©2007 ChapterHouse, LLC—Not to be distributed without permission For additional information, please contact us at (630)968-6880
©2007 ChapterHouse, LLC—Not to be distributed without permission For additional information, please contact us at (630)968-6880
Realizing the Promise of the Retail Market and Saving the Private Healthcare System
Realizing the Promise of the Retail Market and Saving the Private Healthcare System
Presented by ChapterHouseTom Main, Managing Partner
September 27, 2007
©2007 ChapterHouse, LLC—Not to be distributed without permission 2II-9000-136_Consumer Driven Summit
Agenda
Employer Sponsored Affordability and Coverage CrisisEmployer Sponsored Affordability and Coverage Crisis
Promises and Challenges of the Sponsored Retail Marketplace Promises and Challenges of the Sponsored Retail Marketplace
Current Solution Landscape and Breakthrough InnovationsCurrent Solution Landscape and Breakthrough Innovations
Retail Market Development Evolution and Disruptive InnovationRetail Market Development Evolution and Disruptive Innovation
Redefining the Sponsored Retail GameRedefining the Sponsored Retail Game
©2007 ChapterHouse, LLC—Not to be distributed without permission 3II-9000-136_Consumer Driven Summit
Unrelenting Healthcare Costs and Shifts in Employer Sponsorship Are Creating a New Marketplace
6.5M employees or 6.5M employees or 13M members have 13M members have
fallen out of the fallen out of the market—and over market—and over
$73B$73B11 in healthcare in healthcare costs have been costs have been
shifted to employees shifted to employees over the last five over the last five
yearsyears
Notes1. Includes both discontinued employer contributions for members who are no longer covered by a group benefit, as well as cost-shifting to continuing members2. Average uninsured on any given day; equates to 42M on a full year equivalent basisSources: Kaiser Family Foundation, AHRQ-Medical Expenditure Panel Survey, Hewitt Health Value Initiative,
Bureau of Labor Statistics, U.S. Census Bureau (Current Population Survey), ChapterHouse Analysis
©2007 ChapterHouse, LLC—Not to be distributed without permission 4II-9000-136_Consumer Driven Summit
Healthcare Marketplace Scorecard
The general progress required to shift the basis of competition in healthcare has been slow. Creating market-based incentives for providers to compete on cost, quality and outcomes—and to invest in improving their clinical business models is no easy task. Equally difficult is motivating
employers and consumers to become educated buyers of health care. While the industry grapples with these difficult issues, employer sponsorship is eroding and the social concern about the
uninsured and underinsured is on the rise.
Key PointsKey Points
Progress SummaryProgress Summary
Health Economy Performance LeversHealth Economy Performance Levers
New programsin place
Strong momentum
Still losing ground in thesekey markets
Consumer Sponsorship
Employer Sponsorship
Government Sponsorship
Sponsorship and theEconomic Value Equation
Beginning to get consumer and provider engagement in the new model
Still deeply embedded old market behaviors and incentives
Progress is slow
Consumer Engagement
Provider Engagement
Health Service Exchange Defining the Competitive Model
Robust investment climate
Mixed focus MCOs heavily
favored
Unprecedented government reform
More private/ public partnership required
Government Programs
and Regulation
Investment and
Innovation
Marketplace and Business System Enablement
?
