With the announcement of the recent partnership among Amazon, JP Morgan, and Berkshire Hathaway, traditional healthcare players are feeling the impact of disruption powered by the biggest disrupters in other traditional industries. At the essence of the disruption is shopping and consumer experience delivered by technology.
The health exchanges of the Patient Protection and Affordable Care Act (PPACA) were intended to create transparency, choice, and competition to support shopping behavior for insurance coverage. And although players created financial “calculators” to help consumers pick insurance plans, the lack of competition in most marketplaces resulted in no substantive change in either transparency or consumer shopping experience.
The three companies in this new partnership, however, have technologies and experience supporting the digital-first shopper that can be applied to the benefit of the health consumer. For example, they have demonstrated excellence in using technology to provide “helpful” shopping advice across a portfolio of seemingly countless products to millions of consumers daily. Transparent and competitive information about suppliers is also readily available for consumers. Plus, they’ve developed modeling tools and experience that enable millions of consumers to manage their financial planning. Those capabilities are wrapped in consumer experience technology that delivers relevant insight at the customer’s moment of need.
The opportunity exists for this partnership to result in an unprecedented ability to personalize health benefit plans and services, and manage healthcare budgets. Imagine a scenario where a consumer supplies information on his/her family and doctors, then receives a personalized health benefit plan and expected health budget, complete with listing of best in-network doctors. Offers of supplemental coverage that meet the family’s needs to cover unanticipated costs or changes in circumstance would enable financial planning and choice. This trio does it today.
The announcement also puts a fine point on a consumer-centric disruption that is taking place on the clinical/care delivery side of the house. While slow in coming, recent emphasis on the social determinants of health has shed light on the reality of healthcare – most healthcare happens outside of a clinical setting and is not tracked in the electronic medical record (EMR). Traditional technology vendors are rushing to integrate consumer health information into a clinical picture. But that’s retrofitting most of health information and decision-making into the model supporting the smallest, specialized component. Does that make sense? Leading health systems are taking a fresh look at their technology, staffing, and approach to delivering a consumer experience. They are leveraging the same kinds of technology as Amazon to bring insights and value to the consumer experience. Whether shopping for care, scheduling care, or managing their own care, these companies are using consumer experience technology as their primary engagement platform – not the EMR.
And if it doesn’t make sense to manage consumer health relationships using an EMR, let’s look at financial relationships. Health systems are facing a daunting and increasing burden in uncollectable patient liabilities. More than 600,000 consumers file bankruptcy every year due to unmanageable medical bills. Other than the collections department, who is responsible for managing those financial relationships to the mutual benefit of both parties? With a value of over $4.5B in 2017, there’s a lot at stake. Consumers need and want to understand the financial impact of choices. Poor choices impact health organizations not just in uncollectable debt, but lower reimbursement. Leaders in the industry are addressing the need to have one unified relationship with their customers that includes administrative, clinical, and financial dimensions. Enter this partnership and JP Morgan.
At the scale of one million employees, the partnership has the size of a top 30 health insurance company and the bully pulpit of reputation. It’s destined to be a powerhouse. Consumers can only benefit.
LEARN MORE: Even the most cutting-edge technology can’t work in isolation. Read how Pega provides a context-driven architecture that increases collaboration to improve health outcomes.
ABOUT THE AUTHOR: In her role as Vice President and General Manager, and with more than two decades of experience driving technology improvements, Susan Taylor helps healthcare and life sciences organizations plan for and achieve digital transformation to improve health outcomes.