How Health Care is Delivered is Seeing Innovation, Too

In a previous blog we covered a few examples of how health care innovation is hurtling forward as evidenced by investments and operational commitments by health care companies, despite the current policy uncertainty in Washington, D.C. While the news may be filled with Obamacare headlines, Charles Gaba at acasignups.net reminds us, only about 3% of people in the U.S. are on ACA Exchange policies.

Outside of those Exchange offerings, health plans and provider groups across the U.S. are coming up with new ways to deliver health care to patients, and to manage costs and disease more effectively. At the root of the innovation is data.

This summer, Sutter Health, a health care system in northern California, and Aetna, one of the largest health insurers in the U.S., announced a joint venture to create a new jointly owned health plan. The new health plan will offer products to commercial self-insured customers by the middle of 2018 and fully insured PPO products in 2019. While the offerings may not seem that innovative, the approach is. A co-owned joint venture allows Sutter and Aetna to share data more effectively in the hopes of using analytics and predictive modeling to identify at-risk patients sooner. Deeper data integration could also enable population health approaches that will help patients with chronic conditions better manage their health and health care.

Also innovating outside of the ACA Exchanges are large insurer Cigna and pharmacy provider, CVS Health. A new collaboration called Cigna Health Works is now being offered to Cigna’s self-funded employer-sponsored health plans. The new offering allows these Cigna members to receive certain preventive and acute care services at CVS MinuteClinics, the pharmacy chain’s retail health clinics, at a discounted price. Additionally, customers can receive free wellness coaching and discounted over-the-counter medications.

“Cigna data show that roughly 45 percent of their customers’ Urgent Care facility visits could have been conducted at retail health care clinics, potentially reducing their health care costs by 81 percent per visit.”

Additonally, Cigna is aiming to assist those patients who do not use primary care physicians. Cigna Health Works helps patients access preventive services, for example, diabetes screening, at a low cost and convenient time at CVS MinuteClinics. Michele Paige, Vice President and General Manager of Cigna Onsite Health explains, “This new model is based on how the customer wants to consume health care — it’s about creating value and a new way for health care consumers to get more from their health plan, by ensuring that we are there for them at the places they prefer to go for convenient care.”

Early this year we published a book chapter titled, “Essential Characteristics of Service Business Model Innovation in Healthcare: A Case-Study Approach”. These examples of new health care service business models are precisely the effect we were noting. “Now, and increasingly in the future, a healthcare organization must be concerned about the quality of care a patient receives from other providers in accountable care organizations or other parts of the integrated network. Innovation that leads to improved performance requires focusing on the role of cooperation and trust in changing both processes and resources required to deliver value to customers.”

These new collaborative efforts are focused on delivering value to customers and to patients – even if it means cooperating in different ways. Sharing data, using predictive modeling, harnessing sophisticated analytics are the foundational elements of changing the way health care is delivered in the U.S. Companies are surging ahead with innovations and creative problem-solving that will help patients and payers alike, despite on-going debates about the future of health care in DC.