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Getting health care right

Straight from the CEO: Disruptors Welcome

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More and more companies that are neither traditional health insurers nor traditional care providers are entering the industry. Some, like the startup launched by Amazon, JP Morgan, and Berkshire Hathaway, are trying to develop comprehensive models. Others are introducing solutions that focus on a specific segment of the health experience.

Since our organization includes one of the nation’s largest Blue Cross Blue Shield health plan companies as well as a nine-hospital health system, it’s no surprise that I get asked whether we are worried about the threat posed by these “industry disruptors.”

My answer is, first, we embrace anybody who does something exceptional and innovative that enhances the health experience. Where some might see a competitive threat, we see opportunities to learn and to combine what we do well with what others do well to create something new.

Second, we are a disruptor. The Highmark health plan business was one of the first insurers to invest in building a fully integrated regional health system. The model we have evolved since then is an ongoing disruption of “how it was always done” by payers and providers. Key areas of our organization, including the Clinical Transformation Office and teams involved with the True Performance value-based reimbursement program, exist to do fundamentally disruptive work.

We have one foot in the past, bringing forward a legacy of excellence in coverage and care. But the other foot is stepping into the future — which means taking chances and innovating inside our organization, and also collaborating with other disruptors who share our focus on creating better value, and a better health experience, for customers.

Disruption Required

It’s not hard to find agreement that the U.S. health care system is too expensive, doesn’t cover people effectively, and often falls short when it comes to health outcomes and consumer satisfaction. One reason for that is that much of the system was built decades ago and designed around different health challenges, market dynamics, and personal realities than what we have today.

As the phrase “health care system” suggests, the focus has been fixing people after something goes wrong — delivering and paying for care — instead of supporting people’s health. The fee-for-service financial structure that still dominates most of the industry reinforces that mindset. When everyone makes more money simply by selling and managing more “care” — more procedures, more tests, more prescription drugs — it is hard to argue for investments and changes that support health and reduce the need for all that care.

The existing economic model of health care, and the bureaucracy that has grown around it, makes people hesitant to be disruptive. But that’s exactly what is needed — true transformation rather than just incremental changes that preserve volume-based business models.

We believe we have to be in the health business, not the health care business. That means inventing a new, integrated health system where everything from business processes and technological innovation to clinical pathways and core services is reengineered around the goal of keeping people healthy and improving their health experiences and health outcomes.

As an enterprise that includes an insurance company that vertically integrated a health system, we have some cultural and business advantages that enable us to pursue that goal more aggressively than provider systems whose decisions, including launching health plans, have historically been about driving as much volume as possible into their system. Our assumption is that if we make investments that improve people’s health — if we provide more life, less stress, and better health outcomes — then, even if that means less people in our hospital beds, that’s a victory.

That’s a disruptive approach, and we’ve made tremendous progress in operationalizing that approach in a way that still delivers strong, sustainable financial results.

Disruption with a Purpose: “Freeing People to Be Their Best”

Bold, disruptive change requires people to step back from familiar ways of doing things, work through difficult challenges, and commit to a journey that demands extra engagement and effort. To take all that on, people need to believe in the “why” driving the change.

Our mission — “to create a remarkable health experience, freeing people to be their best” — is a clear expression of our “why.” From big capital investments down to one-on-one interactions, that mission says our purpose is to do what we can to make a difference in the lives of the people we serve. 

At an individual level, a person we serve may be a purchaser of insurance one day, and a patient needing care services another day, but every day they have health choices and challenges that impact their ability to be their best. So our purpose pushes us to think beyond the traditional coverage-and-care system and reimagine a health ecosystem that starts with the consumer at the center and is then designed around their needs.

Telemedicine, apps, wearable health devices and similar innovations, programs like the Enhanced Community Care Management (ECCM) — these are a few ways we are making it easier for people to engage in their health and access support and care. For example, if someone has diabetes, a wearable monitor can alert them when their blood sugar is spiking high or dropping low, and provide helpful data to their clinicians. Check-ins from an ECCM nurse can provide practical help and motivation tailored to that person. As an integrated health organization, the purpose is not to sell them a health plan, and then wait for them to come to us if their condition worsens, but instead to make it easier for them to manage their diabetes and be their best.

From a Consumer Perspective, Who Wouldn’t Welcome “Disruptors”?

Shouldn’t the health system of the future do at least as much for health consumers as the best retailers do for their customers? Think about how easy top retailers make it for you to get information, understand choices, and take actions when you want, where you want and how you want. Or think about how retailers use data — the more they understand your needs and preferences, the more they can curate the experience and products to fit you.

That’s what we intend to do.

Different people have different health concerns, needs and preferences depending where they are in their health journeys, so we want to work toward being able to customize interactions to provide what can best support their health in the way they most want to be supported.

Coming back to the question of “disruptors” entering our industry, I have written in the past about the importance of strategic collaboration for Highmark Health’s business model. You see proof of that in our investment with Penn State Health, expanding collaboration with Johns Hopkins, and work with the Blue Cross Blue Shield Institute and Lyft to help people who need to see a doctor but don’t have transportation.

That commitment to strategic collaboration absolutely extends to retail and technology companies that are committed to better health, and share our goals of less stress and more life for consumers, improving measurable outcomes, and lowering the total cost of care. Our centers of excellence include the delivery of health care, how to pay for that care through insurance products, and a growing number of related areas, like our VITAL Innovation test-and-learn platform. But if you think the health experience will be improved by the most effective, simplest platform available for e-commerce and consumer interaction, you welcome disruptors like Amazon, because that’s their area of excellence. If you think it would help to have search algorithms figure out what to show you and be 99 percent right about your health needs and preferences, you welcome disruptors like Google.

There is so much unstructured data around health — from personal fitness trackers, scales that upload your weight data to the Internet, wearable medical devices that record glucose levels, pulse, blood pressure, and more. Ideally, all that data is combined with your medical records to create a whole health picture of you. As a health organization, we see how empowering that whole health picture would be, for you and your clinicians. And we also see the value of pursuing ambitious ideas like that alongside the best and brightest disruptors whose expertise is in machine learning, AI and other areas.

Imagine a Future Where Everyone Embraces Health

Highmark Health’s vision is “a world where everyone embraces health.” We believe we have a unique opportunity to create the DNA for a new health ecosystem that puts the individual at the center, provides more comprehensive support for health, and removes the frustrations and obstacles that sometimes get in the way. A world where everyone embraces health is a world worth being disruptive, and partnering with other disruptors, to achieve.

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A national health and wellness organization as well as the second largest integrated delivery and financing system in America, Highmark Health and our diversified portfolio of businesses employ more than 43,000 talented people who proudly serve millions of Americans in all 50 states and the District of Columbia.

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