Resnick Unplugged

COVID19: Healthcare's Recovery

There are years where nothing happens, and there are months where years happen.

COVID19 has ended business as usual in the healthcare sector after delivering the ultimate in market disruption. Payers, providers and pharma face new challenges and new opportunities. Understanding the impact COVID19 on core business assumptions is the first step as companies move into COVID10 recovery.

Here are 5 healthcare market changes to plan for going forward:

1. Virtual care and telehealth advanced years in a few months. We saw super-charged efforts around consumer and HCP awareness, education, acceptance and engagement. Going forward companies need to plan for scalability, integration into care management programs, and retooling patient healthcare journeys. Healthcare consumers are telling the market they are ready to embrace and experiment with innovative health solutions…meet them where and when the want it.

2. The surge in the number of uninsured Americans (potentially upwards of 45 million), emergence of COVID19 as a pre-existing condition for 2+ million people and glaring community disparities in the pandemic response (i.e., Social Determinants of Health) will revitalize a push for healthcare reform. And, with the Affordable Care Act teetering on extinction in the courts, healthcare will be a central November 3^rd election issue…#VOTE2020.

3. New, more prominent roles for nurse practitioners, physician assistants and other ‘care extenders’ are here to stay. Sites of care will continue to move away from hospital settings and physician offices to an array of retail clinic, virtual and at-home care alternatives. Health delivery systems need to adapt across the care continuum to create frictionless experiences and inspire patients to face personal health challenges.

4. Economic downturn and unemployment will be big influencers in consumer healthcare purchasing form insurance products to pharmaceuticals to DIY care alternatives. Changes in consumer spending combined with healthcare’s growing ‘out-of-pocket culture’ will exacerbate delays in seeking treatments, prescriptions, and elective procedures.

5. Cross-generational psychological and emotional impacts of COVID19 life disruptions (social distancing, quarantines, burnout and job stress) will bolster behavioral health offerings. We’ll see mental health move toward mental wellness with greater focus on early warning signs, breaking down barriers to care, and removing social stigmas.

In tumultuous, transformative times health brands must adopt new strategies and new structures, all human centric,. data driven and balanced between customer needs and enterprise growth & profitability objectives.

Is it still 2020?

 

COVID-19: America's High Anxiety

It’s no surprise that during such an unprecedented crisis such a COVID-19 pandemic, American anxiety levels are at historic highs. In terms of other pandemic diseases, #COVID-19 is breaking new ground in driving extraordinary levels of anxiety. While many Americans working to maintain an optimistic outlook, the convergence of anxieties around health, government and economic are creating a situation never seen before. Having multiple anxiety drivers make it very difficult to predict people’s behavior based on lessons learned from past crises. No doubt, we’re in unique times.

Why track anxiety? We’ve learned over time that consumer anxiety is inversely related to consumer confidence; as anxiety increases, consumer confidence decreases, and spending patterns change.

Based on a late-March Consumer Anxiety Index* we can draw several conclusions:

• On average, Americans are girding for another 3-4 months, putting the “end” in the June/July time period. However in terms of what the next 6 months will bring, Americans are feeling pessimistic; the economy and stock market, politics, COVID-19, access to quality healthcare, and the government’s ability to manage this crisis are all expected to get worse.

• At the moment, people’s economic anxieties are focused on the macro level – the economy and stock market. Americans have yet to pivot to what this is going to mean to their households and personal finances. As quarantines and business shut-downs continue through the coming weeks (and maybe months), the micro economic realities will begin to emerge as people feel the effects much more personally.

• While people are obviously focused on COVID-19 as a healthcare crisis, Americans’ broad concerns about the U.S. #healthcare industry (cost, quality, access, & reliability) remain a persistent area of concern, and one they’re likely thinking about during the current crisis and through the 2020 election.

• As would be expected states with high numbers of COVID-19 cases are highest on the AnxietyIndexTM, however younger Americans are much more anxious than their older counterparts, though it’s not necessarily COVID-19 that’s driving their anxiety. Rather, it’s the economic implications from COVID-19: job prospects, cost of living, cost of goods, etc.

• Political ideologies are clearly playing a significant role in anxiety today, especially as it relates to COVID-19 and the government’s ability to accomplish things during this time - people are concerned about politics getting in the way of what needs to get done.

