Opinion

To Enhance Health Care, Companies Need Insurers

Fed up with the American health system, the titans of U.S. innovation and finance are taking matters into their own hands. Amazon.com Inc., JPMorgan Chase & Co. and Berkshire Hathaway Inc. have announced plans to form a new venture to “address health care for their U.S. employees.” And now we’ve learned that Apple Inc. is creating a network of health clinics for its domestic workforce.

It’s easy to get excited about these developments. If any industry ever needed disruption, it’s this one. The U.S. spends about $10,000 per citizen on health care, but by certain measures, we’re getting worse results.

If anybody can fix that, we’d expect it to be companies like Amazon and Apple, which have sterling track records for reinventing commerce in the consumer’s favor. Apple’s experience blowing up the music industry – which, like health care, operates in a thicket of legal and recordkeeping challenges – could prove particularly valuable.

It appears the folks in technology and finance are focused on the right things: designing workflows and processes that help employees get the information they need to stay healthy. That largely means helping them make good decisions, like exercising and taking their medication.

But if companies want to truly revolutionize health care, I hope it doesn’t stop with the communications between clinicians and patients. While I’m sure these companies have the prowess and financial muscle to build an efficient, effective model for providing health care, that’s only half the battle. Any comprehensive health model has to not only help its consumers understand the best actions for managing their health, but also what those actions will cost. In other words, to create a complete health communication system, the company has to involve insurers.

While many basic wellness choices – going for a walk every morning or giving up red meat – are free, a lot of important health decisions are very expensive. Things like medicine, procedures and on-premises treatments can be critical for managing chronic conditions and other problems that can afflict even the healthiest humans.

One of the greatest failings of our existing health system is that too many people who need those things don’t get them. Often, that’s because they can’t or don’t know how to pay for them. One study shows that a shocking one in four cancer patients skip medication because they can’t afford it. The price of many cancer drugs is so exorbitant that even well-paid employees would struggle to pay for them – especially if they’re also juggling a Silicon Valley mortgage – unless they understand exactly how they’re covered and what assistance programs might be available.

That information resides with their health insurance company. Any effective, modern health care interface would pull it into the primary stream of information flowing to employees. The reality is, making healthy choices impacts financial well-being as much as physical well-being.

Insurers also possess, in their claims data, a wealth of information about their members’ health – information that a clinician may not have. Any wellness program designed around data would be half-baked if it didn’t incorporate insurance-claims data.

Lastly, if these companies don’t address costs, whatever they build will only get halfway there.

 

Mark Nathan is founder and CEO of Zipari.

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