©2007 ChapterHouse, LLC—Not to be distributed without permission 5II-9000-136_Consumer Driven Summit
Agenda
Employer Sponsored Affordability and Coverage CrisisEmployer Sponsored Affordability and Coverage Crisis
Promises and Challenges of the Sponsored Retail Marketplace Promises and Challenges of the Sponsored Retail Marketplace
Current Solution Landscape and Breakthrough InnovationsCurrent Solution Landscape and Breakthrough Innovations
Retail Market Development Evolution and Disruptive InnovationRetail Market Development Evolution and Disruptive Innovation
Redefining the Sponsored Retail GameRedefining the Sponsored Retail Game
©2007 ChapterHouse, LLC—Not to be distributed without permission 6II-9000-136_Consumer Driven Summit
Retail MarketRetail Market
Sponsored Retail Market Holds the Promise of Driving Durable Market Reform Finally Unlocking Competitive Market Forces to Dramatically Improve the Cost/Value Performance Profile of the U.S. Healthcare Delivery System
Building a Sponsored Retail MarketplaceEnabling Market Competitive Forces to Work
Building a Sponsored Retail MarketplaceEnabling Market Competitive Forces to Work
Value-Based Reimbursement
and More Patients
High quality Convenient Available Spanish speaking Financing plan Open to
alternative medicine
On-site pharmacy
High Quality and Cost-Effective Care
Medical school Board certified Patient satisfaction
scores Quality and outcome
scores Location Office hours Integrated wellness Credit card
Healthcare Services Market Exchange
Industry shifts are increasingly moving the market from wholesale to retail: 1) Consumers selecting physicians based on performance information, 2) Providers competing for consumers’ business, and
3) Providers learning about cash businesses. While still in its early stages, the sponsored retail market holds the promise of driving health market reform through free market competitive forces.
©2007 ChapterHouse, LLC—Not to be distributed without permission 7II-9000-136_Consumer Driven Summit
WholesaleEnablementWholesaleEnablement
Retail MarketRetail Market
Value-Based Provider Networks and
Integrated Medical Homes Integrated medical homes
Evidence-based
Transparency and outcomes
Patient experience matters
Integrated Personalized Health
Management Personal health plan
Engagement tied to
personalized health goals
Care coordination and provider
information integration
Health and wellness programs
Whole Person Consumer Engagement Personalized health and financial management plan
Integrated multi-channel consumer engagement model
Whole person benefits and healthcare management model
Aligned Benefit Plans and Integrated
Rewards
Health improvement incentives
Health risk assessment bonus
First dollar prevention
coverage
Treatment compliance
Sponsored Retail Market Means Sponsored by Employers and Enabled by Health Plans, Providers, and the Government
Building a Sponsored Retail MarketplaceEnabling Market Competitive Forces to Work
Building a Sponsored Retail MarketplaceEnabling Market Competitive Forces to Work
Value-Based Reimbursement
and More Patients
High quality Convenient Available Spanish speaking Financing plan Open to
alternative medicine
On-site pharmacy
High Quality and Cost-Effective Care
Medical school Board certified Patient satisfaction
scores Quality and outcome
scores Location Office hours Integrated wellness Credit card
Healthcare Services Market Exchange
©2007 ChapterHouse, LLC—Not to be distributed without permission 8II-9000-136_Consumer Driven Summit
WholesaleEnablementWholesaleEnablement
Value-Based Provider Networks and
Integrated Medical Homes Integrated medical homes
Evidence-based
Transparency and outcomes
Patient experience matters
Integrated Personalized Health
Management Personal health plan
Engagement tied to
personalized health goals
Care coordination and provider
information integration
Health and wellness programs
Retail MarketRetail Market
The Sponsored Retail Market is a Work in Process
Building a Sponsored Retail MarketplaceEnabling Market Competitive Forces to Work
Building a Sponsored Retail MarketplaceEnabling Market Competitive Forces to Work
Improved Consumer Engagement Personalized health and financial management plan
Integrated multi-channel consumer engagement model
Whole person benefits and healthcare management model
Aligned Benefit Plans and Integrated
Rewards
Health improvement incentives
Health risk assessment bonus
First dollar prevention
coverage
Treatment compliance
1. Consumer engagement models are just beginning to be designed to increase consumer involvement in health and benefits management
High quality Convenient Available Spanish speaking Financing plan Open to
alternative medicine
On-site pharmacy
High Quality and Cost-Effective CareValue-Based Reimbursement
and More Patients
Medical school Board certified Patient satisfaction
scores Quality and
outcome scores Location Office hours Integrated wellness Credit card
Healthcare Services Market Exchange
2. Payer’s health management and provider network models are just starting to be architected to drive real improvements in the practice of medicine
©2007 ChapterHouse, LLC—Not to be distributed without permission 9II-9000-136_Consumer Driven Summit
Sponsored Retail Market Development Barriers
Employer & BrokerEmployer & Broker
Sponsorship is erodingSponsorship is eroding
Engagement is weakEngagement is weak
Worksite education Worksite education programs are not well programs are not well supportedsupported
Brokers still focus on Brokers still focus on traditional solutionstraditional solutions
Benefit buy-downs are Benefit buy-downs are working in the short-termworking in the short-term
Challenges by Constituent
Consumer driven healthcare models and health savings accounts alone are not sufficient to effectively address the root cause problems driving medical trend or to solve the growing employer
affordability crisis. Health plans must partner with consumers in the change process while leveraging their collective market clout to drive essential market changes with providers and
employers that are well beyond the reach of the consumer.