• Overall, Americans only have an ‘OK’ (not great) understanding of the facts surrounding COVID-19, equal to about a C+.

• With a more immediate threat in COVID-19, anxieties about technology, data security, social concerns (education, drugs, immigration) have muted.

What’s worrying people most about the impact of COVID-19? There’s significantly more anxiety around how long the disruptions will last than the disruptions themselves…or said another way – uncertainty is driving anxiety. They’re clearly worried about the impact of what an extended period of disruptions will mean. Short-term, the economy crashing and overloading the healthcare system are big concerns.

For companies, this crisis is an opportunity for brands to act. While many industries are facing their own business challenges, brands that show empathy and take action on behalf of the American people will do well in earning the goodwill and admiration of people. What’s more, it’s not just a desire, people feel it is needed to get through the crisis.

Over 90% of consumers say they admire companies that are taking action to alleviate the impact of #coronavirus

 

* Wunderman Thompson AnxietyIndexTM

Healthcare Collaboration Ramps-Up

Expect the healthcare community to step-up efforts in cross-industry collaboration in 2020. While we’ll continue to see vertical and horizontal M&A reshape the landscape, collaborative partnerships will thrive. These approaches will broaden access to care, enhance customer experiences, improve patient outcomes, and bring efficiencies that lower overall cost.

Over the last several years there’s been alliances never before thought possible…retail giants as insurers, providers as payers, pharmacies as primary care clinics, ride-sharing companies as medical transportation hubs, and pharma as HlthTech-MedTech disruptors. Whether its competitors playing defense, regional players seeking national scalability, or others simply wanting to take advantage of an industry in transformation, expect it to ramp-up in 2020.

Collaboration among different parties with different interests and sometimes conflicting business drivers isn’t easy. Addressing shareholder expectations, balancing financial goals, and servicing customer demands takes extraordinary discipline. It requires a combination of cross-functional compatibility and a fair, open value exchange. Success means parties have established common vision, trust and transparency.

For those willing to make the right investment, alliances or partnerships can yield big rewards: open-up new markets, extend product offerings, expand customer base, accelerate innovation, and reap collective financial gain. For healthcare consumers, when an industry comes together to figure out how to align interests, break down barriers, eliminate friction, and create mutual incentives the result is better care and better access at a better cost.

 

MEDICARE AEP 2019: READY. SET. GO.

With over 22 million seniors enrolled, the future of Medicare Advantage looks bright. But, competitive rivalry has never been greater. The top ten MA plans have 74% market share. Most Medicare beneficiaries have access  to at least 20 MA plan options with many having access to extra or supplemental benefits not provided by traditional Medicare such as dental, fitness, eyewear, over-the-counter drugs or medical transportation. And, every year we see new market entrants, either startup insurance companies or hospital sponsored plans challenging incumbents.

This crowded marketplace shows no signs of letting up. Mega-players continue to gobble-up smaller MA plans, reconfigured supplemental benefits are used to differentiate product offerings, and ‘solution selling’ distribution systems are becoming more robust. Taking time to ‘gut check’ Medicare Advantage marketing and sales operations can have a big payoff. Here’s an 8-point checklist:

√  Assess marketing and sales plans, lead generation and media tactics

√  Examine prospect data, lists and MarTech infrastructure

√  Assess Medicare messaging and value differentiation

√  Evaluate media mix, grassroots, social and digital capabilities

√  Assess adequacy of member on-boarding and retention

√  Review integration of compliance, marketing and sales

√  Appraise marketing team structure, talent, functionality and staffing levels

√  Examine marketing metrics: budgets, expense structure, and ROI

Now more than ever Medicare Advantage plans must take a critical look product development, operating technology, customer experiences, and growth strategies to make sure prospective members are getting what they want, when and where they want it. Remember, today’s Medicare customer is redefining old…they work longer, believe in ‘active aging’, and value convenience. Paying attention to the complete customer lifecycle by making sure hard earned new members don’t march out the back door is critical to success. Only an engaged, loyal MA member optimizes LifeTime Value.

 

2019 Mid-Year Healthcare Trends

What’s Keeping You Up At Night?

Assessing where your #healthcare business stands relative to trends shaping its markets is a valuable mid-year endeavor. It establishes a readiness gauge of where you are, where you need to go, and what needs to be retooled to cope with shifting markets. It proactively speaks to long-term relevance, positioning, differentiation and sustainability. It’s essential to create a roadmap to guide your future.

