AHIP Institute: Startups share strategies for success

A presentation at the AHIP conference

LAS VEGAS--The shift to consumer-driven healthcare has paved the way for innovative, disruptive companies to flourish even in the notoriously tough-to-enter health insurance industry, executives said Thursday at the 2016 AHIP Institute.

Disruption, however, isn’t about putting other companies out of business, but about driving change for the better across the healthcare system, according to Vivek Garipalli, CEO and co-founder of Medicare Advantage insurer Clover Health. And that means putting members first.

“What excites us most at Clover is that we’re constantly discussing how to tie long-term profitability to improving our members’ lives,” he said.

For Clover, that means taking on the unique challenges of managing seniors’ care with the aid of cutting-edge technology. One of the company’s first tech projects, Garipalli said, was a cloud-based data warehouse to streamline the “messy” array of clinical information.

It also is improving its predictive analytics modeling with the goal of intervening with members before claims costs rise.

However, particularly in the highly regulated Medicare Advantage space, “we view too-rapid growth as a real enemy,” he noted. “It’s easy to make mistakes, and we’ve definitely made our fair share.”

Oscar Health, meanwhile, thrives in the individual market because it allows the insurer to engage directly with consumers, according to CEO Mario Schlosser.

Though well-known for its atypical and clever advertising, the now-four-year-old company has learned that while marketing and member outreach is vital to a startup’s success, “you also have to build the technology behind it,” Schlosser said.

Thus, Oscar has built systems to both facilitate and measure member engagement, he said. For example, the insurer faxes patients’ doctors when they visit the emergency department and then offers a financial award for them to reach out to the patient.

Indeed, “data technology can certainly fill a very, very important, and in the right hands, transformational role for that patient,” said Harken Health CEO and co-founder Tom Vanderheyden.

But the UnitedHealth subsidiary, which operates clinics and individual and small-group market health plans in Atlanta and Chicago, is more focused on building robust patient relationships with primary care physicians in an effort to improve outcomes and lower costs.

“Technology enables the building of relationships and the facilitating of communications, but does not replace it,” he added.

A strong focus on the individual also is the core philosophy behind a startup still in its infancy, Bright Health. As co-founder and CEO Kyle Rolfing sees it, the Affordable Care Act has changed the game by getting consumers involved in all aspects of healthcare.

So the company, which will offer plans in the Colorado exchange starting next January and delve into the Medicare Advantage market the following year, will build a model that’s “really all about the individual,” he said.

For Bright Health, that will mean starting with a deep, exclusive relationship with provider partner Centura Health--a partnership based on aligned incentives and a patient-focused approach that Rolfing thinks will be the key to its success.

“We’re at the precipice of a whole new definition of what a health plan can actually be,” he said.