Friday, March 18, 2011

#whchpi Closing Panel - how will the industry change.

The final session from the Health Plan Innovation Conference.

CLOSING KEYNOTE ADDRESS: Analyzing the Changing Health Plan Marketplace – Impacts of Aging Boomers, Reform
Mandates, Exchange Implementation and Economic Factors on the Future of the Industry
A panel representing an industry equity analyst, venture capitalist and a research analyst will provide insight into key trends impacting the industry, identifying areas of growth and opportunity, and insight on business models likely to succeed.
  • Trends in private equity and venture funding during a recession and in an era of uncertain health care reform
  • Key attributes of health care business models that are attracting venture capitalist and private equity funding
  • Insights into how health care policy impacts health care financing to drive innovation and foster growth of the U.S. health care system
Stephen Krupa
Founder and Managing Member

 View Biography

Ted Shannon
Investment Analyst
Arrowpoint Partners 

 View Biography

Doug Simpson
Executive Director
Morgan Stanley Research 

 View Biography

Cost shifting to shoulders of employees is driving change.
Co-Pay and deductibles will rise.  Increased interest in lower price point products. Expect that to more focused, narrower networks. 
Expect the reform debate to shift from Access to Cost Savings.
Large groups may not change but small groups (<100 employees) likely to shift to Individual and SHOP exchanges.

Expect Groups to move to HRA based plans and move to employee purchase via exchanges.
Expect an evolution to Health Plans being setup by employers much like the 401(k).

Move to "Sponsored Benefit" rather than provided Benefit will require significant employer education programs to educate employees. This has been seen time and time again in 401(k) market.

We need a transformation in the INFORMATION available to consumer to enable informed decision making.

In the new market we are heading towards the consumer will be able to "fire their healthcare company"

If plans continue to send the communications and EOBs we send today Health Plans will get fired.

"Starvation in the land of plenty" 
Medicare volumes will rise. 
Stratification of benefits. From Comprehensive to minimal.

Consolidation in Payer and Provider Space.
Hospital mergers tripled after passage of Affordable Care Act.
in healthcare top 80% of health business is covered by >20 plans.
50% of industry business is in plans with less than 3M lives.
Expect to see consolidation.
Brand, Breadth and Cost Structure will be factors that manner.
Expect innovation in the smaller payers, which the larger payers will copy.
Consolidation will not lead to better performance until the core issues are addressed.
We may even see Vertical consolidation (Health Plan buys a Hospital)

Seechange Health insurance license in 37 states. Value based plan design. Incentives in to HSA. Sold through Brokers. Providing rate stability to employers and employees. Engage in management of chronic illness in order to achieve cost stability.

Closing comments by Molly Goins-Cox:
Shifts that are occurring:

10. Martin Graf - Regulated Price and unregulated Cost
9. Jim D - Surprise is the enemy of satisfaction
8. Roy - Virtual visits
7. Lori Daniels - Self Service we are all going there. Make sure it is fun and easy. Think out of the box.
6. Lori - Update our systems
5. Kevin Riley - Retail Health it is an important distribution system
4. Mike Phillips - Ancilliaries become adjacencies
3. Sheri Dorfman - Peer to Peer, Education, blogs, Anonymity, Also People wanting coaches and facilitation
2. Jim D - Rate ups - communicate with respect.
1. Naimish - Go where the members are. 

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