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CMB Researcher in Residence: UPMC Health Plan's Jim Villella

Posted by Amy Modini

Tue, Apr 26, 2016

jim_upmc2.pngUniversity of Pittsburgh Medical Center Health Plan’s Director of Market Intelligence, Jim Villella, sat down with CMB’s Amy Modini to discuss the role of insights and market research at UPMC and the health insurance industry at large.

AM: Tell us a bit about your role as Director of Market Intelligence at University of Pittsburgh Medical Center (UPMC) Health Plan.

JV: I oversee all external and internal intelligence within the health insurance industry in our market. Our Insurance Services Division (ISD) includes a lot more than just health insurance. Within the ISD, there are health insurance products as well as a suite of workplace productivity solutions under the WorkPartners brand.  WorkPartners offers worker’s compensation insurance, employee assistance programs, wellness programs, and some business productivity solutions, such as FMLA and short-term disability. Primary research is obviously one of the services that my team offers to all of UPMC ISD. This research is often an assessment of where we are compared to our competitors as well as opinions and attitudes of our current members. We also manage our marketing relational database, which is built at the consumer and employer level, so that we can do targeted marketing campaigns. Overall, it’s a pretty broad list of responsibilities.

AM: It certainly is! As we know, it’s been a disruptive few years for the healthcare industry. Looking ahead, what challenges and opportunities do you see coming?

JV: One of the biggest challenges for many health insurance companies who don’t have a large direct-to-consumer business sector is the end of the extension of the allowance for small groups under 50 to keep the plans they had prior to the implementation of the ACA. When the allowance goes away in 2017, those groups are going to have to move to community-rated insurance plans. Many of those groups will have to evaluate their situation when rates change in 2018, so that’s a challenge that insurers will face: transitioning what happens with those groups. The insurance companies will have to meet that challenge and ensure that they continue to insure those same people, whether it’s through a group or through the individual process. 

There are a lot of constraints on insurance companies with the Affordable Care Act (ACA). There are limitations on profitability and also on mitigating risk, so it’s a little bit harder to make a profit. And, as you can see in some markets, some of the more profit-driven public entities have chosen to take themselves out of the individual market in many areas because they’re finding it hard to have a viable business model in the current environment. There’s a lot of uncertainty in the market about who’s going to be there to provide the insurance solutions that are part of the ACA. 

AM: Do you think being part of an integrated system puts UPMC in a different position than other carriers that are just health insurance companies?

JV: Yes, I do. Because we’re an integrated delivery system, we have a lot more dialogue between the provider and the payer, which gives us more opportunities to intervene and identify solutions that will help people get better and stay healthy. Different payment models also emerge out of this position, which allows us to move away from a situation in which someone is paying providers for a service and move toward compensating them based on the effectiveness of the care. That’s much easier to do in an integrated system where we have direct relationships with a big portion of our provider-base. 

AM: What role do you believe healthcare insights, in particular, could play with some of the challenges and changes in the industry you mentioned?

JV: At the end of the day, much of what we deliver in the insurance business is somewhat commoditized. You have to offer things, in addition to paying claims and providing access to doctors and hospitals that members want, so that they remain with you when they have the opportunity to evaluate options in open enrollment periods. Research helps us immensely in identifying those unmet needs or identifying how well we can meet their needs that go beyond the basics of health insurance. 

Carriers have to move toward having one-on-one relationships between themselves and the individuals that they cover. In the past, carriers have had more of a relationship with a group that covers hundreds or thousands of people at a time, so the model is narrowing to an individual-level, much like auto insurance. You don’t really have employer-sponsored auto insurance. Every one of those carriers is dealing with each individual person one at a time, and that’s what the future of health insurance appears to be moving rapidly toward. The employer model is still the foundation for most U.S. health care, but if the health insurance exchanges continue to be successful and maintain competition and lower premiums—depending on who’s elected—it could continue to become more of an accepted way for Americans to obtain health insurance. 

AM: Let’s shift gears a little bit. Let’s talk about the market share analysis work we’ve done with you over the past couple of years. Can you talk a little bit about this work, and why it’s so important now?

