By: Holly Fletcher
Clear Health Analytics designs its tools to help people navigate choosing health insurance by writing to a fourth grade level.
The company uses “12 monthly payments” instead of “premium” because of early feedback from an advisor that insurance lingo didn’t register with insurance users.
It would design tools without words at all if it could, said Jennifer Sclar, CEO of the Clear Health Analytics out of Stamford, Conn., that’s getting funding from Jumpstart Foundry. The start-up builds tools to help people shopping on the insurance exchange as well as for employees choosing between job-based plans.
“If we could figure out a way to do that, we would do that because with decision support tools you’re dealing with two kinds of literacy — both the ability to read and comprehend as well as numeracy literacy,” said Sclar.
Translating healthcare jargon
It’s a fool’s errand, she said, to try to teach people the difference between copay and coinsurance. They’re not going to remember it — and Sclar doesn’t think people should have to understand the complex jargon to understand how to effectively use the plan.
There’s a growing but small subset of companies geared toward translating and opening up the health care system to people who come from all walks of life and income and education.
The proliferation of high deducible health plans, or consumer directed health plans, combined with the necessity of capping the rise of health care spending means the industry will have to change how it thinks about its processes, overhead and interactions with people.
“Everyone likes to talk about the ‘consumerization of health care’ but without offering people good information you can’t really ask them to be a partner,” said Sclar. “I think it’s integral to the ability of consumers and employees to participate and be engaged that they must have — they must have — access to really quality information about what they are buying and how much it’s going to cost them.”
People need care but health care providers haven’t gotten much better at showcasing value
Health care is an unusual industry because people don’t (often) wake-up and decide they need to be a patient.
Disease and injury can creep or spring up due to lifestyle, an accident or genetics.
People enter the system when they need care, and they find an expensive, complex system that seemingly requires training just to navigate a local system.
For many people transitioning from a copay insurance plan to a high deducible plan is a challenge because the necessary information to inform decisions is not readily available.
Healthcare Bluebook is piloting a search in Middle Tennessee that allows people to compare and shop for health care services.
People have been shielded from price for so long that “you tend to think all care costs $25,” said Bill Kampine, co-founder of Healthcare Bluebook.
“That can be a shock,” said Kampine.
In some ways, the companies’ digital platforms — or decision support tools — are a bridge connecting people to the existing payment and service system, which is waiting to morph into its next phase.
The companies are carving out a niche by throwing back the veil on small pockets of health care, and educating people about how to be smart shoppers when information is available.
The existing model is, slowly, being flipped on its head. As more costs shift to consumers, providers are left to convince patients — not insurance companies — their services are worth the money.
Issues arise when companies are trying to solve the problems of a consumer, and have to explain value. For years value had to be explained to the insurance company — not the person receiving the service.
“That’s what going to have to happen in health care,” said Larry Van Horn, executive director of health affairs at Vanderbilt University’s Owen Graduate School of Management. “It’s going to be incumbent on providers. The onus is on the provider, not the consumer.”
‘None of this will move quickly’
The catalyst for broader changes to the way people make decisions to buy services or products is likely to come from companies outside of health care that have experience filling gaps in people’s lives that they didn’t know existed.
Google, Apple and, increasingly Amazon, are taking on health care projects, said Phil Gibbs, principle of the Disruption Lab. Each is more attuned to the desires and expectations of shoppers, in part because they created the platforms that people have come to see as benchmarks.
The Disruption Lab, created to help companies evolve rather than go extinct, is taking a group of Nashvillians to New York and Barcelona — the Silicon Valley of Europe — this fall to talk to companies that are re-shaping a variety of industries.
“It’s going to happen in health care delivery here in Nashville,” said Gibbs.
But for people who are balancing every day costs of living with increasing share of their responsibility for health care payment, getting access to the information they need — in a format they understand — is rare and often relegated to pockets of the industry.
“This will be a much slower evolution than what I would like to see as an economist. None of this will move quickly, in part, because we have such strong vested interest in the ways things are,” said Van Horn.