by Joe Wilds, Chief Solutions Officer, SVP

PORTLAND, October 26, 2016

I was working out at the gym doing my normal routine, when I overheard the trainer and his client.

“If you really want to see change,” the trainer said, “You’re going to have to redefine and reshape your core. That includes what kind of food you eat and what kind of exercises you do, because your core controls largely everything that you want to do. By reshaping your core, you truly achieve the change you’re looking for.”

Then it hit me.

The insurance industry has rarely seen what I would call radical or monumental shifts in change. We’ve seen only slight shifts or little tweaks. What would reshaping the core of healthcare look like? And really, what is core in healthcare plans today? Looking back ten or fifteen years ago, the core of insurance used to be: How efficient am I at paying claims? How strong am I at customer service? How quickly can I enroll?

These efficiencies in claims and billing are your blocking and tackling, but the challenge is that this a lot to consider your core. If everybody has these, then what do you have? The blocking and tackling become table stakes. You have to do them well. If you don’t do them well, they only hurt you. Blocking and tackling cause dissatisfaction if they aren’t done right; if they’re done well, it’s just expected

What happens then, when what you used to consider core is now only commodity? To differentiate yourself in a commoditized world and really start making changes in how you do business, you must first redefine, then reshape your core. In the future, the core of healthcare plans will be inextricably linked to product and data management. And the end of the day, that’s what you sell, that’s what you service, and that’s what your entire world is built around.

Here’s how we can begin to reshape the future core of healthcare and avoid those missed opportunities:

Be more than the prettiest pig in the sty

If you only compare yourself to those who you compete with on a daily basis, you’re missing the main point. Chances are, your customers are comparing you to the experience they have in other industries. And if that experience is really good—for example say, purchasing products on Amazon—then it doesn’t matter if you’re the prettiest pig in the sty. If you look at a net promoter score of Nike or Apple, and then compare it to a health insurance company, you’re going to see very stark differences.

Own your products

Your product is your core. Owning product means everything from how you understand what the market wants and desires, to how this product fits into your center, to how you then serve this product once it’s been purchased. If you don’t understand what your clients want, you’re missing a significant opportunity. If you can’t serve that product after it’s been sold and is now in production, then you’re missing a significant opportunity to really create and drive a net promoter score that rivals Nike or Apple.

The biggest challenge to owning your core is that you must control the entire chain surrounding it. And this is hard. Your business processes— your service model, your structure, your culture— must shift once you realize that everything outside your product could largely be outsourced. If you’re caught up in blocking and tackling mode, you remain like everyone else. Your business processes need to evolve around the product-core to truly drive change and deliver value to your customers. It’s just like the trainer’s advice to his client: if you focus solely on exercise, but don’t change your diet or spiritual mindset, you won’t get any results.

Leverage the data model

Now, you can’t drive product as your core without having the data management and modeling as leverage to support it. You can have all the data in the world, but if you don’t have any way to leverage and productize, you’re again missing a significant opportunity.

A health carrier needs to become more of a data company. We need to leverage this amazing asset called data to drive greater value into our customers. It shouldn’t be used against the consumer, but rather be used to help them become better, smarter, and more engaged.

Integrate— virtually

Integration on its own has a real negative connotation. In the past, integration was scary because it usually equated to massive costs and failed implementation. No one ever said, Boy I had the most amazing integration. And that’s because integration almost always had these hard wired systems trying to line up together from an architectural standpoint. It was a real challenge.
But now if you know your core, you’ve defined it, and you’ve owned it, you can virtually integrate to anything. How? Perception! You don’t have to truly integrate, only look integrated and seamless to your customer. What is visual to the customer— whether it’s the individual consumer, the large group, the hospital system— is a shield to the massive effort behind the scenes.

Consider Disney Corporation. They may not own a lot that happens inside the Disney experience— from the tickets, to the hotels to the airport shuttle, to the food, to the fast pass— but what you see when you get on the plane is an acknowledgement that you’re going to Disneyworld. Welcome to a great adventure.

When you get on the airport shuttle, that experience doesn’t change. When you get to the hotel, that experience doesn’t change. All that happens could all be owned— or none of it could be owned— by Disney Corporation. But at the end of the day, as a consumer, you really don’t care. Disney has virtually integrated so much of the experience that it doesn’t matter where it comes from. No one can own everything.

Virtual integration will be difficult in the health space because our blueprints— whether you’re a hospital company, an insurance company, or a consumer— are different. It will depend upon this trifecta of patient, payer, and doctor, coming together to drive the integration experience.

And it will be worth it. Virtual integration is a cost effective way, behind the scenes, to become a tangible product and experience to the customer. You don’t have to connect hard wires to make something look truly integrated because that’s where there’s cost. Instead, find opportunities to leverage your platform to feed to the desired downstream system. You can get information without hooking up or connecting—again, that’s where cost comes in—and find other ways to make this experience appear seamless to the customer.

When you begin to reshape your core, it takes amazing discipline. It takes focus. And it takes all those involved, who have skin in the game, to align. Just like the trainer brought up, we could do all the exercises to strengthen your core and reshape it, but if you’re not eating correctly, you’re not disciplined, then the effort is futile. As in healthcare, if your core changes to product and data management, how you feed it, and how disciplined you stay, is really what will determine the strength of your success. You can’t go into it half-heartedly.

We’re at a point now in our healthcare lifecycle where redefining your core is critical to staying on a sustainable path. In the future, if product is the only thing you own, and the services and culture behind it have reshaped to support that product, you can be sure that core is strong, healthy, and ready to compete.