ConsumerConsumer
Low trust of the health planLow trust of the health plan
Limited engagement in Limited engagement in managing healthmanaging health
Unprepared for new Unprepared for new responsibilitiesresponsibilities
Big gaps in tools, support Big gaps in tools, support and reliable informationand reliable information
ProviderProvider
Focused on transactional Focused on transactional medicinemedicine
Misaligned economic Misaligned economic incentivesincentives
Limited care collaborationLimited care collaboration
Significant practice Significant practice variabilityvariability
©2007 ChapterHouse, LLC—Not to be distributed without permission 10II-9000-136_Consumer Driven Summit
Agenda
Employer Sponsored Affordability and Coverage CrisisEmployer Sponsored Affordability and Coverage Crisis
Promises and Challenges of the Sponsored Retail Marketplace Promises and Challenges of the Sponsored Retail Marketplace
Current Solution Landscape and Breakthrough InnovationsCurrent Solution Landscape and Breakthrough Innovations
Retail Market Development Evolution and Disruptive InnovationRetail Market Development Evolution and Disruptive Innovation
Redefining the Sponsored Retail GameRedefining the Sponsored Retail Game
©2007 ChapterHouse, LLC—Not to be distributed without permission 11II-9000-136_Consumer Driven Summit
Current Solutions—Product Benefits Continuum
Product Benefits ContinuumProduct Benefits Continuum
Health plans mainly compete on point solutions without addressing trade-offs in health management, networks or value-based benefits.
Value-Based Benefit DesignsValue-Based
Benefit DesignsIntegrated
Medical/DisabilityIntegrated
Medical/Disability
Integrated Medical/
Behavioral Health
Integrated Medical/
Behavioral Health
Savings Account Based
Savings Account Based
DefinedContribution
DefinedContribution
Health, Wealth and Retirement
Planning
Health, Wealth and Retirement
Planning
A la Carte Health/Wealth
Solutions
A la Carte Health/Wealth
Solutions
Catastrophic Plans
Catastrophic Plans
Short-TermCoverage
Short-TermCoverage
Voluntary ProductsVoluntary Products
Critical Illness Products
Critical Illness Products
Mini-MedMini-Med
Discount CardsDiscount Cards
High Deductible Plans
High Deductible Plans
Engagement-Based ProductsEngagement-
Based Products
Outcome-Based Products
Outcome-Based Products
Tiered NetworksTiered Networks
Specialty Network-Based
Products
Specialty Network-Based
Products
Integrated Medical Homes
Integrated Medical Homes
Focused Benefit Focused Benefit SolutionsSolutions
Focused Benefit Focused Benefit SolutionsSolutions
Integrated Product Integrated Product Solutions Solutions
Integrated Product Integrated Product Solutions Solutions
Network Network SolutionsSolutionsNetwork Network
SolutionsSolutionsValue-Based Value-Based
Benefit DesignsBenefit DesignsValue-Based Value-Based
Benefit DesignsBenefit DesignsHealth and Health and
Wealth SolutionsWealth SolutionsHealth and Health and
Wealth SolutionsWealth SolutionsAffordability Affordability
SolutionsSolutionsAffordability Affordability
SolutionsSolutions
Ben
efi
ts
Ben
efi
ts
Fo
cu
se
dF
oc
us
ed H
ealth
H
ealth
F
oc
us
ed
Fo
cu
se
d
©2007 ChapterHouse, LLC—Not to be distributed without permission 12II-9000-136_Consumer Driven Summit
Evolving Product Categories
Catastrophic Plans Mini-Med Discount Cards Short-Term
Coverage Voluntary Products Critical Illness
Products
Integrated Medical and Disability Benefits
Integrated Medical and Behavioral Health Benefits
Savings Account Based
Defined Contribution Health, Wealth, and
Retirement Planning A la Carte
Health/Wealth Solutions
Tiered Networks Specialty Network-
Based Products Integrated Medical
Homes
High Deductible Plans
Engagement-Based Products
Outcome-Based Products
Value Based Benefit Designs based on assessment of the clinical benefits to specific patient populations such as diabetics or asthma patients to improve treatment regimen compliance
Product Types
Product Types
MarketExamples
MarketExamples
The current product landscape is marked by innovation in plan design and integration, but not the fundamental health management that underlies medical trend abatement and disease market reform.