JV: The rapid change in market share, year over year, is something we need to assess as quickly as possible, and the secondary sources we rely on to give us our definitive market share take several months to report. So, when we want to know in January what the market share shift has been, waiting for our secondary sources until July is simply too long. We partner with CMB so we can get a very quick, but accurate, assessment of how much the share has changed. The change in market share used to move at a glacial pace, but now it changes several percentage points for some carriers in a single year. We need to know about those changes as quickly as possible. We also use that study to assess perceptions and opinions of brands as well as what’s important to decision-makers, which helps us do some strategic planning for marketing purposes. 

AM: You’ve already touched on this a little bit, but how does this work play into your larger insights strategy?

JV: It helps us position ourselves and try to identify which areas of the geography we’re in that we could potentially focus on more. We get a more robust view of that at the county level from our secondary source in July. If we were to find opportunities or weaknesses in that share data—such as gaining or losing to a particular carrier in a particular region—we could react to that. It also helps us understand where the national competitors have gained traction—which ones are winning out and where. We need to be able to respond and understand who our competitors are as quickly as possible. 

AM: As you think about the next challenges for your organization, tell us what you look for in an insights partner.

JV: Several things:

  • Experience with our industry is helpful if not essential. Health insurance is a very complicated industry. I think it’s very difficult to partner with a research vendor that has no familiarity with the business. Even the terminology is difficult, so it would be hard to have to explain things about the industry over and over again.
  • A partner that does independent preparation and doesn’t rely exclusively on us to provide everything because they’ve done their homework.
  • Good problem-solving skills. Marketing and market research is basically just problem solving, and that manifests itself in even trying to design a research study. We need a partner that’s constantly asking: what’s the best way to do this?
  • Creative sample design. We sometimes have difficulty reaching certain audiences because we’re limited by our geographic footprint in western PA. So, finding a partner that can suggest alternatives for reliable ways of getting the same level of information is a huge component of what we need in a partner.
  • Visual interpretation of data is another one. That’s an art and a science, and partners who know how to show you information in a visual way are extremely helpful because that’s usually how it gets delivered to senior management, which is much easier to access than large, detailed crosstabs. 

These are all things we have working with you, and of course, we’ve had many years working together, so you know us very well and that familiarity is very helpful.

Got a market research question that you're just dying to have answered? Ask our Chief Methodologist and VP of Advanced Analytics, and he might tackle your question in his next blog!

Ask Dr. Jay!  

Topics: healthcare research, health insurance research, Researchers in Residence

South Street Strategy Guest Blog: Healthcare Reform: Who's Looking out for the Small Guy?

Posted by Rachel Corn

Tue, Jul 30, 2013

 

stethoscopeIn early 2012 we did some research on healthcare reform predictions. At the time, there was a pretty strong consensus that large groups, most of which were already insured, would experience little impact. The uncertainty lay around small businesses (<100 employees) offer rates: the Robert Wood Johnson Foundation predicted pretty much neutral effect, but RAND predicted an overall increase in offerings. So where do we stand now?We have found most analysts are pretty shy when it comes to forecasting new numbers. For the overall market (all sizes) the International Foundation of Employee Benefit Plans (IFEBP) reports that 94% of employers are definitely or very likely to continue employer-sponsored health care. That’s a pretty good indication of no major drop outs compared to 2012, when only 46% were certain that they would continue sponsorship.

But expanded health insurance coverage will come at a cost, and small employers particularly are vulnerable. As a result, they are implementing cost control tactics: encouraging healthy behaviors and wise usage that reduces costs, entering private health exchanges, offering self-insurance for small groups, and reducing the number of full timers.

For insurance companies, reform opens up new opportunities to serve the small business market. Small businesses today are treated as a uniform group with similar needs. As reform unfolds, the market will fragment into: those who truly believe in providing insurance to their employees and will continue to do so, those who cannot afford to pay increased premiums but are still interested, and those who simply opt to exit the market. Smart and creative insurers will look for ways to serve the middle segment with unique offerings, whether those are self-insurance, stripped down plans, voluntary products, or others. The insurers that will move first by matching deep customer knowledge with creativity and innovation will have a leg up in this rapidly evolving market.

