Senator Scott Brown Visits Venture Café!

On June 10, 2011, Senator Scott Brown stopped by at Venture Café and Cambridge Innovation Center (CIC)!  There was a lot of excitement in the air for his arrival.

Senator Scott Brown encourages entrepreneurs.

All smiles around for Brian Wang, Venture Café Operations Manager; Senator Scott Brown; Renee Lin, Venture Café Acting Community Manager.

Senator Brown gave a talk to CIC clients about jobs, innovation and Massachusetts.  Afterwards, he stayed and mingled to hear about projects that CIC clients are working on.  Thanks to Senator Brown for the visit and inspiration!

How to Replace Health Plan Core Administration Systems

Health Plans spanning the entire United States from Rhode Island to Hawaii will at one point face the challenge of replacing their core administration systems.  These systems are the backbone of these health plans and manage key processes like Member Enrollment, Premium Billing and Claims Processing.  The reason why health plans look to replace these systems is because they no longer can easily support the continuous changing rules of the business, such as changes in plan design.  As Federal Healthcare Reform continues on and Payment Reform continues to evolve, these administration systems must be able to support payment changes too, like bundled payments.  Health plans in their search for a new solution, consider solutions not limited to TriZetto QXNT, TriZetto Facets, Perot Diamond and DST AMISYS.

The initiative to replace a core administration system is no easy task.  It takes a lot of brainpower, years and money.  It is such a hard task in fact, that many health plans have even scrapped the initiative after spending years on the project.

As health plans continue with replacing their core administration systems, here are some key points to consider:

Appoint Exceptional Leadership.  It really does matter who is leading the initiative.  The project team will become so large, that it’s important to make sure that the overall project leader and the leaders below can understand how the whole project ties together and what objectives their teams must meet to make the overall solution work.  All leaders must understand how to implement a replacement system, understand the importance of their team’s contribution to the solution and be able to direct the team to stay focused on the business goal.  It is important for the leaders to be able to recognize when the project has gone off course and to redirect efforts.  An exceptional leader that really understands both systems and business process is essential.

Put your Best Team on it.  The core system replacement will no doubt be one of the health plan’s most difficult tasks ever.  It will take the brightest and most committed team to give it the best chance for success.  There will be many challenges along the way that will require only the best problem solvers.  Commitment is also important because the project will go on for a long time.  There will be up’s and down’s and the team must be able to brave the storm. 

Break it up into Phases.  This means not to try to do everything all at once.  The Health plan is replacing the core systems that cover almost every process; it seems impossible to do it all at once.  Instead, break it up into phases either by grouping the customer accounts into phases or by separating business functions into phases.

Pick the Right Solution.  Make sure to understand what the business and technical requirements are for an ideal core administration system replacement before choosing the solution.  Remember to consider future needs too.  Take time to research which solution meets the needs of your requirements. 

Learn the Product.  Even after choosing a solution, take time to learn in-depth how the product works before configuring it.  An understanding of how the product works will allow you to visualize how to configure it best to work in the business environment.  After visualizing the overall configuration strategy, the detailed configurations can be filled in.

Health “Data Liberacion” – What do we do now?

This month, Todd Park CTO of Health and Human Services and co-founder of athenahealth spoke about what he calls “Data Liberacion”.  I attended this talk organized by Xconomy and witnessed his passion and enthusiasm for this initiative.

Pictured left to right: Chris Herot, CEO of SBR Health; Todd Park, CTO of Health and Human Services; Renee Lin, the “Health Plan Geek”

“Data Liberacion” makes tremendous amounts of health data metrics available to the Public and anyone that wants it, for the purposes of creating new and useful health applications.  Todd recommended reading “The Hot Spotters” in the New Yorker, as a related example of how data can be applied in valuable ways.  “The Hot Spotters” details one Physician who analyzed health data to map out the highest utilization and highest cost geographic points in his nearby city.  The Physician then focused his energy on these high utilization areas with the challenge to increase patient health and lower utilization.  This Physician’s story is admirable, useful and an example of how health data can be applied to add value to everyone in healthcare.