Product Benefits ContinuumProduct Benefits Continuum
Focused Benefit Focused Benefit SolutionsSolutions
Focused Benefit Focused Benefit SolutionsSolutions
Integrated Product Integrated Product SolutionsSolutions
Integrated Product Integrated Product SolutionsSolutions
Network Network SolutionsSolutionsNetwork Network
SolutionsSolutionsValue-Based Value-Based
Benefit DesignsBenefit DesignsValue-Based Value-Based
Benefit DesignsBenefit DesignsHealth and Health and
Wealth SolutionsWealth SolutionsHealth and Health and
Wealth SolutionsWealth SolutionsAffordability Affordability
SolutionsSolutionsAffordability Affordability
SolutionsSolutions
Ben
efi
ts
Ben
efi
ts
Fo
cu
se
dF
oc
us
ed H
ealth
H
ealth
F
oc
us
ed
Fo
cu
se
d
Aetna SCR BeniCard UnitedHealthcare
Belay Conseco Cancer
Secure
CIGNA Disability Solutions for Chronic Conditions
Humana/Corphealth Integrated Health-and-Wellness Program
Fidelity (“Health meets Wealth”)
Wells Fargo Ameriprise Aetna Accelerated
Death Benefits
Aetna Aexcel UnitedHealthcare Premera Blue Cross Medica Focus Blue Shield Net
Value HMO
WellPoint TONIK Humana No Worry BCN Healthy Blue
Living United Healthcare/
BeneComp Accretive Care RedBrick Health
Marriot International Inc./Hewitt Associates/Active Health—Reduced co-payments for diabetes, asthma, heart disease, colonoscopies, mammograms and childhood immunizations
Eastman Chemical/ Towers Perrin: Free drugs and supplies for diabetes, free mammograms and childhood immunizations
©2007 ChapterHouse, LLC—Not to be distributed without permission 13II-9000-136_Consumer Driven Summit
Solution focus shifting to consumer health management from benefit buy-downs (only)
Current Solutions—Level of Development
Product opportunities based on their level of maturity and their target market segments
MoreMature
Level of Development
All Segments
All Segments
EmployerSponsoredEmployer
Sponsored
IndividualIndividual
Early Stage
= Focused Benefit Solutions = Integrated Product Solutions = Network Solutions = Affordability Solutions = Value-Based Benefit Designs = Health and Wealth Solutions
Value-Based Benefit DesignsValue-Based
Benefit Designs
Tiered NetworksTiered Networks
Specialty Network-Based
Products
Specialty Network-Based
Products
A la Carte Health/Wealth
Solutions
A la Carte Health/Wealth
Solutions
High Deductible Health Plans
High Deductible Health Plans Engagement-
Based ProductsEngagement-
Based Products
Outcome-Based Products
Outcome-Based Products
Health, Wealth and Retirement
Planning
Health, Wealth and Retirement
Planning
Integrated Medical/Disability
Integrated Medical/Disability
Integrated Medical/Behavioral Health
Integrated Medical/Behavioral Health
DefinedContribution
DefinedContribution
Catastrophic Plans
Catastrophic Plans
Short-TermCoverage
Short-TermCoverage
Voluntary ProductsVoluntary Products
Critical Illness Products
Critical Illness ProductsMini-MedMini-Med
Discount CardsDiscount Cards
