Posted in Uncategorized

Strategic Market Tea Leaves: The Health Plan Perspective

By Gregg A. Masters, MPH

JPMorgan Healthcare Conference 2013 HealthNet PresoWhether you love em (anyone love their health insurance company?) or hate em, major health plans are in a reasonable position to lead if not steward the needed healthcare transformation. While physicians aka ‘disorganized medicine’ too often circle the wagons and shoot in, and whereas hospital systems present too much baggage and institutional inefficiencies, health plans with a ‘utility company’ mindset and access to local, regional and national market ‘big data’ footprints are likely candidates to support if not direct and brand local innovation.

In a continuing series to sample and curate narrative from the rich content at JP Morgan Healthcare conference 2013 here are some highlights as well as the audio webcast and deck proffered by industry veteran Jay Gellert, CEO and President of HealthNet.

Setting context for his remarks and visualizing the future he stipulates:

We think that whatever happens over the next 3-4-5 years [in our business] is going to be an increasingly Government driven market (‘B to G’).’

“…historically at this conference until very recently the vast majority of presenter’s talks has been about how to increase revenue….we think that’s kind of the past as we move to budget driven system…a much more radical change than people have come to grips with…

Gellert’s strategic thesis for HealthNet is offered upfront:

Gellert HealthNet Thesis: JPMorgan Healthcare Conference

Meanwhile some of the other market worthy observations include:

One of the benefits of being in California is that you’ve seen this [risk migration/management] movie before…”

“We’ve really never had an experience in the history of this country where we’ve moved from medical underwriting to community rating without intense disruption…

“…whether successful or not…one of the key challenges for all of us to remember is the individual market is only 5% of the [total]..

Key themes included positioning for the health insurance exchanges, ‘scrubbing the [commercial] book’, positioning for membership growth in Medicaid (MediCal), dual eligibles’, Medicare Advantage and continued uncertainties associated with specific provisions of the Affordable Care Act.

Up next @Aetna, then @Cigna.

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