Rachel is a Director at  South Street Strategy Group, she specializes in finding growth opportunities in new market segments, new products and businesses and innovative business models.

South Street Strategy Group, an independent sister company of Chadwick Martin South Street Strategy GroupBailey, integrates the best of strategy consulting and marketing science to develop better growth and value delivery strategies. 

 

Topics: South Street Strategy Group, strategy consulting, healthcare research, health insurance research

Myth-Busting Customer Centricity In Healthcare

Posted by Jennifer von Briesen

Tue, Jul 16, 2013

Target consumer or accountHealthcare in the US has been a hot media topic, and the Affordable Care Act’s next key provision that goes into effect on October 1 will bring about profound change in the health insurance industry. Consumers looking to buy individual health insurance will be able to enroll in subsidized plans offered through state-based exchanges with coverage beginning in January 2014.Regardless of the politics and adoption hurdles surrounding the subject, it’s crystal clear that health insurers will need to change the way they approach the market in the coming years. Challenging as it may be, this change represents opportunity as well. Not only will this regulation open up channels to sell direct to new customer segments that have previously been underserved or never served, but the shift to a more retail-oriented business model will push customer-centricity to the forefront of health insurers’ strategy.

So, what does customer centricity actually mean for insurers? It’s not something I have hard and fast answers to yet, but we’re collaborating with our clients to help define a path forward. Here are my top-level thoughts on some of the myths that need to be put to rest in order to build a successful customer strategy in the space:

MYTH: The consumer matters more than the ecosystem.
FACT: Up to now, consumers have generally been “extended stakeholders” in the health insurance ecosystem, and they are definitely an audience that insurers should be learning about and listening to more given the change on the horizon. However, serving the consumer well means also understanding how other players—employers, brokers and providers—are preparing for change. Be careful not to develop blind spots toward traditional stakeholders.

MYTH: If you build technology, the customers will come.
FACT: No doubt today’s consumers are open to social tools, apps and other tech solutions that will help them learn about and interact with companies. But in order for a new technology to really matter to consumers, it has to solve a pain point.  Without a deep understanding of what customers need, and a willingness to address root-level issues (such as consumer trust), a new technology is just a shiny object.

MYTH: You’ve got the right data…and it’s Big.
FACT: Insurers have a lot of data. But it’s primarily based on claims and transactional data, with very little gleaned directly from healthcare consumers themselves about wants, needs, and interaction pain points. The industry’s legacy of being claim-oriented continues to drive consumer dissatisfaction and distrust, so it’s not the ideal source for data that will build customer intimacy.

What other myths need to be busted in order for insurers to be truly customer centric? We’d love to hear from you and promise to share our thinking as it evolves.

Jennifer is a Director at  South Street Strategy Group. She recently received the 2013 “Member of the Year” award by the Association for Strategic Planning (ASP), the preeminent professional association for those engaged in strategic thinking, planning and action.

South Street Strategy Group, an independent sister company of Chadwick Martin Bailey, integrates the best of strategy consulting and marketing science to develop better growth and value delivery strategies. 

Topics: South Street Strategy Group, strategy consulting, healthcare research, health insurance research, big data, customer experience and loyalty

Key Questions for Insurers in Wake of Supreme Court Decision

Posted by Amy Modini

Mon, Jul 02, 2012

Obamacare and health insurersAlong with millions of Americans-patients,doctors,lawyers and, politicians-health insurers also waited with bated breath for last week's Supreme Court’s ruling on health reform. Now that the Supreme Court has upheld the basic provisions of the law, health insurers face the challenge of understanding how traditional markets will be impacted by the individual mandate and implementation of health insurance exchanges.  

Even with the ruling, there is still much that remains unknown about the law’s impact, and significant uncertainty about how the law will be enforced in each state.  But there are still critical questions insurers must consider now as they adapt to a new era in health reform, including:
  • How will this ruling and the establishment of exchanges impact company revenue and profitability?  Are there ways to take advantage of this ruling and increase company margins and revenues?

