Future Now
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Joan Kennedy: President Health Management Corporation
Joan Kennedy: President Health Management Corporation
Senior Vice President, WellPoint, Inc.
1. Joan’s Work
Dual roles Comprehensive Health solutions – drive strategic and clinical direction of WellPoint, 360 degree health, Comprehensive health solutions has over 30 products
AIM – American Imaging Management – automated radiology oversight, to make the administration of care more effective. Subsidiary of WellPoint. Use the different parts of WellPoint to drive value, partnerships, federal government, how do we bring the value of these companies to drive more effectiveness.
President of HMC
Joan Kennedy is senior vice president of Comprehensive Health Services (CHS) for WellPoint, with oversight of Health Management Corporation (HMC), and American Imaging Management, Inc. (AIM), focusing on advancing positive health outcomes for WellPoint members and external clients through an integrated sales, marketing and clinical product design. Additionally, Joan oversees PBM marketing and product functions for WellPoint NextRx, WellPoint’s Pharmacy Benefit Manager (PBM).
Macro – Over the next decade, where we believe the future is moving - time to look at a second revolution in health care:
• Great assets (doctors, programs, leading technologies, pharmaceutical support) rich resources.
• Challenged in the financing models and structural ways we are organized, lack of using technology to integrate, not where we would like to be.
• In order to do a better job, need to think about a next revolution in health care. How do we not hinder the good pieces but make it more accessible and functioning for the larger population as a whole.
• Larger structural changes need to be made. Impact all of the work streams (e.g. care stream, health IT stream).
• Structural re-engineering, economic burden of our health care system is not sustainable in order to become competitive and viable for the economy as a whole.
Three main areas that we have been focusing on
- how do we promote health and wellness, move to promote health and prevention, focus huge amount of resources and effort directed towards chronic illness and reacting to health problems, now we know through much research that unhealthy lifestyles lead to chronic illness, want to focus on prevention, promoting aspects of health and wellness, keeping people healthy vs. focusing on illness and treatment
- accessibility – need to have access for all Americans. Vicious cycle – people don’t have health care and the economy is exacerbating this problem. Supporting basic health care for our children sets them up for healthy habits later in life. Working with state and federal government – insure city, states, federal employees actively part of their coverage program, Medicaid services, state driven, etc. Need to stop the vicious cycle to create stability.
- How do we bring about consistent evidence-based care services? Lots of services that are unnecessary, drive medical errors, waste, litigation. Using good clinical evidence, becoming more transparent, using technology to drive higher standards of care. Try to drive to the optimal clinical guidelines. Treatment plans and guidelines, adherence to best practices.
TRENDS/CHALLENGES
2. How optimistic about future of health/healthcare in 2020?
Health care will be a vibrant and dominant industry. The demographics of aging baby boomers and the need for health care services exists. We have an optimistic future. But it needs to be re-organized and re-structured to create an evolution to take away the bad parts of the system. Optimistic but have some heavy lifting yet to do.
Private public partnership:
- how do you get universal coverage
- figure out universal risk management
- how to merge with an employer-based system
- how to finance it
- drive technology to take out some of the human cost and waste that exists
- change gears about promoting health
- empowering people to make good decisions, push some responsibility onto consumers to manage health account, people understand the insurance plans they have for their car, understand their finances, this needs to carry over to health care
- need to align decision making with consequences about responsibility for lifestyle choices. Big shift. Health care industry, doctors and nurses help get members to be more comfortable with taking more personal responsibility and participating in the decision making process. Understand what will motivate the individual to change behavior. Consumer model vs. health care model.
3-4. Biggest trends or challenges & responses to overall health care
1. Promotion of health in a consumer–driven model
2. Financing piece – need to face this and figure out how to make it happen. Need to make health care affordable without taking the quality out, critical to keep the good things alive, the vibrancy of industry, financing adjustments, universal access.
3. Technology, services – Google and Sun have mass automated processes, bring this type of thinking into health care to achieve productivity gains, minimize variance, reduce errors, enhance transparency.
Trends in Wellness
1. Incorporate technology solutions into philosophy for how and where we live, bring wellness to daily lives in a more technology oriented fashion: entire culture around technology (e.g. social networks) and can enable the technology for health care applications to drive wellness. Lifestyle adjustments, create consumer driven models and meet people where they are, less cumbersome vs. clinical. Take our medical knowledge and meet people where they are in life.
2. Health care industry and workplace productivity – where they overlap: Employer-based care: 26% of cost is around straight health care costs, the other 74% is around - productivity, absenteeism, etc. Through research – member health indexes, gallup survey work – these 2 issues of health and productivity are critically intertwined and keeping them separated is not the way people think. One driving factor of chronic disease has to do with the employee’s relationship with their boss. Does health drive productivity? Does productivity drive health? Need to reassess and create productive work environments, how to align these powerful tools together and now they are in isolation.