With all this data now available and more soon to be available, what should healthcare organizations do now?  I would suggest a couple of actions: implementing the use of some of the data now, exploring what is available in the data sets (listed below) and then monitoring what kind of applications spawn from it.  One example of something that Health Plans are doing now is to integrate data with their Provider Search tools, such as the Patient Hospital Survey (HCAHPS) and Hospital Compare data sets from Medicare which will help consumers choose a Hospital or Physician by reviews/quality.  Healthcare organizations should also explore what is available in the data sets and brainstorm how the data can add value to existing services already offered.  Also, it would be wise to monitor the applications that come to market as a result of this data availability and make available the helpful applications to consumers.  As we take a look at the data, we may see that some of it still needs some refinement.  Just as an example of the state of some of the data: when I searched for teenage births “Births to Mothers Under 18” on the Health Indicators Warehouse, I received back the metrics for non-teenage females “aged 15-54 years; Female”.  The data could still use some cleaning up, however, as the industry starts to use the data, we should see refinements in the data.

Here are some of the public health data sets to start (re)exploring:

• Consumer Assessment of Healthcare Providers and Systems
• Healthdata.gov
• Health Indicators Warehouse 
• HHS Open Data Sets
• Medicare Data Sets
• NPI Data 

10 Career Opportunities in Health Insurance

Two weeks ago, I wrote here on my blog about some implications of the potential merger of two local health insurance companies, Harvard Pilgrim and Tufts Health Plan.  In response to that post, I received some questions about layoffs due to a merger.  In an increasingly complex industry, the company faces the challenge to remain an attractive product while also doing "the right thing" for members and employees.  So can there be layoffs?  Sure.  Will there also be new career opportunities?  Sure.  I see the need to move employees into new roles to help the company succeed.  As we face a new horizon for what a new valuable Health Plan really can be, new roles must be considered to propel the Health Plan and make it efficient, competitive and grow.  So here is my forecast of ten upcoming career opportunities within any health plan that wants to be efficient, competitive and grow.

1)Re-engineering Process and Systems

As health consumers demand lower costs in healthcare, everyone must do a part to decrease the administrative cost wherever we can.  Now is the time to take a look at current processes and brainstorm how they can be made more efficient.  The optimized process will also identify new system solutions that will enable the new efficiencies.  If the re-engineering is done well, I believe it will be the key driver in lowering cost and create a dominant market appeal.  Employees with knowledge of current business process, current systems and who are forward thinking will be needed to achieve these efficiencies by defining the new processes and implementing the new systems.

2)Vendor Management

With the re-engineering effort, many new service vendors will be in consideration.  Employees will be needed to take a look at existing contracts, re-negotiate contracts and draft new contracts with existing/new vendors.

3)Growth Strategy

How aggressive does the company want to be in signing on new employer groups and members?  What is the best way to compete with competitors?  What will be the strategy?  Employees will be needed to help the company achieve membership goals through building the winning growth strategy.  In the case of Harvard Pilgrim and Tufts Health Plan, they together will be offering insurance in: Massachusetts, Maine, New Hampshire, Rhode Island and must strategize on membership growth starting in these four states.

4)Actuarial

Actuarial is a good role to get into within the industry because there always seems to be a shortage in Actuarial professionals that understand the risk factors in health insurance.  Due to many federal and state regulations now and in the future, Actuaries are needed to analyze the increasing number of new business scenarios, such as New Product Designs (for example, upcoming MA Division of Insurance select/tiered provider network product designs) and new provider reimbursement methods.

5)Healthcare Informatics
Healthcare Informatics is hot now and will continue to be for some time.  Employees will be needed to slice and dice the data to find ways to lower cost, measure results of new programs, monitor provider quality and segment members to offer personalized care.

6)Regulatory Projects

Now until 2016, there will be a focus on Regulatory Projects, such as ICD-10, Federal Health Reform and additional Federal and State Mandates.  Employees that understand the health insurance business and systems will be needed to make policy, process and system changes.

7)Social Media Management

Social Media Management is about protecting and extending the company brand.  Social Media Managers monitor what is being said about the company online, such as reviewing web posts, Twitter comments and Facebook comments.  If faced with a poor review/comment, the Social Media Manager performs damage control by offering to help and hear the situation (sometimes taking the follow-on conversations offline due to privacy).  The Social Media Manager will also perform some marketing and public relations activities to promote the company brand.  Social Media Management is a fairly new career opportunity in the health insurance industry.  Don’t forget that Social Media should be managed in the Member and Provider online mediums.

8)Multi-Lingual Services

In an increasingly diverse country, it is important to provide Multi-Lingual services via written and spoken mediums.  There is a push from consumer advocate groups to better engage, educate and support non-English speaking consumers to promote public health and better access to care.  Healthcare organizations have created units in order to better service the non-English speaking population.  Employees with capability to speak/write a foreign language, perform English translations and who possess good customer service skills are needed to fill these roles.

