Monthly Archives: October 2011

Insight #3: Demonstrating Efficiency and Coordinated Care will Score Big Points (Seven Insights to Help Connect with Employers, Unpacked)

Tuesday, October 25th, 2011

Kriste Goad
Senior Vice President, Revive

There’s a lot of talk these days about coordinated care, but employers still need help understanding what it means for them and how it really works.

Employers want to know that their health care dollars are going toward better management of chronic conditions, fewer lost days of work, healthier employees, and lower health-care costs in the long-term.

That means speaking the language of the business owners who want to know that the people being paid to help keep their employees healthy are focused on the same issues they care about: “cost” and “value.”

Whether it’s narrow networks, direct contracting or on-site wellness, the changing health care landscape, with its evolving clinical models of care and payment, demands that hospitals and health systems build closer, more transparent, more mutually beneficial relationships with the employers in their communities.  That calls for something very basic to succeed: good communications and a well-conceived story.

From thousands of interviews with employers of all sizes across the country to find out what resonates, what moves the needle, and what annoys them when it comes to the health care information they receive, we’ve gleaned Seven Insights to guide more effective communications and an employer-friendly business strategy.  We’ve talked about quality and mumbo jumbo, but how should providers talk to employers about coordinated care?

- Focus on benefits, not just features and “health care speak.”

- Use this opportunity to educate.  Employers are unfamiliar with medical homes and ACOs but support the concepts.  Even if they are familiar, they think medical homes will improve care, but not costs, yet most believe ACOs will decrease costs.

- Give a real-life example of coordinated care.  There’s value in coordinated care and wellness beyond just cost, but until we can help employers understand that value, they will continue to fixate on cost above anything else.

- Demonstrate and articulate clinical and administrative efficiency.  Employers think it’s important and that it saves money.

More and more providers are engaging and communicating with employers directly as part of their business strategy.  As employer engagement efforts expand, and certain programs and services grow, the focus must remain not on healthcare speak, but on the real, tangible benefits to employers — healthier employees, better management of chronic conditions, fewer lost days of work, and lower health-care costs in the long-term.

Coordinated care sounds a whole lot better than the alternative, right?  But what are you actually doing to coordinate care, and what difference does it make to patient health and to the employers’ bottom line?  Identify those two things, start communicating them in simple English to the business community, and see how it makes a difference to your top and bottom lines.

Coming up: Employer Insight #4: Employers value wellness, and they want help from hospitals and physicians (not payors).

Insight #2: Nothing Personal? (Seven Insights to Help Connect with Employers, Unpacked)

Wednesday, October 19th, 2011

Kriste Goad
Senior Vice President, Revive

Despite all the readily available quality data and rankings, most people still choose providers on the basis of three criteria: 1) what their insurance covers, 2) what their doctor recommends, and 3) personal experience or on the recommendation of family or friends. Likewise, most employers form their opinions of health care cost and quality based on what they hear—from brokers, consultants, health plans and, yes, the media.

So what can providers do? Start talking and use simple English. Health care is complex, yet communicating your value doesn’t have to be. Engage your local employer and broker communities directly, educate them, and build relationships. Help them navigate the information that’s out there. Most importantly, drop the jargon and keep a smiling human face at the front of everything you do.

We’ve conducted interviews with thousands of employers of all sizes and geographies to find out what resonates, what moves the needle, and what annoys them when it comes to the health care information they receive. From those interviews, we’ve learned some pretty compelling insights, and today, we look more closely at what employers look for when it comes to Quality.

First, be cautious about too much focus on data and “populations;” the language itself dehumanizes care. These are important elements, and employers want to know about the broader efforts—but they think of their employees as people, not “populations.” Be sure you always offer specific examples relating to individual personal cases that represent a broader problem and solution.

Second, employers see limited value in the data without understanding how it will be used and what benefits it will create. Emphasize what you’re doing to treat people like individuals. People expect more than one-size-fits-all care. Emphasize what you’re doing to provide individualized attention, from personalized care plans, to nurse care coordinators, to individually tailored disease management programs. Get personal.