• Allow members to lead the Wellness movement, it is not a prescriptive/diagnostic/treatment model. Personal sustainability – project at HMC and spent time with Wall Mart – empowers associates about going green movement, half of them selected health care goals as part of this going green movement. Don’t see a break between environment and health. Environment – community and health go together, use resources to allow like people to support each other and let them drive the movement. Achieve greater results with members driving the movement. Community based examples become important.
Organizations driving trends:
- Health Plans, Health and Wellness Companies
- will be seeing more government influence, Obama’s Administration – massive push towards health and wellness, health IT
- a lot of opportunity for non-health care companies to improve the infrastructure: Intel, Microsoft, Google, to help push consumer-based strategy
- Banking and health care, health and wealth management. Health Spending Accounts, healthy behaviors, financial planning for the future as it relates to health. Contingency planning, financial planners and health planners, risk mitigation, have not done a good job at personal accountability, as people pay for larger amounts of their health care, there will be more of a need for wealth and health management to overlap. Promotion of healthy behaviors in order to preserve wealth. Universal plan about how to live your life more effectively. Empower people to understand the cost of their health care, risk mitigation. As people become more accountable and have to pay for more of their health care burden, then need to bring the two together in overall planning.
Tipping point? Perfect storm – financial health, world wide economy, global heightened state of affairs.
Although capitalism is supposed to increase happiness and reduce suffering, the US population has become fairly hedonist and all-consuming and we are just beginning to feel the ramifications which is leading the culture to experience a massive shock. A universal culture must be created that allows us to lead happier, healthier lives, and we must begin to take accountability for our health care dollars which may lead to the mitigation of health trends. One example of this shift in culture is that due to the current economic environment, consumption has been drastically reduced which has impacted the waste management problem – there has been much less waste recently due to the precipitous drop in consumption. Trimming back on consumption can have such a huge impact on the environment.
5. Have these trends surfaced before?
When managed care companies came about in the 70s, 80s, 90s, to deal with spiraling health care costs, the HMO concept was a new revolution, we have seen it before from a trend perspective. With the technology and mature industries that we have can help with a second generation or revolution, next evolution of structure, improve the techniques to create a better system this time around.
How quickly will this trend move?
Because of the acute nature of the economy across the world, the spiraling access issue with the cost of health care where we are at today – it will be dealt with quicker
- loss of coverage
- companies don’t have the money to pay the double digit increases
- the cycle to change things is compressed because of the economy
6. Challenges/responses not on radar now?
Going to be a lot of cross industry solutions in health care. Instead of traditional health plans and physician structures – see the influx of other industries helping: consumer model Colgate Palmolive, Wall Mart, Google – technology options
PCPs and gerontologists are out of business, not enough coming out of school, we have a deficiency of PCPs at a time when the baby boomers need care. How we create an augmentation strategy about serving the needs of primary care and geriatrics. This will be a great industry.
FUTURE SCENARIOS
7. Most preferable scenario
Macro-level: Private Public Partnership, a lot of good stuff comes out of private competition ingenuity, nice balance public/private
Health IT – technology support, overhall the infrastructure, how we transmit data, should have access to records, should be like the bank system where you can withdraw money anywhere, too much money in record management and over-testing, really getting to a promotion of health and accountability, consumer driven and empowerment model.
Signs: Obama Administration, watching how other industries are coming into health care, how the answers to those solutions come about. Looking at how the communities are coming together, people’s participation in health, looking at Macro health trends. Will eventually see leading indicators of wellness and prevention as people begin to right size their lives.
8. Most plausible scenario
Macro-level: combination of private-public partnership, not a straight private/employer driven model. Medicare driven due to baby-boomers aging. Public/private partnerships will lead great innovation and ideas in concert with large risk pools. Use knowledge of other industries, capabilities of dealing with the challenges we have automation, technology, financing to help drive this
9. Most negative scenario
Fully Federal structure would be negative, it does not seem to work to legislate health care – use Belgium as an example mandate full coverage for paid time off for sick leave – the average sick leave isf 35 days, what they are doing is demotivating the workforce through a mandate – unintended consequences can result from legislation.
Need a combination of accountability with consumer and public support coming together for a system
Averting this negative scenario – active integration of parties coming together to try to solve the solution. Resource wise, the various entities are needed to solve the problem, Administration is bringing different entities, coming up with models to support change, lots of good efforts, like Tom Daschle’s idea – the Feds of health care, macro knowledge about treatment standards, allows the private infrastructure to execute treatments more effectively. Many good ideas are being generated, now need to execute effectively.
10. Wrap-up
Books/Articles: reading a lot more lately, understand the productivity aspect, environment, job, health, financing, understanding how they impact each other. Gallop surveys around this is important, health and human capital research is important, understanding how the economy is going to impact this and where the Federal reform is going is important to understand. Financial infrastructure will be important to understand, being broad in reading and research is how Joan is thinking about in terms of trends.
People to speak with:
Wendy Lynch – Health and Human Capital Foundation
A couple of Federal Lobbying Bodies – promoting wellness in the federal reform area, driving wellness reform, tapping into the CEOs of wellness