Private health insurers know that someday the inevitable will happen—a significant number of people will refuse or be unable to pay the high health insurance premiums the industry has shamelessly extracted for decades. Insurers also know that all of their “cost-saving” efforts over the years were simply stalling tactics, temporary appeasements to employers (payers) to make them feel like they had some control over their multi-million dollar health plans. Insurers were so confident in their relationships with employers that they even took the name “payers” for themselves. However, lately, large employers have questioned their partnerships with insurers and are taking steps to improve the health care experience for their employees and decrease their health plan budgets. But get this; they’re keeping their private health insurance plans.

Large Employers Are Tinkering With Their Health Plans And Calling It Innovation

If you read about health care even occasionally, you know about the new company, Haven. A venture created by the heads of Amazon, Berkshire Hathaway, and JPMorgan Chase. Large companies that got together to create a health insurance company with the goal of lowering health insurance and health care costs for their employees. The health insurance status quo said, have at it. Private health insurers know better than most what’s required to make health care more affordable—medical care price controls and health care trade-offs. Insurers have perfected the art of managing health care trade-offs—most benefit plan documents contain pages of excluded health care benefits. And since employers aren’t talking about price controls, with the exception of reference based pricing, which is technically a form of price controls but with numbers that are easy to manipulate, insurers aren’t that pressed about this new wave of employer health care “innovation.”


Still, we don’t know what “innovations” to expect from Haven, but based on what I’ve read so far, it involves technology. And Haven’s not the first group of large, wealthy employers exploring how technology can help control health care costs. According to a very informative article in Benefits News, before Haven, there was The Employer Health Innovation Roundtable (EHIR), “a grassroots group made up of nearly 60 of the country’s biggest employers that represent nearly 8 million employees.” This group includes mega companies such as Apple, Target, and Google. Basically, representatives from EHIR watch presentations from health care tech start-ups and decide if they want to pilot the “benefit” at one of their companies and report back its findings to the large group via case study or some other format. Continue Reading...

Tags: health care innovation, health care , health care technology, Haven, EHIR

Oscar Health, founded, in 2012, originally set out to develop and sell tech products to established health insurance companies. When that plan did not work, Oscar Health’s founders took the millions of dollars raised from investors and started a health insurance company centered around its custom tech. Six years later, and with a recent $375 million investment from Google’s parent company, Alphabet, Oscar is doubling down on being an health insurance technology company. Or, are they a technology company that sells health insurance? And is Silicon Valley-style tech the missing component in health care reform?

Improving Services And Saving Lives

Oscar’s social media branding approach to health care and real-time data decision tools are a welcome contrast to the everything-but-the-kitchen-sink websites of other health insurers. A system that uses real-time prior authorization for surgeries is a huge improvement over faxing forms and waiting days or weeks for a response from the insurer before you can schedule an appointment. An insurance company that pays claims in real-time, while you’re still at the doctor’s office, is much better than waiting for a bill from the doctor and then waiting for the insurer to pay its portion before you know what you owe.

Innovative technology is good for the health care industry and the trash-talking bros at Oscar (these guys can't get through an interview without a negative comment about their competitors’ antiquated legacy systems) are producing tech that improves the health care experience and has the potential to save lives.

We know that the technology doctors and hospitals use to diagnose and treat patients can save lives, but so can having immediate access to real-time data. A recently reported story on Forbes Online about an Australian cancer patient, Mettaloka Halwala, illustrates how faxing forms can result in medical errors. In Mettaloka’s case, it was a death sentence. Less serious, but still frustrating, administrative errors occur in health care every day. Since 2014, Blue Shield in Los Angeles’s enrollment system, the one used for individual health plan purchasers, has been on the fritz. The enrollment system unexpectedly terminates policies of individuals whose premiums were paid. Customers spend hours on the phone trying to get their insurance coverage reinstated, all while skipping medical appointments and delaying prescription drug refills for days, weeks, and months. Blue Shield in LA’s continual system problems for the most basic of services is one of the worst examples of a major health care industry customer service failure due to inadequate technology.

Big Data, Innovative Tech, And The Human Condition

The rollout of the Affordable Care Act (aka Obamacare) had its technology challenges. But the Act achieved its primary purpose of providing affordable health insurance coverage to the millions of people without coverage. A glitch-free enrollment system, impervious to attack by political rivals, would have been a good start for Obamacare supporters and enrollees, but, what’s more important—affordable coverage or a streamlined health plan enrollment system? The guys at Oscar might think that they are providing both, but are they? Using data analytics, predictive modeling, and artificial intelligence may eventually lead to administrative savings in health care, but other factors can replace those costs. Continue Reading...

Tags: Oscar Health, obamacare, health care technology, Social determinants of health