Savings Account Based
Savings Account Based
Integrated Medical Homes
Integrated Medical Homes
©2007 ChapterHouse, LLC—Not to be distributed without permission 14II-9000-136_Consumer Driven Summit
Success of Early CDH Innovators
United’s Definity product has experienced:
– Lower utilization of non-preventive care services
– Decrease in emergency room utilization
– Fewer hospital admissions compared to industry
– Higher generic substitution rate
– Employer renewal rates below national trends
United’s Simply Engaged program offers rate discounts in exchange for employer commitments
CIGNA’s Choice Fund results included:
– Lower costs of health care for CDHP members
– Higher degrees of engagement
– More frequent use of preventive care
– Increased use of medications to treat chronic conditions like diabetes
– Greater awareness of health care cost and quality
Integrates CareGain’s Defined-Care platform to further customize and enhance Choice Fund
Humana’s SmartSuite improved:
– Members compliance with maintenance drugs
– Annual medical cost range (4 to 5%)
Humana introduces “No Worry” rate cap product for 51 to 99 to ease employers into CDH
Introduces “Smart Results” product for ASO 300+ groups that reduces fees if employer lowers claim expenses
Success of Early CDH Innovators
WellPoint’s Lumenos customer survey revealed:
– Increased knowledge of managing their health care
– Improved health-related behaviors, such as exercise and eating healthier
– More engaged and more likely to use Lumenos' online health site
Offers first full-service, FDIC-insured HSA plan on the market
One of the first payers to bring across-the-board support to the Small Group Market
CDH pioneers have driven meaningful breakthroughs—where innovative solutions have resulted in positive measurable outcomes.
Aetna’s HealthFund has improved:
– Medication compliance among chronic patients
– Preventive care screenings
– Generic drug utilization
Aetna spearheads provider transparency
– Pricing information for 100k providers
– Quality information for 22k specialists
Aetna’s Aexcel performance network expands to 31 markets
©2007 ChapterHouse, LLC—Not to be distributed without permission 15II-9000-136_Consumer Driven Summit
Agenda
Employer Sponsored Affordability and Coverage CrisisEmployer Sponsored Affordability and Coverage Crisis
Promises and Challenges of the Sponsored Retail Marketplace Promises and Challenges of the Sponsored Retail Marketplace
Current Solution Landscape and Breakthrough InnovationsCurrent Solution Landscape and Breakthrough Innovations
Retail Market Development Evolution and Disruptive Retail Market Development Evolution and Disruptive InnovationInnovation
Redefining the Sponsored Retail GameRedefining the Sponsored Retail Game
©2007 ChapterHouse, LLC—Not to be distributed without permission 16II-9000-136_Consumer Driven Summit
Retail Consumer Market Evolution—Building Momentum or Stalled?