9)Leadership Development Program

With a growing number of health plan employees approaching and taking retirement, health plans must make investments to ensure that the health plan is able to carry forward a strong business into the future.  A Leadership Development Program can be a rotational, mentorship program to train promising staff to become the next leaders.  Participants in the Leadership Development Program must be offered incentives to stay with the company after the Program is over, otherwise, they may take their talent to other companies.  The desired skill set for candidate selection into a Leadership Development Program, should be: vision, social responsibility and integrity.

10)New Business Ventures

As the health plan recognizes that their core competency is offering insurance, they may begin to diversify into different States and other insurance products, like comprehensive dental insurance, stop loss insurance or worker's compensation.  Any of these would be a huge effort and would require experienced human resources with different skill sets in order to make this possible.

Ten Technologies to Engage Members in Healthy Behavior [Posted in Healthcare IT News]

As the availability of technical consumer healthcare applications continue to grow and with increasing complexity, members can realize the health benefits of technology.  There is also a mutual benefit for healthcare organizations where healthier members lead to higher value care with lower cost.  In order to support members in this process, healthcare organizations can support making these healthy tools available to members.  Here is a look at ten technologies to engage members in healthy behavior.

1)Real-Time Video Communication

Real-time video communication enables a patient to be “seen” by a medical provider from a computer, without actually being geographically together.  Follow-up and consultation can be done one-on-one with medical providers in the comfort of the patient’s home.  Consumer monitoring devices attach to a home computer to allow a medical provider on the other end to see how recovery is progressing, such as a magnified look of a recovering surface wound.  Checking on the patient at-home can ensure that the treatment plan is working.  SBR Health makes these visits possible through their video technology.

2)Mobile Health (mHealth) Apps

Mobile health apps allow members to self-manage and track their health and conditions everywhere they go, using their smartphone or tablet.  The health data collected can also be electronically shared with a medical provider to monitor care.  There are mobile health apps available for every major condition, which makes it possible for relevant content and services to be delivered to the member.  One example is Ubiqi Health’s Migraine app which allows members suffering from migraines to track triggers, record treatments and see patterns.

3)Electronic Personal Health Record (PHR)

The electronic Personal Health Record is a patient-owned digital copy of their health records, including patient data like drug reactions, medications, illnesses, etc.  Since the patient maintains their Personal Health Record, they can quickly share it with any healthcare provider that they choose.  In a medical emergency, the quick availability of this information can help a new physician to determine the best course for treatment.

4)Text Messaging

Text Message is a message that is delivered to an individual’s cell phone.  Healthcare organizations can use this medium to send personalized messages to members, to remind them of appointments, medications, treatment or general motivational messages.  Companies, such as Silverlink, churn through the member analytics to create personalized messages to individuals, which makes communication meaningful to the individual.  Another company, Text4Baby has a popular application for expectant mothers, which sends healthy text messages each week, timed to their baby’s due date.

5)Feature-Rich Member Web Portal

A traditional member web portal offers tools like personal health information and health content.  This traditional offering, enhanced with an online social community makes the member portal more personal and increasingly valuable.  The social elements of the portal would enable members to share and research information to improve community health such as Provider Ratings and Treatment Reviews (within HIPAA Privacy limits).  Myregence.com is an example of a healthcare social community with features such as rewards, ratings, decision support tools and content.

6)Facebook Business Page 

A Healthcare organization can create a Facebook Business Page to extend their communication with members.  Members add this Business Page to their Favorites on Facebook and this lets them see public messages, photos, videos, comments and participate in public discussions, promotions and contests from the organization.  Health organizations can promote health using Facebook’s reach to encourage healthy behaviors and engage in public health conversations.  MayoClinic’s Facebook Page has a large following.

7)Twitter

Twitter works well to offer short, frequent public health tips to members and advertise health events.  Members choose to follow others on Twitter and members see a list of messages (newest to oldest) of everyone that they follow.  MayoClinic uses Twitter well to communicate health tips and promote their open talk-to-a-doctor telephone conference forums.

8)YouTube

YouTube is an online video community.  Healthcare organizations create accounts on YouTube to share videos with the public.  Members can choose to subscribe (free) to the healthcare organization to follow the videos posted by the organizations.  Videos appeal well to visual learners.  MayoClinic uses YouTube to share information about their health facilities and MayoClinic physicians share information about wellness and specialty care.

9)Email
Email is on this list because it is a key tool to engage members, one-on-one, who do not have a smartphone.  Email sent one-on-one between a member and medical professional can make the care more personal and connected.

