HEALTH MARKET 2.0: REINVENTING A $3T INDUSTRY, ONE CONSUMER AT A TIME APRIL 28, 2015
Sam Glick sam.glick@oliverwyman.com
HEALTH & LIFE SCIENCES © Oliver Wyman
The world is changing
By 2018, 1
in 3 Americans will be buying a
different insurance product than they do today, through a channel that didn’t
exist three
years ago, receiving 30% of their care outside of a traditional health system.
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Individuals are shouldering more of the cost burden
$1,500
$1,250
Legal definition of high deductible Deductible
$1,217
$1,050 $1,000
Average plan deductible
$584 $500 2006
2007
2008
2009
2010
2011
2012
2013
2014
Year Š Oliver Wyman
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Consumers are confused…
Health Insurance Care Delivery Health & Lifestyle
Doctor’s hours don’t match real life hours
I have no idea how my insurance works – it’s so confusing
I have so much stress from work
I'm often surprised by high costs on things I expect to be covered
I had no idea how stressful taking care of my father would be
My doctor controls my referrals, and I don’t know who provides the best care My marriage is in trouble, how am I supposed to worry about my health?
I can't afford a plan that meets my needs
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I feel rushed during doctor visits
I have trouble finding time for healthy activities
I have trouble remembering to take my medication
I don't know which coverage is best for my family
I have trouble getting to the doctor
I don’t feel as safe in my home anymore – I wish I still knew all my neighbors!
I just want this claim to be paid!
It’s difficult to get an appointment with the specialist I need to see
I can't pay my premium / bill electronically
I have trouble getting motivated to exercise 3
…and don’t know how to make smart choices
Volume of procedures (in thousands)
Hip & Knee Replacements 60
Median price 50
40
$45,455
Minimum price
$5,304
Maximum price
$223,373
30
20
10
0 0-5 5-10 10- 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80- 85- 90- 95- 100- 105- 110- 115- 120- 125- 130- 135- 140- 145-150+ 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100 105 110 115 120 125 130 135 140 145 150
Price (in thousands of dollars)
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They don’t trust their health plans… 2014 Forrester Customer Experience Index Very Poor
Poor
OK Good
Excellent
Retailers Hotels Parcel shipping/delivery providers Industry average
Consumer electronics manufacturers
Individual company score
Banks Insurance providers Investment firms Airlines Credit card providers Wireless service providers Rental cars TV service providers Internet service providers Health insurance providers 0% © Oliver Wyman
20%
40%
60%
80%
100% 5
‌and everyone is gunning for them Traditional Healthcare Players
Traditional Consumer Players
Providers
Retailers
Total consumer healthcare wallet Technology & Consumer Goods
Health Plans
New entrants Š Oliver Wyman
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Employers continue to spend (do you want to?) Self-Insured Employers, Non-Claims Healthcare Spending 160
$150B
140 120 100 $B
$90B
80 60 40 20 0 2013
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2018 7
Other complex markets have simplified
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The new transparent market
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The new front door to health
Virtual Care
Retail Clinics
Mobile apps
Wellness Programs
Providers
Smart Care Team
H
Direct Payment
Telehealth
Health Coach
ATM
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Personalized and preventative health
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What if American Express went into healthcare? Industry-leading customer service – by phone, web, twitter, email
Cards and rewards designed for your lifestyle/ motivational profile
Easy health account management and mobile bill pay
Dispute resolution for merchant billing questions / issues
Book procedures and pay in advance – transparency in pricing
@AskAmex
Real-time mobile offers, on the go, linked to your HSA & rewards
Question or concern about this charge? Send a note to the dispute resolution team:
$5,700 9/15
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Knee Replacement Memorial Hospital
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Who will emerge? Who will win? … At stake: $1T+ in value
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