Stage I: Stage I: EmergingEmerging
Financial engagement stimulated by buy downs and
costs shifting
Stage II: Stage II: DevelopingDeveloping
Informed and improved healthcare decision making
Stage III: Stage III: MaturingMaturing
Increased health management engagement resulting in behavior changes and improved outcomes
Stage IV: Stage IV: TransformingTransforming
Collective consumer voice driving market reform
To
da
y’s
Ma
rke
tT
od
ay
’s M
ark
et
To
mo
rro
w’s
Ma
rke
tT
om
orr
ow
’s M
ark
et
©2007 ChapterHouse, LLC—Not to be distributed without permission 17II-9000-136_Consumer Driven Summit
Expect Disruptive Innovation
Core CompetenciesCore Competencies Consumer BrandConsumer Brand Consumer TrustConsumer Trust Consumer InnovationConsumer Innovation Health Benefits ExpertiseHealth Benefits Expertise Clinical ExpertiseClinical Expertise Financial ExpertiseFinancial Expertise Personal Services, Coaching Personal Services, Coaching
and Intimacy and Intimacy Local Market KnowledgeLocal Market Knowledge IT, Integration, Decision IT, Integration, Decision
Support Support and Procurementand Procurement
Financial Services
Insurance Products
ConsumerSoftware
& Services
Health Benefits Services
Retailers
MedicalProducts &
Services
Consumer Products
Provider & Payer
Solutions
Pharmacy & Biotech
Disease Management
Healthcare Delivery
©2007 ChapterHouse, LLC—Not to be distributed without permission 18II-9000-136_Consumer Driven Summit
Emerging Competitors and Niche Players
A health services company that utilizes financial tools, incentives, personalized wellness plans, and independent customer service advocacy to achieve greater accountability, behavior change and return on healthcare investments
A new business focused on reducing total medical costs by providing a high touch patient guidance system
Assumes total risk by guaranteeing trend/savings
A leading provider of business and financial management solutions for consumers, accounting professionals and small to mid-size employers
Declared healthcare as new business vertical introducing personal healthcare financial management programs
Mission is to organize the world’s information and make it universally accessible and useful
Recently declared and established focus on healthcare
“What’s needed is an independent advocate on behalf of customers.”
Kyle Rolfing, CEO
“…Guiding each of your employees, their families and their physicians to personalized, high-quality healthcare allows us to grow employee satisfaction…”
Tom Spann,CEO
“The personal intimacy and drop-dead ease of the solutions is only possible if you’re a consumer-driven company.”
Scott Cook, Chairman and Founder
“Focus on the user and all else will follow.”
Larry Page and Sergey Brin,Co-Founders
Direct to employer Direct to employer Direct to consumer Direct to consumer
Goal is to help people be healthy Concierge services to be offered
through the website and through a call center
Elected new board member focused on “creating a consumer-centric system”
Help patients navigate healthcare system
Establish trust-based relationship with customers
Backed by investors that “deliver meaningful and unique value to their customers”
Only pursue opportunities that provide incremental value over other options for the consumer
“Follow them home” approach Vision of the customer:
aggregates all consumer touch points
Web communities Responses to feedback buttons
within the software Intuitive experience
Most services are free Global access by supporting 90
languages Develop services that
significantly improve the lives of as many people as possible
Credible track record with innovative employers
Entrepreneurial spirit
No barrier mentality with expertise outside of healthcare
Brand Consumer experience and
expertise
Brand Consumer experience and
expertise
DescriptionDescription
ApproachApproach
Key AssetsKey Assets
Non-traditional competitors are entering the broad health and wealth space to fulfill unmet needs and have the potential to disrupt the market.