  • How do we compete effectively in an open exchange?  If price is the key criteria to consumer decision making, is there a way to minimize its influence and yet be successful?

  • Is there a need to re-examine the existing client base beyond the traditional demographics? Will an alternate classification help create a competitive advantage?

  • How do we move beyond the traditional employer sponsored channel?  How can we take advantage of technological shifts?

  • How relevant is the present communication strategy? Is there an opportunity to approach the future in a new, cohesive way that complements the product and distribution strategy?

Addressing these questions and mitigating the coming challenges will not be easy; surviving and flourishing in a changing market requires a truly new and innovative approach. We believe insurers must:

  • Reconsider how they approach product development – the insurers who will be successful in this new reality will be those who are able and willing to stretch boundaries of what insurance products look like to meet the needs of the customers, including offering supplemental insurance, wellness programs, incentives and monetary gains for meeting health goals, etc.

  • Go beyond traditional ways of looking at the market – motivations, attitudes, goals, and behaviors will become as, if not more, important to understanding and effectively messaging to insurance customers. Alternate classification of consumers could help insurance companies underwrite consumers in a more effective and efficient manner.  This could be especially advantageous for smaller insurance companies that cannot compete solely on price; perhaps it is time to start looking at a niche strategy. For a more detailed look at alternative market segmentation for health insurance, read our white paper: A New Approach to Segmentation for the Changing Insurance Industry.

  • Embrace the leaps in technology – insurers must explore the possibility of reaching consumers directly (internet, smartphone, etc.), and simplifying the purchasing process.  A simple product lineup with an easy buying process can go a long way in increasing an insurer’s favorability rating.

  • Consider a new messaging strategy – the health industry’s transition is a great time to consider resetting the existing image. Great products and great service need great messaging.  What are the goals people are trying to achieve? What is it that truly motivates them? What is it that truly sets us apart and does it add value to our customers’ lives? Is there a need to have specific messages to specific groups of consumers? Think about the answers to these questions. Insurers in the end must be able to convince consumers that they are partners in this journey and are mutually dependent on each other’s success.

Amidst all the uncertainty insurers are facing, we believe that to mitigate the uncertainties of the reform landscape, insurers will have to go back to the drawing board, rethink how they look at the market, engage in product development and address the fundamental goals of their customers. Insurers must recognize and leverage core capabilities that others cannot replicate. Competitive advantages stem from not one but from a series of strategic decisions. The correct mix of product, distribution, message and market coupled with inherent operational strengths (e.g., knowledge of a local market, ability to underwrite at low costs,  relationships with existing customers) can set insurers apart from competition and pave the way to long term success.

Posted by Amy Modini. Amy is an Account Director for CMB’s Healthcare Practice, when she gets the time she loves going to the beach with her two kids.

Topics: healthcare research, product development, health insurance research, market strategy and segmentation

An Innovative Approach to Segmentation for a Changing Insurance Industry

Posted by Mark Carr

Tue, Mar 13, 2012

Segmenting the health care market CMBThe 2014 implementation of many of the Affordable Care Act’s (ACA) key provisions has sparked a great deal of speculation about the future of the healthcare market; there seems to be no end to the models predicting how the law will impact the insurance industry. There is no question that reform will shift the health insurance industry to a more retail based model, and in the process challenge traditional insurers to develop new consumer oriented capabilities.  A vital piece of planning for this shift will require understanding changes in consumer decision-making. The traditional approach of health insurers to segmenting the market is unlikely to provide the kind of insight necessary to win in an industry facing such fundamental regulatory, economic, and cultural change.

Traditional segmentation approaches cut the consumer market by demographics (e.g. age, gender) or funding source (e.g. who pays).  This approach was appropriate in years past when there was relatively little competition, differentiation, and when choice was limited. However, the insurance industry’s move to a more complex and competitive model requires a more nuanced understanding of customer needs and differentiators. The newly minted college grad indeed has different needs from their parents moving toward retirement or the young professional starting a family. This is proven out in some recent research we conducted.