Third, value is only as good as the professionals delivering the care. Employers want to hear about your nurses and physicians, not just your facilities. They also want to know how your nurses and physicians treat people, and not just with medical care. That means putting physicians and nurses in the forefront of your communications efforts and making sure they’re effectively communicating with patients every step of the way. This must be an inside/outside effort, not just one or the other.

If you don’t have an internal communications plan for this, it’s important to develop one. Once you do, tell the outside world about it (with a particular mind toward the business community) in simple, relatable, personal terms. If you don’t, who will?

Next week, we’ll take a deeper dive into Employer Insight #3: Demonstrating Efficiency and Coordinated Care Will Score Big Points. In the meantime, call or email us (805.617.2832 or learnmore@revivepr.com to learn more about how we can help your organization connect with employers in your community and effectively communicate your value.

Let Me Get This Straight…

Friday, October 7th, 2011

Brandon Edwards
President and Founder, Revive

The latest media coverage of health insurance is more of the same – premiums going up double digits every year, including the most recent period as reported by the Kaiser Family Foundation.  This is just more of the same, right?  More health care services, provided to more and more people, with hospitals and doctors and drug companies charging ever-higher prices for their services – right?  The insurance companies are just passing those costs along, right?

Um, wrong.

The New York Times coverage says, “Major health insurance companies have been charging sharply higher premiums this year.  Aetna and United Health/Oxford said their requested rate increases… largely reflected actual hospital, physician, and pharmacy costs… ‘Our rate requests are simply keeping pace,’ said a payor spokeswoman.  The increases requested by Aetna range from 8.8% to 53.6%, while those from United range from 13% to 34%, according to the New York State Insurance Department.”

Pointing the figure at “actual” costs may make for convenient media coverage, deflecting blame from the payors to the provider community.  The problem is, it’s just not true.  In fact, the payors’ own statements to Wall Street run counter to their own statements in the media.

Recent coverage by Carl McDonald at Citi reveals the truth about medical costs.  “The Blues enjoyed a 300 basis point positive spread between pricing and cost trend in the first half, as medical costs rose just 1.0% on a PMPM basis, contributing to an 81% commercial group loss ratio in the first half of the year, 240 basis points better than last year.”  That means premium pricing rose a full 3% faster than underlying medical costs, and that doesn’t even count increases in copays, deductibles, and patient financial responsibility.

Carl goes on to say, “Before factoring in cost sharing, like copays and deductibles, we estimate that industry pricing is up 7.0-7.5% this year, while cost trends have been about 6.0% in the first half, or maybe even a touch lower.”  These are Blue Cross premium price increases – the national for-profit payors are projecting even higher increases.

United Health Group’s information is even more striking.  “Utilization trends continue to be extremely favorable, and United’s quarter suggested the cost environment is improving…Since it appears utilization, particularly at inpatient facilities, continues to deteriorate, we think United’s assumption of more normal cost trends in the second half of the year is wrong, which will result in meaningful EPS upside.”  In short, higher premiums, lower cost trend, and lower utilization.

Carl McDonald goes on to say, “What United reported jives with the data we’ve seen. CIRA’s hospital analyst, Gary Taylor, conducts a monthly survey of hospital admissions, and the results suggest that inpatient admissions seem to be deteriorating as the year progresses.  In June, the survey results indicated that admissions fell 150 basis points relative to the prior year…United noted that its inpatient bed days were flat to slightly down in the second quarter.”

So let’s recap the facts: Hospital CPI for the last year was 5.9%, medical CPI even lower, and utilization for people with commercial insurance is down in every category of care.  If price increases are down and utilization is down, it would seem that the premium increases are doing a little more than “keeping pace.”  In fact, these premium increases are driving the most significant margin expansion and resulting profitability that the payor industry has ever experienced.

The New York Times says, “The increase in premiums was striking because in a poor economy, many people put off going to doctors, to avoid co-payments and higher deductibles.  Despite a decrease in the use of medical services, companies have defended higher premiums – and their high profits – reasoning that their costs would rebound once the economy recovered.”  So these payors are raising premiums because costs will rebound some day?  Some day, when the economy recovers?  Shouldn’t they raise prices then instead of now?

