Purchasers + Entrepreneurs = Outcomes

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Editor’s Note: Cambia Grove is proud to partner with the innovation community to amplify their perspectives on topics applicable to the larger health care ecosystem. This blog post is part of our 5 Points of Health Care™ series, a Cambia Grove original framework designed to better understand the health care system by breaking the system into five distinct sectors: Patient, Payer, Policymaker, Provider and Purchaser. This guest post from Stephanie Fiano, from Forum Solutions, kicks off our focus on the purchaser in the month of June as our final installment in the 5 Points of Health Care™ 2019 series. Join us for a dynamic panel conversation on June 5th.

The views expressed in this article are solely those of the author and do not necessarily reflect the opinions or positions of Cambia, Cambia Grove, or any other entity or organization.



Health care purchasers are becoming more outspoken and proactive in demanding better outcomes. Realizing change from within the industry is an incredibly laborious process, innovation through entrepreneurial partnerships provides an opportunity to achieve desired cost, quality and experience outcomes. 

Collectively, the United States spends $3.5 trillion on health care. Employers are a vital stakeholder, covering nearly 156 million people (58% of nonelderly population). These employers have a responsibility to represent the best interests of their employees and possess the power to be change agents. Employers have led pivotal moments in the health care industry (check out this timeline for more background) demanding new health care models to meet employee needs. We are amid another employer-led period of disruption, with recent activity including Boeing, Walmart and others taking a direct-to-employer approach, Amazon-Berkshire-JPMorgan creating an employer collaboration and organizations deploying wellness programs.

Smaller, self-funded employers are also exploring how to get more from their health care investment, better distinguishing between high-value services and commodities. One example is the increasing prevalence of digital-first benefits platform Zenefits, which enables administrative efficiency.

Yet there are plenty more opportunities to improve outcomes. In most industries the purchaser (in this case, employers) is the “voice” of demand and today companies who focus on the customer experience are the most successful. However, in health care the employer’s ability to communicate preferences is hindered by several complexities: the expert nature of services (and thus not fully understanding the “product”), complicated regulatory environment and complex payment arrangements.

As a result, services received are often not what is needed. Purchasers pay for a product that is opaquely overpriced (we spend twice as much as other high-income countries), frustratingly inefficient (broad operational hinderances in hospitals, just one stakeholder) and frequently ineffective (for example, inpatient activity for preventable diseases including heart failure and diabetes is relatively higher). This level of ineffectiveness is unique, and for almost 70 years the industry has been enabling this misalignment as the behemoth industry grows.

Entrepreneurs now fill a critical need for purchasers to realize improved outcomes. As an entrepreneur, you know that results are what matter. Employers have ideas about what types of outcomes they want and need help finding solutions. They also have a keen eye for efficiencies and the ability to move quickly. Purchasers have been underwhelmed with the value of health care for decades but are just now becoming activated to hold the health care industry accountable.

Our advice to entrepreneurs: 

  • Focus on solutions with short-term, tangible value propositions and a long-term value story. Today’s purchasers are more likely to move quicker than ever before.
  • Drive outcomes with one purchaser-partner to provide proof of concept and others will follow. Leave the broader system implications to purchasers in mass, as they demand system change.
  • Simplify. Employers dislike jargon just as much as you and seek straightforward, simple solutions.

Entrepreneurs have an unprecedented opportunity to support purchasers and help them realize their desired health care-related outcomes.

 

About Stephanie Fiano

Stephanie Fiano is an experienced management consultant who works to improve the health care ecosystem where she helps her clients make critical data-driven decisions. Stephanie is skilled in strategic planning, go-to-market analysis, product development, stakeholder engagement and implementation.

About Forum Solutions

Forum Solutions is a management consulting company that works with Seattle’s business and nonprofit leaders to build and implement effective strategies for transformative growth and sustainable results. Forum offers clients the right skills for every job: strategic expertise, lean execution, and agile resourcing – improving businesses at any level – from the executive suite to the individual contributor.

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