Insights from Large Group Experts
Rob Carnaroli, Sutter Health Plus Vice President of Sales, was recently interviewed for an article published in the December 2019 issue of California Broker. The following are his responses.
What are the most important trends affecting large groups in California? For example, do you believe the Association Health Plans (AHP) rule will have an impact on the large group market, particularly in California?
California still enjoys some of the lowest average premiums in the country; however, with premium levels continuing to rise, consumer expectations for quality, value and convenience are trending high. The pressure is on carriers to deliver a greater value for the healthcare dollar, which is why we are seeing a shift to value-based care models. HMOs have never been more popular and the plans offering a seamless, integrated delivery platform are well-positioned.
Healthcare organizations are also ramping up investments in technology to enhance the member experience. Partnerships with innovative start-ups have the potential to completely flip the way healthcare is delivered in the near future. Additionally, we know there are many reasons why healthcare and Rx costs keep going up. A reliance on big data is gaining momentum for carriers to more effectively manage high-cost enrollees. Health plans have been slow to tap into data analytics, and I think it’s a smart way for carriers to strategically manage their resources.
Specifically, regarding the question about AHPs, currently California law does not allow large group plans to be sold to individuals or small employers through an AHP, so I don’t see AHPs making an impact on the large group market anytime soon in California.
We’ve heard from some producers that they are directly linking some groups to healthcare providers, in effect focusing on bringing healthcare to consumers rather than bringing health insurance to consumers (their words). Is this on your radar and what do you think about it?
In California, we have seen some employers experimenting with direct partnerships with health systems. Although I am not sure the benefits outweigh the massive effort it takes to implement this model of care, the concept again centers around the practice of value-based healthcare, and keeping the insurance company out of the equation. This type of partnership may allow an employer to gain more control of how their healthcare spend is allocated.
The industry is embracing integrated care. The inclusive process of sharing data and making healthcare decisions directly with healthcare providers is part of what these large employers are working to accomplish.
What are the most effective ways to sell to large groups in California right now?
As we head into the open enrollment season, it’s important for brokers to take a step back and examine the current marketplace with their clients in mind. Northern California, the center of technology and innovation, is changing the game in terms of how consumers shop for and view healthcare. The conversation with large employers is around the transformation of the traditional access model in bold new ways.
The demand for innovation is here and modern entry points are emerging—like neighborhood retail clinics, walk-in care locations and same-day pharmacy delivery. Video visits and virtual-first primary care, specifically with in-network physicians, are no longer just for early adopters. The next wave of consumer interest in virtual care is connectedness to a consumer’s own medical system and not a third-party panel of physicians. This allows for better coordination through shared electronic health records—from virtual visits to follow-up care.
Finally, using artificial intelligence through virtual assistants is becoming prevalent as well. Triaging symptoms ahead of a physician’s visit may help the office visit be more productive, and it reflects today’s trend in performing online research as a first step in getting answers.
California employers are embracing innovation, and a distribution channel that understands and can articulate the changing landscape can demonstrate real value to their clients.
You can read the full article here.
Vice President of Sales, Sutter Health Plus | LinkedIn