10)Podcasts
Podcast is a digital talk series that members can automatically have downloaded to their computer; members then listen to downloaded Podcast.  This tool is an additional medium that can be used to push health information to members.  MayoClinic also offers Podcasts.

Save Healthcare Now!

I urge us all to do everything we can to Save Healthcare Now!  I attended the Health Care Quality and Cost Council (HCQCC) - Full Council meeting last week on Wednesday to hear the latest on quality and cost.  This Council in Massachusetts is trying hard to solve the problems around rising healthcare costs in the Commonwealth.  Every time I attend a talk around this topic, I always leave the meeting a bit sad about the healthcare cost crisis that we are in and this time was no different.  In addition, I think about the fact that I had started following this issue about three years ago with my first exposure to this problem at the Massachusetts Medical Society Annual Conference in May 2008.  It is a disappointment that almost three years later, we don't seem to be much better off.

At the HCQCC Full Council Meeting last week, we were reminded of high-level ideas that are in the works to better the quality and cost of care, like ACO's, insurer/provider increase caps, tiering providers/select networks, cost transparency, global payments and risk sharing.  However, the highlight of the meeting for me was two repeated blaring alarms coming from the Inspector General, Gregory Sullivan who pressed that we have to do something NOW.  At the end of last year, there was a public forum for payment reform where public comments received used words like "cautiously" or "slowly" in talking about reform.  The Inspector General illustrated that a common family insurance plan that has a price tag of $21,000 is the equivalent of paying $10/hour from a paycheck!  And with the continued annual increase in healthcare premiums, healthcare affordability is getting farther out of reach and out of control.  While it would be nice to be "cautious" and "slow", we also have to consider that we have to do something NOW if we want to be able to control this crisis.

To me, this problem is so big that it needs EVERYONE to solve it; especially since we are all consumers in this problem.  We should all do a part as patients/consumers, employers, insurers, providers, government and service vendors.

What can we all do now to help lower the cost of healthcare for everyone?  Let's all be mindful of cost in our decisions.  In addition:

Patients/Consumers - Eat and be healthy.  Consider cost too when choosing a Provider.  Consolidate multiple appointments into fewer appointments, if possible.  Be prepared with a full list of what you want to talk about with the Provider.  Share publicly ideas to lower cost.

Employers - Incent employees to be healthy.  Consider selecting plan designs that encourages employees to consider cost when seeking care.

Insurers - Streamline processes (be lean) as much as possible to further lower admin cost.  Keep innovating with new quality plan designs.  Collaborate with other Insurers and Providers to do non-competitive tasks together.

Providers - Streamline processes (be lean).  Keep being thoughtful of cost in recommending and ordering care.  Collaborate with other Insurers and Providers to do non-competitive tasks together.

Government - Encourage, engage and support discussion in the healthcare ecosystem to identify ideas to lower cost.  Be ready to move on good ideas.

Service Vendors - Be innovative and create solutions/systems to lower cost.  Find ways to lower the cost of services billed to clients.

What other high-quality ideas can you think of to save on healthcare?

City of Boston - Ideas to Save on Healthcare

On January 11, 2011, Boston Mayor Menino spoke about the City and mentioned two ways the City of Boston can save on the increasing costs of healthcare. His address titled the "State of the City 2011" was well attended by many government leaders, including Governor Patrick and Senator Brown.

During his speech, Mayor Menino highlighted two different measures to curb the cost of healthcare. The first is an initiative called Neighbor Care. He says, "Neighbor Care will increase the use of community health centers - providing more hours and more services in the neighborhoods." This initiative would also save healthcare dollars through channelling patients to the less expensive community health centers, as opposed to the higher cost big name hospitals. The idea is that common conditions can and should be treated at community health centers/hospitals, while the very specialized conditions would be referred out to the specialty hospitals.

Mayor Menino also spoke about the potential offering of health insurance to City employees that is modeled after the Group Insurance Commission (GIC) which is the self-insured health insurance plan available to State employees. He says "If Boston had the same plan design (as the State), we could save one million dollars a month." The GIC also has an innovative plan design which is comprised of three tiers of physicians. Physicians and facilities that have the highest quality and lowest cost measures are in the "top tier", which have the lowest copay to the patient. The low copay provides an incentive to a patient to goto the "top tier" high quality, low cost physician. The offering of a product like GIC is still in the works and not yet approved.

With the costs of healthcare soaring, many are continuing to find ways to curb the cost. What ideas have you come across?