PhilosophiesPhilosophies
Customer-Centric
Initiatives
Customer-Centric
Initiatives
©2007 ChapterHouse, LLC—Not to be distributed without permission 19II-9000-136_Consumer Driven Summit
Agenda
Employer Sponsored Affordability and Coverage CrisisEmployer Sponsored Affordability and Coverage Crisis
Promises and Challenges of the Sponsored Retail Marketplace Promises and Challenges of the Sponsored Retail Marketplace
Current Solution Landscape and Breakthrough InnovationsCurrent Solution Landscape and Breakthrough Innovations
Retail Market Development Evolution and Disruptive InnovationRetail Market Development Evolution and Disruptive Innovation
Redefining the Sponsored Retail GameRedefining the Sponsored Retail Game
©2007 ChapterHouse, LLC—Not to be distributed without permission 20II-9000-136_Consumer Driven Summit
Employer Benefits and Product Market
Today Market
Consumer Benefits and Product Market
Consumer Health/ Wealth Service
Market
Employer Healthcare Affordability Market
Employer Healthcare Affordability Market
The New Competitive Landscape—Charting Your CourseF
rom
Insu
ran
ce t
o H
ealt
h M
anag
emen
t
From Wholesale to RetailWholesale(Employer)
Retail(Consumer)
Products/Benefits
HealthManagement
High Quality and Cost-Effective
Care
Value-Based Reimbursement
and More Patients
Healthcare Services Market
Exchange
$2.0T Marketplace Driving Competition and Investment
©2007 ChapterHouse, LLC—Not to be distributed without permission 21II-9000-136_Consumer Driven Summit
Health Plans and Innovators are Defining New Markets
Current LandscapeCurrent Landscape
Consumer Health/ Wealth Service
Market
Consumer Health/ Wealth Service
Market
Employer Healthcare
Affordability Market
Employer Healthcare
Affordability Market
Consumer Benefits and Product MarketConsumer Benefits and Product Market
Employer Benefits and Product Market
Today Market
Employer Benefits and Product Market
Today MarketFro
m In
sura
nce
to
Hea
lth
Man
agem
ent
From Wholesale to RetailWholesale(Employer)
Retail(Consumer)
Products/Benefits
HealthManagement
Consumer
Service
Companies
Consumer Product Companies
Health Management and Delivery Companies
©2007 ChapterHouse, LLC—Not to be distributed without permission 22II-9000-136_Consumer Driven Summit
Moving the Retail Market Forward
Employer and consumer-centric modelEmployer and consumer-centric model
Positive, constructive work site environment Positive, constructive work site environment
Personal relationship with every member with aligned health and finance goalsPersonal relationship with every member with aligned health and finance goals
Balanced consumer accountability with real decision consequencesBalanced consumer accountability with real decision consequences
Proactive integrated whole person consumer engagement modelProactive integrated whole person consumer engagement model
Evidence based medicine (clinical efficacy) and informed treatment optionsEvidence based medicine (clinical efficacy) and informed treatment options
Aligned provider economic model with role clarityAligned provider economic model with role clarity
Provider information integration and advanced medical homesProvider information integration and advanced medical homes
Design Guidelines Stage I: Stage I: EmergingEmerging
Stage II: Stage II: DevelopingDeveloping
Financial engagement stimulated by buy downs and
costs shifting
Informed and improved healthcare decision making
Stage III: Stage III: MaturingMaturing
Stage IV: Stage IV: TransformingTransforming
Increased health management engagement resulting in behavior changes and improved outcomes
Collective consumer voice driving market reform
©2007 ChapterHouse, LLC—Not to be distributed without permission 23II-9000-136_Consumer Driven Summit
Sponsored Retail Business Model—A New Value Chain
Promising lower costs, improving trend
performance, and increasing customer satisfaction through superior consumer engagement and
provider integration
Establishing the consumer as the
customer and building an information and
relationship foundation for personalized
integrated health/wellness
management
Engaging the consumer through a
personalized integrated experience leading to improved health, high levels of
satisfaction and increased value
Partnering with providers through the medical home model to improve the quality of care and facilitate
care coordination and information flow between/among
providers, consumers, and health plans
Evaluating performance
demonstrating total value for consumers and employers and
determining program refinements
Expanding customer relationships through deep understanding of
needs and differentiated
experience and outcomes
Sponsored Retail Business ModelSponsored Retail Business Model
Market Development
Consumer Relationship
Initiation
Consumer Engagement Management
Care andProvider
Integration Management
