In the future world of healthcare molded by the legislation of healthcare reform, doctors, hospitals and insurers are going to have to make changes to their business models if they want to be successful, according to an analysis by the Psilos Group.
The healthcare services venture capital firm's study determined that a real market economy is developing under healthcare reform and participants in the system have to step up. Doctors, hospitals and insurers will have to demonstrate value-based performance and deliver better patient outcomes at reasonable prices, the report says.
And as consumers take more control of their healthcare needs, those in the industry – especially insurers – will have to become more consumer-friendly in the same way that prominent companies like Apple and Amazon are.
[See also: Prudential survey shows drop in employee education on healthcare benefits; Expert: Reform could prompt employers to drop health insurance.]
"If you're an insurer," said Lisa Suennen, co-founder of the Psilos Group and one of the authors of the report, "you can't just skate by doing what you have been doing."
She said insurers deal mostly with companies buying plans for their employees, but under healthcare reform, as more employers start giving their employees money so they can find their own plans rather than provide them with a plan, insurers will be faced with selling their products directly to millions of individual customers.
"A lot of times today when consumers think about their health plans, they assume their phone call won't get answered, they're going to get materials they don't understand and they're going to have providers in the network they don't want," Suennen said. "But if you are an employee and you now are being given a chunk of change to go buy a plan on your own, you're going to look for the kinds of things you look for when you buy a car: friendly salesperson, quality service, 'I understand what's happening' – the paperwork and all that."
"Insurers have to figure out how to build brand equity on the consumer front," she said. "The first way you do that is by providing good service. Answer your phone. Create networks that people actually want to go see. They're going to have to become like the Apple computers, the Amazons, the whoevers of the world, building products people actually want to buy and servicing them on the back end."
Hospitals have to get on the technology bandwagon, Suennen said. They will have to adopt more interactive and comprehensive care planning procedures because they aren't going to be paid any more for unnecessary readmissions and medical errors.
Consumers aren't off the hook, either, she said. They'll have responsibilities, too, as the healthcare system changes under healthcare reform.
"They're going to have to step up and not be afraid to learn about it," Suennen said. "They're going to have to take ownership of the process. Learn how to select a health plan just like they learned how to select funds from a 401K."