These 2019 mid-year healthcare trends provide important context as you anticipate change and manage through obstacles and opportunities ahead.

1. The “Medicare for All” debate will rage on.

2. Uninsured Americans on an upward trajectory.

3. Consolidation means teamwork makes the dream work.

4. Healthcare consumerism is a ‘crawl, walk, run’ journey.

5. Healthcare technology is an unseen power tool.

6. A year from now you may wish you started today.

Full article here: Six Mid-Year Healthcare Trends to Watch

 

REALITY CHECK: MEDICARE-FOR-ALL

The past two years of “politics over policy” bluster coming out of Washington’s healthcare scene is seeing a shift in focus…the next round of elections looms large. Let’s not forget, over 40% of midterm voters said healthcare was the top issue facing the country far ahead of immigration and the economy. While Congressional gridlock and legislative logjams will impede progress on health policy in the short-term, some BIG hairy issues will take center stage over the next couple of years: drug pricing, ACA vandalism, surprise health care bills, and Medicaid expansion.

One issue that will dominate leading up to the 2020 election is ‘Medicare-For-All’. The following assessment from Bank of America provides a useful reality check on passage of Medicare-For-All, particularly when it’s defined as a single payer system.

 10 reasons why MFA has little chance of passing*

Congress recently released a “Medicare for All” proposal that would completely replace the current managed care model by moving everyone to the traditional Medicare program. Although this has hurt multiples for the managed care sector, we essentially see this as an issue of headline risk with very little chance of implementation. Below we highlight 10 points on the “Medicare for All” (MFA) bill and why we see little chance of the bill being passed in the next 5-years.

1. There are 107 co-sponsors of this bill, underscoring importance of the issue. However, this is below the 124 people who co-sponsored a similar bill last year.
2. There are few details on how this would work and no details on how it will be funded. Cost has sunk every such provision in the past and we think is likely the biggest roadblock this time.
3. The current Medicare program is expected to go bankrupt in 7 years. This program would cover more things than Medicare – vision, dental, hearing, LT care, have no premiums, copays or deductible and all providers will be in-network.
4. We estimate paying hospitals Medicare rates would bankrupt the industry. The Center for American Progress estimates that hospitals need to be paid 20% more than the Medicare rate and doctors need to be paid 10% more to make those businesses viable – which would make it even more difficult to finance.
5. Few (if any) industries are likely to support this proposal – beyond eliminating MCOs, it would eliminate all for-profit HC providers (hospitals, nursing homes, etc) and Medicare would negotiate drug pricing. We expect significant lobbying against this bill.
6. Simplistic view is that Dems say we don’t need managed care. Factual evidence indicates government can’t manage utilization and MCOs must play a role.
7. Medicaid MCOs manage 51% of Medicaid spending (vs 26% 10 yrs ago) and save states 10-15% and improve quality. Dem and Republican states have moved to MCOs.
8. Medicare Advantage (MA) covers 35% of seniors (up from 25% 10 yrs ago despite rate cuts) as it is able to provide better benefits than Medicare for the same price.
9. The stars have to align. Dems would need to win the Presidency and Senate (likely a large majority) to pass the bill. The President would need to make “Medicare for All” the key initiative for the agenda.
10. But even that is no guarantee - Trump failed to repeal the ACA despite controlling the House (large majority) and Senate (52 seats). Obama almost failed to pass the Affordable Care Act (ACA) (a much less aggressive plan) despite controlling the House (large majority) and Senate (60 seats).

* Bank of America, Merrill Lynch, Industry Overview | March 2019

2019: Medicare Advantage Landscape

The Medicare Advantage (MA) market has crossed 21 million beneficiaries. With growing popularity, it’s expected to move from 35% to 50% market share in the next 2-4 years. Health plans, hospital systems and disruptive start-ups continue to be attracted to this high-revenue, direct-to-consumer market segment. And, with a surge of new-to-Medicare Boomers aging into the marketplace every day, upwards of 10,000, one thing is for sure…it’s a fiercely competitive segment with no signs of slowing down any time soon. 

About 58 million people were enrolled in Medicare at the end of last year and more than 75 million people are expected to be enrolled in the program by 2027. For consumers, there’s good news: on average a Medicare beneficiary has access to over 20 Medicare Advantage plans. 