Performance Management
Relationship Extension
©2007 ChapterHouse, LLC—Not to be distributed without permission 24II-9000-136_Consumer Driven Summit
Building the Health Plan Business Model for the Consumer
Developing the Consumer as a Customer and
Establishing the Foundation for
Partnershipand Advocacy
Developing the Consumer as a Customer and
Establishing the Foundation for
Partnershipand Advocacy
Consumer Relationship
Initiation
HealthHealth
AttitudinalAttitudinal
FinancialFinancial
BehavioralBehavioral
FamilyFamily
Demographicsand Culture
Demographicsand Culture
Personalized integrated health/wellness and financial management plan (including
assessment) with shared goals
Consumer Engagement and Integrated Health, Wellness, Finance and Lifestyle Management
Consumer Engagement and Integrated Health, Wellness, Finance and Lifestyle Management
Consumer Engagement Management
PersonalPlanning
Benefits Coaching and Financial Management
CareManagement
ProviderSelection
IntegratedConsumer Experience
Fragmented Whole Person
New Market Development Model With Employer
Partnership and Consumer Engagement
New Market Development Model With Employer
Partnership and Consumer Engagement
Market Development
Sponsored Retail Business ModelSponsored Retail Business Model
EmployerSegmentation
Model
EmployerSegments
EmployerProfiles
Frozen in Place
Partners in Health
Price Buyers
Desperate Trailblazers
Attitudes
Demographics
Workforce profile
Labor market
Beliefs about roles
SegmentationModel
Refining Provider Partnerships and
Integrated Care Delivery
Refining Provider Partnerships and
Integrated Care Delivery
Care and Provider Integration
Management
CoordinatedCare with SharedHealth Benefitsand Household
ExpenseInformation
CoordinatedCare with SharedHealth Benefitsand Household
ExpenseInformation
HealthPlan
AdvancedMedicalHome
Patient
0%
20%
15%
10%
5%
Payer as the Trusted Resource
Using Deep Customer Understanding to Renew
and Expand Relationships
Using Deep Customer Understanding to Renew
and Expand Relationships
Relationship Extension
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q460%
100%
Performance Perspective
90%
80%
70%
Satisfaction
Trend
Co
nsu
mer
Sat
isfa
ctio
n Health
care Tren
d
Measuring Employer and Consumer
Performance Against Goals and Refine
Programs to ImproveTotal Value
Measuring Employer and Consumer
Performance Against Goals and Refine
Programs to ImproveTotal Value
Performance Management
Household budget for healthcare
100%1x day1x dayInsulin management
33%1x wk3x wkFitness program attendance
90%135/90120/75Blood pressure
90%225200Cholesterol
100%200208Weight
ResultActualGoalPersonal Plan
Consumer Performance Evaluation
80%$325/mo$300/mo
©2007 ChapterHouse, LLC—Not to be distributed without permission 25II-9000-136_Consumer Driven Summit
Employer segmentation and consultative sales approach
Broker segmentation and broker service model
New Market Development Model
With Employer Partnership and
Consumer Engagement
New Market Development Model
With Employer Partnership and
Consumer Engagement
Market Development
1
2
Sponsored Retail Business ModelSponsored Retail Business Model
A Dozen Innovations Required to Shift the Model
Integrated product, solution and service offerings based on deep employer and consumer knowledge
Using Deep Customer
Understanding to Renew and Expand
Relationships
Using Deep Customer
Understanding to Renew and Expand
Relationships
Relationship Extension
12Consumer performance management capability tied to personal plan and integrated rewards
Measuring Employer and Consumer
Performance Against Goals and Refine
Programs to Improve Total Value
Measuring Employer and Consumer
Performance Against Goals and Refine
Programs to Improve Total Value
Performance Management
11Integrated or partnered provider relationships with aligned reimbursement model
Advanced medical homes
Shared evidence-based medicine guidelines and preference sensitive treatment options
Refining Provider Partnerships and Integrated Care
Delivery
Refining Provider Partnerships and Integrated Care
Delivery
Care and Provider
Integration Management
8
9
10
Personalized integrated health and finance plan with goals
Benefits models to align incentives and promote health
Whole person consumer engagement model tied to personal plan
Consumer Engagement and Integrated Health, Wellness, Finance
and Lifestyle Management
Consumer Engagement and Integrated Health, Wellness, Finance
and Lifestyle Management
Consumer Engagement Management
5
6
7
Worksite education programs promoting a culture of health
Consumer profile development replacing current enrollment process
Developing the Consumer as a Customer and
Establishing the Foundation for Partnership and
Advocacy
Developing the Consumer as a Customer and
Establishing the Foundation for Partnership and
Advocacy
Consumer Relationship
Initiation
3
4