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Customer Experience and Design

ACO: “If you build it, they will come”. Really? Not without a Payor Marketing Plan.

There is an ACO belief out there that “if you build it, they will come.” This belief is all based on honorable intentions for the patient and our communities. I just want to know what marketing plan and mobile application was used to contact all the baseball fans to go to Iowa in the movie “Field of Dreams”. Also, what was setup to make this sustainable for each State resident? Oh, and who and what system is matching fan to phone number (i.e., record), verifying that the population was managed fairly, with safety as number one, streamed-lined, and fan experience was tracked for opportunities for improvement?
If we continue with reality and the “Field of Dreams”, then fans had to have the money to take this trip, insurance if the trip exceeded what they could afford, or Medicare/Medicaid to cover the trip cost. There must have been an IT Infrastructure and Financial Operations of some sort.
The good news is that the Healthcare Industry is stepping up to the plate. No pun intended. Payors, Providers, and Facilities are coming together to develop the organization, IT infrastructure, quality contract, and coordination to “build it”, the ACO. There is no bad news…. it is just hard IT and process work with a fantastic cross-functional and cross-companies organizational change management plan.
However, I keep thinking about the marketing plan. Who is developing the marketing plan to reach the fans? Is it going to be the ACO to get patients… wait is the ACO going to have a health plan? Is it going to be the health plan that has a network of ACOs? Is it Medicaid/Medicare or the government? What is going to motivate the healthy patient to want an ACO as the network for their health plan? What is going to motivate the patient with a condition to have their life or condition monitored with expectation of their participation level? Patients will want to become healthy, but what is going to motivate them to change their behavior (e.g., lifestyle changes) to stay at the best possible health level? Some patients will be fine with only meeting 5 out of 10 outcomes as a positive.

It has been my experience as a business and IT consultant, industry product manager, and insurance broker that what motivates clients is the value proposition and great product roll-out. The Payor and ACO will need to match the member to the right health plan and show the monetary value of staying and/or improving their health. The smart Payor will contract with as many ACOs in a community as possible. Next, to roll-out this plan.. which insurance plan? Traditional or Non-traditional (HSA)? I advocate the Non-traditional. Why? You have ERs who want costs controlled, EEs who want costs controlled since first dollar is out of their pocket, and providers who want to control cost. Everyone doesn’t want unnecessary testing. They want a single-point-of-contact with accountability which the patient will monitor with their carrier/plan and personal health record. What will really motivate patients is monetary…. remember this is the “Field of Dreams”… is a HSA with a deductible that lowers over time as the patient maintains a healthy lifestyle and/or shows improvement of a chronic condition over time. Ok… I will keep going with the dream… the health plan is portable and not dependent on ER. The patient can stay tied to their preferred carrier and community-specific ACO… long-term relationships are developed all around. Continuity of care with a Health Plan and ACO, EHR, PHR, global payment, payer member services, etc… become an eco-system that everyone wants to keep green and growing.

What are your thoughts on ACO, Payors, Plans, etc.?

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