For MA plan sponsors, there’s good news too: a steady stream of prospective customers in a market where companies have a history of retaining their members, and for the foreseeable future, MA has a favorable political and payment outlook. Plus, Medicare Advantage continues to outpace the 14 million member Medicare Supplement market. But beware, MA competition is tough…the top eight Medicare Advantage plans have 75% market share. 

How to stand out? Differentiating on core product or price isn’t easy, so expect add-on or supplemental benefits to get creative around healthy living, transportation, in-home services, telehealth, and others addressing components of social determinants of health. 

Also, differentiating around customer service excellence will also gain traction in 2019. Making sure the MA customer journey is personalized will set winners apart from the pack. By leveraging data-driven insights to better understand MA beneficiaries, plans will tailor ‘know me and keep winning me’ experiences across the customer life cycle — from brand awareness to direct-to-consumer acquisition to customer activation to member retention. In 2019, we’ll see a new respect not only for customer satisfaction as part of Star Ratings, but as part of MA plans’ renewed focus on customer ‘lifetime value.’ 

Who’s the competition? Expect new market entrants and partnerships to reshape the MA landscape in 2019. Whether ‘disruptor’ insurance plans or hospitals taking full risk on an MA plan, the potential revenue is too enticing for these players to stay away. Many of the new start-ups are attracting significant venture funding. They’re also gaining attention for their ‘unique’ value proposition as ‘technology companies’ – FinTech or HealthTech. These innovators place more importance on engineers, designers and coders compared traditional health insurance functions. Starting with a clean slate, they are able to design internal processes and workflows around the customer. They also place a heavy emphasis on the personal nature of their customer relationship, CX simplicity, and the ‘patient–provider’ connection. 

Lastly, add to the mix market ‘disintermediators’ partnering with MA plans such as national pharmacy chains, big box retailers or mega-primary care networks, and you’ll see markets shift and consumer loyalties challenged. 

What’s next? Medicare Advantage will likely add another 5 million beneficiaries over the next 4-years. There are plenty of opportunities to grow in the MA marketplace. In addition to a booming age-in market, expensive Medicare Supplement options remain vulnerable to MA’s value proposition. But most of all sustainable growth takes a combination of well-honed preparation: tightly articulated brand narrative, data-based prospect targeting, robust direct-to-consumer marketing, multichannel selling, and a beneficiary experience built around convenience and simplicity. Medicare Advantage’s direct-to-consumer focus means being relevant. In other words addressing consumers’ long list of pain points: economic woes, too many choices, preexisting conditions, and the complexities of Medicare…admit it, on a good day Medicare can be a bureaucratic nightmare held together with red tape.

 

Healthcare Marketing 2019

Healthcare organizations―payer, provider, and pharma―must keep pace with their customers. They can no longer rely on market share dominance, legacy brand preference or regulatory protections. Success in a transformative landscape requires marketing leaders to reexamine strategic imperatives, anticipate ‘what’s coming next’ and deftly navigate a fast moving set of obstacles and opportunities to capture customer mind-share.

In 2019, five themes will guide healthcare marketing:

1. Data Personalization
2. Digital Transformation
3. Customer Experience
4. Health Inertia
5. Modern Marketing

For some of these themes, such as customer experience, data personalization, and digital transformation the clock is ticking. Slow-moving companies risk losing significant ground as competitors advance along the direct-to-consumer digital marketing maturity curve. From a consumer perspective, leveraging data to better understand how people view their health in order to create personal, emotion-based content is critical to influences health decision-making.

Trusted healthcare brands need to reach and connect with every customer wherever they are in their healthcare journey—there’s nothing more fundamental, more personal, or more valuable than an individual’s health. Modern marketing, online or offline, is powerless without an ability to move an audience to action.

The complete article in CMO.com can be found here:

5 Themes That Will Drive Healthcare Marketing In 2019

 

 

Employees Drive Healthcare Consumerism

Over 150 million Americans get their health insurance from their employer. More than 40% are enrolled in a high deductible health plan (HDHP)…ten years ago it was fewer than 15%. In the Individual marketplace, HDHPs are the norm. At a time when one-in-three Americans say healthcare is their biggest financial burden, plans with employee cost shifting have gone mainstream…and they’re not going away.