Ask yourself: Do employers know this?  Or, do they assume your hospital deserves the blame for the pain they’re feeling?  Don’t let your organization assume the blame for higher insurance premiums.  Engage your local employer and broker community, educate them, and build relationships.  Help them navigate the information that’s out there.

For more ways to engage with this audience, take a look at our latest thoughts, Seven Insights to Help Connect with Employers.  You can also call or email us (805.617.2832 or learnmore@revivepr.com) to learn more about how we can help your organization connect with employers and brokers in your community.

Interested in Insights from the Upcoming Health Care Leaders Summit?

Hear what the most respected thought leaders in health care are saying about the future of care delivery, their near- and long-term strategies for accountable care, strategies for taking risk or bundled payments, the latest approaches for payor contracting, and all the implications of health reform.  Attendance is strictly limited, so email us if you’re interested in learning more.

Can’t make it to New Orleans?  Don’t worry!  You can still take advantage of the many benefits and key insights from the Summit through our real-time updates via Twitter and e-blasts highlighting the events most talked about topics.  You’ll definitely want to stay tuned to these big topics from the Big Easy.

Insight #1: Lose the Mumbo Jumbo (Seven Insights to Help Connect with Employers, Unpacked)

Thursday, October 6th, 2011

Kriste Goad
Senior Vice President, Revive

We promised we’d unpack the Seven Insights behind a successful employer engagement effort, and today we take on Insight #1: Lose the “Mumbo Jumbo.”

Business is booming for firms that can help companies navigate the Patient Protection and Affordable Care Act, according to a recent article in the Des Moines Register, because “less than 10 percent of employers totally understand the law.”

Being generous, that’s probably about equal to the percentage of Congress that understood the law before they passed it.  Even the most astute members had to work from a plain-English summary of what was supposedly in the bill because the actual language of the bill was so “confusing,” “arcane,” “incomprehensible,” and “hard stuff to understand” (actual words used by legislators to describe the bill).

Prior to its passing, Sen. Thomas Carper, D-Del., was quoted as saying, “I don’t expect to actually read the legislative language because reading the legislative language is among the more confusing things I’ve ever read in my life.”

So what did Sen. Carper and hundreds more do before deciding on the bill?  They read the translated version, and they listened to those they trusted to give them the information they needed to take action.

That’s exactly what most employers do when making decisions about their health care spending, and too often providers just sit back and let the payors do most of the talking.

If you’re a provider and you think it’s important to develop a strategy to survive and thrive in the wake of health reform, then you should also think about how you’re communicating your strategy to the community: namely, the business community.

After all, if you’re not talking to employers, you can bet your revenue stream that someone else is, and they’re most likely talking about you in less-than-flattering ways.

Too much is as stake to let others define you.  Make the connection with employers and the business community to tell your story.  And when you do, lose the “mumbo jumbo.” Shoot straight.  That’s what we heard from interviews with thousands of employers across the country.

The vernacular is extremely important.

People glaze over when they hear terms like “accountable care organization,” “population health,” and “patient-centered medical home.”  They’re unfamiliar terms, and there aren’t really any examples to provide a point of reference.  Without definition, most employers believe these new models of care are government programs.

Once you explain the terms, however, employers are in favor, and medical homes test better than ACOs.  Many believe new models have the potential to lower costs and increase coordination of care.  The key is communicating about these things in relatable terms.

Answer the question, “What does this mean for me?” Rebrand or package these models, or whatever efforts you’re pursuing, in a way that will be memorable, meaningful, and understandable to the community.  Employers want to see a focus on efficiency, reducing duplication of care, and greater coordination that will result in better quality and lower costs over time.

When you open up a dialogue and communicate clearly and honestly with employers and brokers, they will give you the benefit of the doubt.  They might even take your advice, influencing their benefit plan choices and coverage decisions.

If you want to take steps to open up that dialogue with your employer community and communicate in plain English, we can help.  Just call or email us (805.617.2832 or learnmore@RevivePR.com).

NEXT UP: A closer look at Employer Insight #2: Quality is about people, and being treated like a person.