A Future of Empowered Consumers with Ann Mond Johnson and Health 2.0 EDU

AnnMondJOhnsonOn Sunday September 29, Health 2.0 EDU Live is kicking off the Seventh Annual Fall Conference with a workshop event addressing topics ranging from app design to health care reform to big data analytics. Joining us is Chairman of the Board of Managers at ConnectedHealth, Ann Mond Johnson. Her extensive experience working in health care and business strategy has made her an expert in understanding and analyzing how individuals interact with the U.S. health care system. At Health 2.0 EDU Live Ann will be addressing the role and responsibilities of the consumer pre and post Affordable Care Act. Register Here.

EDU: Tell us about the experience your friend Jane had when filling a prescription and how that brought you to work with Health 2.0 EDU.

AMJ: The story is about my pal Jane, who started a new plan year this summer. Her previous plan was an HSA-qualified HDHP, and she did the math and decided to choose the same plan this year, although the providers and network were different due to a change in carriers.

Jane’s husband first went to see his ophthalmologist for a routine eye exam. The doctor spent a cursory amount of time with him, mentioned that one of his eyelids was drooping and discussed the benefits of Lasik surgery (without Jane’s husband asking). When Jane received the EOB, turns out the ophthalmologist’s office coded his visit as a diagnostic rather than a preventive visit, resulting both in a higher reimbursement to the office and a higher bill for Jane, because a preventive visit would have been covered under her plan.

A few days later, Jane’s husband went to CostCo pharmacy to fill his prescription. Jane was horrified to learn that the prescription had cost $180 (cash, out of pocket). It turns out that CostCo is no longer a pharmacy provider in Jane’s plan, though no mention of this was made to Jane’s husband when he filled his prescription.

Frustrated, Jane called her carrier about both experiences and the response was that she would have to deal with both the doctor’s office and the pharmacy on her own. Jane called the doctor’s office, asked to have the visit recoded as a preventive visit – because it was – and the office refused. Not until Jane spoke with the office manager and threatened to go public with what she considered dishonest practice did the office manager concede and agree to resubmit the code to the carrier.

Jane then called CostCo, explained what happened and asked the customer service representative why her husband wasn’t told that CostCo was no longer in the plan. The response? A full apology. “This is our fault. Please bring back the medication and we will reimburse you 100 percent. And please accept our apologies for this.”

Customer service, right? It is an attitude and an approach to treating patients like the customers they are, with the service they deserve. The carrier could have done a better job of communicating to Jane as a new enrollee what she would need to know about the providers and network in her new plan. We call that onboarding. And the take-away experience for Jane? She will absolutely remain a CostCo shopper – the unequivocal way they handled her complaint built loyalty. But what about the provider? Increasingly Americans are holding health-care providers to the same service standards as retailers. Jane is watching her dollars and maximizing her benefits and is using the same savvy in health care as she does everywhere else in her life. I think a lot of people can relate to her situation. Health 2.0 is committed to bringing a new experience in health care to consumers, and I am 100% for that.

 EDU: What social impacts do you foresee as millions of United States citizens enter the health care “marketplace”?

AMJ: We’ll see some people who are reasonably comfortable navigating and advocating for themselves, their family and friends. Another social impact will be many traditional clinical services that will migrate to new platforms (think mobile) and less expensive venues (a la Minute Clinics) to make it more convenient for consumers. So health care services will increasingly be where you want them and when you need them. Another social impact will be that some of our fellow citizens will be less comfortable navigating the system. We have an obligation to help those people, as there may be underlying socioeconomic reasons why their ability to succeed in the system is difficult. Finally, we may see more evidence of a two-tiered health care system, which is an unintended consequence.

EDU: Do you expect to see resistance from individuals to fulfill their new consumer role? Or do you expect to see excitement and engagement?

AMJ: We’ll likely see a range of reactions from individuals (excitement, engagement, resistance, and frustration), depending on where they are in assuming their new responsibilities. Health care is inherently difficult to understand, and until we make it more consumer-centric, we’ll continue to have challenges. We also expect that there will be generational differences. For example, my millennial children have different expectations and needs then I do. Consequently, their reactions will be likely be different from mine for many situations.

EDU: How do you feel companies can be most successful in integrating consumerism into their business model? Do you feel the consumer focused business model will be the only way to be a successful health care company post Oct. 1? 

AMJ: There are many business models. At ConnectedHealth, for example, we’re working with carriers, employers, and aggregators of employers to reach consumers. Employers, for instance, still have an interest in providing health insurance and related services to their employees, and are an effective channel for reaching consumers, even if it is for individual (and not group) products. Ultimately, every business will need to be more consumer-centric in their approach.

EDU: What are you most looking forward to about lecturing at the Health 2.0 EDU Live workshop in Santa Clara on the 29th?

AMJ: I always learn and see something new at Health 2.0 conferences. In particular, I’m looking forward to hearing what Carol McCall has to say on September 29. Health 2.0 has been extremely successful at attracting some of the hottest companies and interesting minds in the industry, so it will be exciting to be exposed to this energy and creativity.

 

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