 

Healthcare’s shifting financial burden is forcing consumers to take a close look at their family budget. A quarter of Americans have avoided, postponed or refused medical treatment because of cost. The good news: out-of-pocket responsibilities are fueling the healthcare consumerism movement. Once consumers are responsible for spending health dollars out of their own wallet you have their attention. However, buying healthcare services—from insurance to prescription drugs to routine check-ups to MRIs—isn’t easy given health literacy disparities, providers’ control of resources, and inconsistent access to consumer-centric information.

 

Being a smart healthcare shopper able to make confident, value-based choices challenges every American. We’ve seen this with consumers’ reluctance to question their physician about cost or site of care. For example recent research on MRI scans, one of the easiest services to price compare, shows that if consumers shopped local MRI sites, price variation is significant and savings would be substantial. However, doctors’ suggestions proved to carry more weight with patients than the potential for savings, with most doctors referring to only a single MRI provider (often the higher-priced option operated by their affiliated hospital).

 

The retailization of healthcare is here to stay. A retail mindset means consumers compare products and services, ask friends, read and publish reviews, price check, and quickly cast aside brand loyalty for a better deal. Shopping for healthcare may not follow a traditional retail path-to-purchase, but for most Americans it’s one of the most important buying decisions they make. That’s where health care companies AND employers can play a critical role: create reliable, understandable information and decision support tools to help consumers and employees navigate healthcare’s massive maze of bureaucracy. Turn employees into savvy customers. Replace consumer healthcare insecurity with healthcare confidence.

 

 

Trumpcare Exposes Uninsured

With a ‘politics over policy’ bluster coming out of the DC healthcare scene the country’s on track to see a significant uptick in the number of uninsured Americans. It’s already on the move. After implementation of the Affordable Care Act (ACA) The U.S. in 2016 the uninsured rate fell to its lowest level. However according to a recent survey the number of uninsured Americans has risen from 12.7% in 2016 to 15.5% today. Texas for example, has the highest uninsured rate in the country at 21%...and growing.

The orchestrated Trump administration ‘sabotage’ of the ACA (aka Obamacare) is restricting access to coverage and driving up premiums under a mantra of ‘Let Obamacare implode’. With this backdoor, partisan approach to repealing ACA, there haven’t been any coordinated, sound policy solutions offered-up to ‘replace’ core legislative components to help threatened consumers. Two approaches put forth as fixes, Short-Term Medical Plans and Association Health Plans, promise to provide relief, however they offer limited insurance protection and are best known by a history of fraud, scams & insolvencies.

As insurers establish prices for the upcoming 2019 enrollment, they are taking into account repeal of the individual mandate (elimination of a penalty for not purchasing insurance) and the likely spread of short-term health plans. The result will be people who now purchase individual insurance exiting the market causing health plans to proactively increase premiums.

SUMMARY: ACA SABOTAGE & NEGLECT

• Eliminating ‘individual mandate’ requiring individuals to purchase health insurance
• Refusing to defend protections for pre-existing condition exclusions
• Halting risk-adjustment payments to insurers enrolling higher risk people
• Slashing funding for outreach and enrollment ‘Navigators’
• Pushing consumers into low-benefit ‘junk’ insurance plans

The implications of an increase in the number of uninsured for healthcare stakeholders goes wide and deep: destabilization of consumer insurance markets, product-line exits, Medicaid contraction, and reduced marketplace competition. Hospitals and physicians are already seeing a rise in uncompensated care and bad debt. Payers are quickly reengineering risk management models and product pricing. Service providers such as care management, health technology and revenue cycle management companies are questioning established business models.

And of course, let’s not forget consumers. In today’s out-of-pocket health care ecosystem, one-in-three Americans claim healthcare is the biggest financial burden they face. In 2018, the cost of healthcare for a typical American family of four covered by a typical employer-sponsored PPO plan is $28,166.00. At the same time, high deductible health plans are approaching half of all employer-based coverage and almost all individually purchased policies. This shifting financial burden is forcing consumers to take a close look at their healthcare budgets, especially in the context of overall financial demands such as college debt, credit card balances, stagnant wages, increasing cost of living pressures, and their personal ‘invincibility’ index.

With insurance markets basic formula of ‘access-benefits-cost’ continually disrupted and exposed, health care consumers are confused, frustrated and worried about the future of their healthcare. “Nobody knew that healthcare could be so complicated”.