3 min

We are living in a time when leadership is at a premium. This is especially true as we adapt to a “new normal” in our personal and professional lives. In the healthcare arena, the premium on leadership is multiplied by several factors.

• We have a costly, opaque, anticompetitive, and inefficient system.
• Health care represents 1 in every 5 dollars of Gross Domestic Product and continues to grow faster than any other consumer price index category.
• Like food, housing, and a means to support oneself and one’s family, health is a deeply personal necessity. Illness, injury, and disease compromise our ability to meet life needs. A lack of access to health care or to affordable health care compounds the consequences of personal and family health challenges.

These factors should elevate the expectations of next generation leadership in the health sector and hold us to higher standards in our current efforts and especially in our capacity to influence change.

It is not my intent to define leadership here. This has been done many times in many places. However, I’d like to suggest that as executive leaders within a healthcare ecosystem that needs great improvements, we should hold ourselves to next generation aims and actions. Here are some tenets that might help to keep us pointed in the right direction.

Leading Healthcare with Integrity

1. Do no harm.*

Questionable practices across stakeholders in the U.S. healthcare, pharma, and insurance systems have shaken the foundation of trust. Many “solutions” created by the legacy industry and new entrants inherit the current system’s ethical challenges, such as egregious billing and shared savings, hidden fees, and unscrupulous contracts.

Many are smaller versions of the same problems. For example, direct contracting meant to address valueless provider networks is often based on the same model of discounts off price-blind billing.

As next generation leaders, we need to ask, and answer, hard questions. Are we creating and delivering integrity-based products and services? Are our decisions and actions improving affordability? Lowering barriers to access? Increasing transparency? Creating more competition? Eliminating conflicts of interest? Making things better for patients, care providers, and payers?

* Contrary to popular belief, “do no harm” isn’t actually a part of the Hippocratic Oath.

2. The majority is almost always wrong.

This is the reason ingenuity, innovation, and positive change can take hold in the first place. Consolidating entities in a compromised system, like the unchecked hospital, PBM, and insurance carrier acquisition activity over the past decades, worsens existing problems, monopolizes thinking, and homogenizes behavior. This creates a spiral of further system regression, making change much harder.

Next generation leadership asks “If we could start anew, what would we do?”

3. Incrementalism is a way to avoid real change.

Incrementalism is an attractive proxy for standing still. In our current healthcare system, staying the same means getting worse by default. We see this in the form of minor tweaks staged as major advances, such as ACOs and value-based care attempts to blunt out of control fee-for-service.

A variant of incrementalism involves offerings designed to “manage the racketeering.” Examples of this include industries that have cropped up attempting to optimize PBM contracts or engage in an auditing arms race with hospital revenue maximization specialists and systems.

Next generation health leaders are not afraid to create much needed separation from the mainstream with offerings that will seem audacious to the status quo.

4. Look out-of-field for solutions.

This is a hallmark of innovation and invention across all disciplines. What can we learn and adopt from operational efficiency in other industries? From healthier buyer-seller-customer arrangements in unrelated arenas? From financial transaction reinvention in other sectors? Or from businesses that take care of people in spaces outside of healthcare? Importantly, what can we learn from those at ground level every day in the current system?

5. Take risks.

Outside of medical research, the established system is averse to risk and change. This prohibits progress. It requires courage from leaders who will embrace the unknown to step away from the majority and make real change happen through better solutions. We need leaders who are not afraid to ask “What if…?”

v2.0 Healthcare Leadership

In our new normal, we are at a time and place that is ripe for next generation health leaders who have the morals and courage to lead with bigger, bolder steps. If not us, who? If not now, when?

2 min

When evaluating a traditional employee health plan, employers and brokers typically focus on premiums, deductibles and co-pays, and the nuts and bolts of the plan’s coverage. Customer service is an afterthought. Historically, it has been enough that employees can call a toll-free number when they have questions.

Thankfully, the opposite is true when employers look at alternatives to these outdated insurance carrier plans. Instead of accepting the unacceptable status quo, there is growing demand for a significantly better member support experience. It’s about time!

A Better, More Compassionate Approach

There is no reason for employees to sit on hold waiting to speak with a random agent at a far-flung call center. Besides taking advantage of the many technologies available to connect and collaborate, members are better served speaking with a dedicated advocate who can guide them through the complexities of finding quality health care at a lower cost.

Health plans that prioritize the member experience help employees access more affordable health care, in all areas of care. Convenient and easy-to-use tools and personalized assistance ensure members (and employers) get the most value from their plan. This is as it should be, yet it is NOT what members get from a legacy insurance carrier.

Checklist for Better Member Support

Before renewing the current health plan, pause and seriously evaluate how well it meets member and employer needs. Apply these attributes to any plan under consideration and all stakeholders will be much better off.

• Compassionate Advocacy
  Advocates are a member’s most important resource. Services should range from simple questions asked and answered, such as benefit verification, all the way to personal assistance in complex matters. When members need to access specialty care or find the physician or facility most capable of providing needed care, they deserve to work with a proven, trustworthy team that’s ready to jump in and advocate on their behalf.
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• Flexible On-Demand Access
  While there will always be traditional phone support, a truly great support experience includes multiple platforms to simplify communication between members and their support team. Options should include in-app and online member portal messaging capabilities, online document uploading, and secure text messaging. This will encourage more and better communication by providing members with the platforms they are most comfortable using.
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• Ongoing Education
  The more members know about their health plan, the more value they can realize. Most “education” takes place during the Open Enrollment period when members are inundated with flyers, fact sheets, and plan summaries. But it’s after enrollment that they really need help. Member-focused education provides readily available process guides, short “how to” videos, and regular communications throughout the year. It also highlights plan features to promote awareness and guidance on how to access them.

Members and their families benefit most from advocacy that supports them every step of the way. They deserve a trusted support team that is empathetic to their needs and is dedicated to removing barriers to needed health care

Comprehensive member support is a critical component of an employee health plan. And it’s what employers are demanding as they seek alternatives to legacy plans. With superior health plan alternatives available, isn’t it time to leave outdated insurance carriers behind and choose something better for both members and the business bottom line?
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As Managing Director of the Client & Member Experience at Vitori Health, Johanna Newsome is passionate about nurturing positive, lasting relationships and building teams with a client-centric focus to collaboratively facilitate a positive member experience.