plans can and should step into this gap themselves. For example, they should offer guaranteed payment to the provider, and collect deductibles and coinsurance from plan members themselves.
This process is much more efficient for providers, who can focus on care delivery, and members, who can look to a single monthly statement and payment process that includes options for installment payment.
Averde Health is doing just this. For more information on Complete Care Financing, please visit: http://www.averdehealth.com
Actually, the new intermediaries are here, and they ain’t CitiGroup or Bank of America. The most promising of them is the star of Health 2.0 (so far), AthenaHealth, but there are others such as Availity (a Humana/Blue Cross jv.).
Agree w/ comment about the profound loss of momentum behind market based reforms. Most of them assume that payers will have increased leverage in an individual health insurance market, yet they are locked down on cost by local provider monopolies and a seemingly unbreakable fee for service payment system. Providers have organized themselves to eliminate competition, and secure guaranteed payment for their services thru political mandates.
McKinsey is right about the size of direct consumer payments- if you include nutrition/healthy products, “alternative medicine”, and out of pocket spending for traditional health services, it’s at least $350 billion. But that has almost certainly slowed to a crawl due to household cash crunch. The Regina Herzlinger scenario just isn’t going to happen.
The McKinsey stuff is pretty interesting but the role that banks and financial systems are going to play in healthcare the near future is complete bunk. A Bank of America or JP Morgan Chase are moving further down stream and offering additional RCM services/functions to their large hospital accounts around ERAs and lockbox services. These firms just aren’t interested in processing/adjudicating claims, acquiring this capability, or dealing with the ambulatory market except for just offering basic small business services which mainly consists of holding their accounts.
Might some new intermediaries emerge. Yeah but much more likely that existing players like clearinghouses will change skin and newer firms with better technology solutions/services/support will displace some of the older firms. Don’t know if I call that new “intermediaries.” Frankly, the financial side of the ledge in healthcare needs less “intermediaries” and not more.
One thing I just don’t put much stock in is this notion of an “advisory service” for healthcare financial transactions in next 3-5 years. Been floating around since early part of this decade with little to no traction. Basically comes down to fact that even if McCain wins this Nov., the tax credits employers get for purchasing health insurance coverage for there employees aren’t going anywhere in the next 3-5 years.
Maybe the Widen bill or something similiar passes but I wouldn’t be willing to stake a bet on a startup on this idea over the next 4 years unless you are thinking really long-term investment strategy (5-7 years).
The hallmark of this report is that McKinsey believes the healthcare system is going to evolve into a more consumer oriented market. That is not the current state and there are substantial policy changes to be made to provide such an environment. I find it interesting that McKinsey would insinuate that this is the ultimate direction of the US healthcare system. Do they know something the broad public does not?
Two years ago, they published a brilliant analysis of why our health costs are so much higher than in other countries. The McKinsey Global Institute is doing great analytic work. However, there is also a lot of predictable sniffing for big engagements, witness the really naive piece to which you allude about how banking and financial institutions (e.g. the people who have written off $300 billion in bad loans they didn’t know they had) could help put healthcare’s billing systems right. . . They have not exactly been thoughtleaders, but they do great analysis.