HILLSBORO, OR – Luis Machuca is a man with a mission. He wants the nation’s health plans to realize they won’t survive without change.
“They haven’t changed fundamentally in 30 years,” says the CEO of Kryptiq, a Hillsboro, Ore.-based provider of interoperability and workflow connectivity solutions. “But healthcare is becoming much more of a market, and they have to learn to embrace this.”
Machuca has been busy lately. In April, he appeared at the World Healthcare Congress in Washington, D.C., where he and Mark Ganz, CEO of the Oregon-based Regence Blue Cross Blue Shield plan, lectured on “Integrated Work-Site Health and Wellness.” More recently, his company announced a strategic alliance with The TriZetto Group, a Newport Beach, Calif.-based software vendor, “to meet increased consumer demands for cost efficiency, data transparency and value.”
Kryptiq’s main customer base is the healthcare provider market. The $4.8 million company provides middleware software to integrate and manage workflows and information, including messaging, electronic prescribing, disease management and contract management. Its primary competitors include IBM and TIBCO Software.
Machuca says today’s consumer is much more savvy about his or her healthcare choices, and wants to compare health plans and medical options before committing to a course of action. This is forcing health plans to become more transparent.
“The toothpaste is coming out of the tube,” he says, an analogy to the realization that consumers are taking control of their own personal health records and won’t be giving that power back any time soon. “We need to drive behaviors and respond to … concerns. The value proposition has to move from transactions to workflow.”
Machuca says Kryptiq “takes entities that have been operating with a rear-view mirror and gives them a forward view.” By his estimate, only 20 percent of the nation’s health plans have that forward view, while the rest are struggling to adapt to the times.
“Health plans are very quick to copy each other,” he adds.
“They’re very fast to be second, but they’re not very fast to be first.”
With the push toward transparency, Machuca says health plans have to focus on three directives: creating a “node of information power;” providing cost and quality transparency; and providing chronic disease and condition management.
In short, he says, they have to provide the customer with information, ranging from preventative medicine to directed information to improve lifestyles.
“They have to re-invent the way they manage their provider networks (and) embrace a collaborative approach to the value chain,” he says. “They have to learn to connect the dots.”
Within 10 years, Machuca predicts, healthcare consumers will have “an overwhelming amount of directed knowledge.” In that arena, health plans will transform into clearinghouses of therapeutic, interventional and informational data.