To get a better sense of insurance consumers and their preferences, CMB and the South Street Strategy Group analyzed the responses of nearly 1,500 Americans over the age of 18, surveyed as part of CMB’s Consumer Pulse Program.  We then segmented the market by plan features and found five distinct segments that illustrate the needs and goals people have for their insurance coverage.

The segments we found are defined not solely by age or insurance source but by the needs and goals people have for their insurance coverage, and provide far more insight than traditional methods. For example one large segment, who we’ve termed “e-Patients” are the most interested in managing their healthcare or “visiting” their doctor online.  They’re price sensitive, want out-of-network coverage and are willing to switch primary care providers to get the benefits they want. Knowing the attributes of this and other significant segments of the insured population is invaluable to insurance providers who are facing an increasingly customer-centric industry.

Health Insurance SegmentationTo learn more about our approach and see more detailed profiles of the other segments click here.

Posted by J. Mark Carr, Mark is co-founder and managing partner of South Street Strategy Group.

South Street Strategy Group, an independent sister company of Chadwick Martin Bailey, integrates the best of strategy consulting and marketing science to develop better growth and value delivery strategies. 

Topics: South Street Strategy Group, health insurance research, Consumer Pulse, market strategy and segmentation

Health Reform Offers Both An Opportunity and Threat for Insurers

Posted by Kristen Garvey

Wed, Jan 05, 2011

As we enter 2011, the confusion and uncertainty around health reform only seems to be mounting. Amidst this uncertainty, consumers are looking for a reliable and trusted source of information, and they have the expectation that insurers will fill that role. Insurance carriers have the opportunity to become a trusted partner by providing the information consumers are so desperately seeking.

Consumer insights around healthcare reform

CMB conducted consumer research in mid 2010 which shows there is a clear gap between the level of knowledge consumers have around reform, and how they think reform will personally impact them. The result is that many consumers feel helpless.  As one consumer said,

“While I have tried to keep up with the legislation and have read articles and watched news programs on the topic, I'm not sure I know all the details.  For that matter, many of the ''experts'' don't seem to know everything either!” - Male, 50-54

Insurance carriers have an opportunity to become more than just another information source— they can become a trusted partner. In fact 61% of consumers expect health insurance companies to inform them about healthcare reform.

Join us for a webinar to learn more about the expectations consumers have towards reform. For Insurance carriers with foresight, health reform represents a rare, one time chance to grab market share and position their organizations for future growth.  

CMB Webinar on health reformWebinar: Challenges and Opportunities for Insurance Carriers in the Face of Health Reform

January 13, 2011 at Noon ET

Join Amy Modini of Chadwick Martin Bailey and J. Mark Carr of South Street Strategy Group as they look at how Americans are feeling about health reform and share consumer perceptions about the role of insurance carriers going forward. 

Topics: South Street Strategy Group, healthcare research, health insurance research, Consumer Pulse, webinar

Consumer Insights Show Consumer Uncertainty on Health Reform

Posted by Julie Kurd

Fri, Sep 24, 2010

 

health reformRegardless of your political leaning, it’s undeniable that the Patient Protection and Affordable Care Act will shift much of the healthcare insurance market from the current wholesale market to a consumer market.  At CMB, we recently conducted a national Pulse study and found that US consumers expect Health Reform to impact them personally, they’re just not sure how.

  • 75% of consumers say health insurance carriers are responsible for lowering health costs where <50% cited regulators as responsible.   
  • 78% of consumers say they seek information online (the mighty Google and WebMD etc.) 

Carriers need to educate their members and to set reasonable expectations for their role in lowering costs. And, according to the data,  the best way to get this message out is through health-related online sites and search-engine optimization efforts (to make their information more visible.)

...And now that the US is shifting from a wholesale market to a consumer market in health insurance, opportunities and risks for carriers are abound.

Posted by Julie Kurd. Julie is a Director on CMB's Financial Services/Insurance and Healthcare Practice who loves ski racing, Tuckerman’s Ravine, sailing and bananagrams. You can follow her @julie1research

consumer opinions of health reform

Topics: healthcare research, health insurance research

Innovation Ideas for Health Insurers Inspired by the Front End of Innovation Conference

Posted by Julie Kurd

Thu, May 13, 2010

You don't often hear health insurance and innovation in the same sentence but as I sat through many of the great sessions at the 2010 Front End of Innovation Conference here in Boston, I kept thinking to myself... "these hackers could really help the health insurance industry."

Many of the presentations we heard were about the new ‘go to market' reality....it's better, faster and cheaper than ever.  But most companies aren't there yet.  Think about the last time your company launched a product, service, program or tool... Did that product cost your company 2 and 2 (two years and two million) to launch?  Maybe longer?  Maybe more dollars? 

Below are two examples of people who seem to be doing it right with my take on how that  could specifically be applied to the health insurance world.

1)      Better, more useful information for consumers.  As a working mom, one of my goals is to make sure my children are eating somewhat healthy food.  Safeway's Foodflex program is a loyalty program on steroids (if steroids were good for you)...it doesn't just spew out coupons to try to get the cardholder to try a new snack product or brand.  Instead, it takes to heart the goals, needs, wants and desires of regular people like me.  Safeway drills down to nutritional information of all of the goods a person purchases and actually provides a graph of healthy purchase profile (calcium purchased, sodium purchased etc.).  Then it suggests substitutions to help you reduce your family's sodium intake or increase your family's calcium etc.  WOW!!!    Why can't my local grocer do that? 

Musing for the health insurance industry.  With obesity becoming the #1 cause of preventable death in the US, hello health insurers...why can't providers tie these Foodflex style programs in with my health insurance plan so I get a rebate if I rack up enough ‘healthy eating' points.  Forget about that $150 rebate you are willing to give me if I pay for (but don't actually use) a gym membership and focus on supporting healthy every day choices for the whole family.

2)       Faster to market (with hacker apps).  Peter Corbett from iStrategy showed us "apps for democracy" or ‘fixmycitydc' (Fix my city of Washington DC) to see how common citizens created apps to fix potholes, broken parking meters and other nuisances.  These guys are doing amazing things....a common citizen can take a picture (actually, it's a link not a picture) of a pothole, attach it to a GPS location and send it in to the government.  Then, the site is integrated with Washington DC's 311 system and the ‘open job order' to fix the pothole or the parking meter etc. is checked by the system until the job order closes.  And when it closes, you get a notification that ‘your' pothole or meter was fixed!   How's that for a closed loop process.?

In the past, it seems that broken parking meters took an average 6 days to repair and now...well, it's much faster.  A ‘hacker' came up with an app and now the government can track it...check it out... http://bit.ly/apps4all.  

Musing for the health insurance industry.  Like many of you, I have a high deductible insurance plan.   Can a ‘hacker' come up with an app for us so we can easily evaluate a) convenience, b) cost, and c) medical outcomes of particular procedures?  From the simple strep throat test (let me evaluate minute clinics in my area vs. a formal appointment) to things such as knee surgery, I should be able to quickly and easily make choices that fundamentally lower my out of pocket healthcare costs of shopping among providers with an equal or better outcome than my default ‘primary' and with the level of convenience I'm seeking. 

Heck, I may even decide to become a ‘medical tourist' in the US...if I needed a planned procedure that was more inexpensively executed in someplace like Buffalo, NY and with a better outcome, why wouldn't I go and visit friends, zip over to Niagara Falls, get my whatever fixed and then return home?  Isn't all that information available and just like ‘fixmycitydc,' can't someone link it all up to help me make wise choices in managing my health?  

With healthcare costing us about 16-17% of GDP in the US and the outcomes no better than in countries such as Germany with ~9% spending of GDP, can't we just completely change the game?

Below you can see what attendees thought  other highlights from FEI 2010 were.  Enjoy!    

Posted by Julie Kurd. Julie is a Director on CMB's Financial Services, Healthcare, and Insurance Practice.

 

 


Topics: health insurance research, conference recap