Health Insurance and the Internet:
Current and Future
Clif Gaus, Sc.D.
The Gaus Group
February 1, 2001
Agenda
● Overview of e-Health Insurance
● E-Health Insurance Sales/Marketing
● B2B Administrative Transactions
● B2B2C Care Management
● Consumer/Patient Health Information
● Conclusions/Predictions
Agenda
● Overview of e-Health Insurance
Overview of e-Health Insurance
The Booming E-Economy
Overview of e-Health Insurance
Oh Boy… How Things Have Changed
Will
Deliver
Food.
com
Overview of e-Health Insurance
Trend in products
● Movement of HMO to PPO products
● Premium/cost sharing upward trend
● Movement toward defined contribution
● Increase of empowerment of consumers
Overview of e-Health Insurance
Growth of U.S. E-Commerce Spending
4000
200
180
3500
160
3000
140
2500
120
100
Total US on-line
B2C revenue
(billions)
2000
80
1500
60
1000
40
Average on-line
spending per
on-line shopping
household
500
20
0
0
2000
2001
2002
2003
2004
Forrester Research, September 1999
Overview of e-Health Insurance
Growth of Internet in Health Care
●
97 million total U.S. adults on the Web1
●
70 million U.S. adults seek health info on the Web1
●
~ 15,000 to 20,000 health care related websites2
●
2/3 of physicians indicate that patients use Web
info to question treatment2
Overview of e-Health Insurance
Key E-Functions in Health Insurance
CONSUMER INFORMATION
(content)
•Disease information
•Prevention/lifestyle
•Provider finders
•Chat rooms
•Guidelines/decision tools
ADMINISTRATIVE
TRANSACTIONS
(connectivity)
•Eligibility
•Claims
•Referrals
CARE MANAGEMENT
(clinical)
•Disease management
•Case management
•Population assessment
MARKETING/SELLING
(commerce)
•Plan design
•Competing products/prices
•Enrollment
•Employer/benefits
administration
Overview of e-Health Insurance
Key Stakeholders and Types of Transactions
•Sales/Enrollment
•Claims
•Consumer Info
PLANS
•Eligibility
•Sales
•Enrollment
PATIENT
(consumer)
•Claims
•Clinical
•Eligibility
PURCHASER
(employer)
•Clinical
•Consumer Info
PROVIDER
Agenda
● Overview of e-Health Insurance
● E-Health Insurance Sales/Marketing
E-Health Insurance Sales/Marketing
Web’s Influence
● $11 billion+ insurance sales will be Web-
influenced by 20033
● 37% of All On-line Adults would sign-up or
purchase health insurance on the Web4
● Almost 3 million adults connect to
providers and payers online in 19995
E-Health Insurance Sales/Marketing
Types of Companies
● B & M Health Insurance Companies
● e-Large Group Benefit Administrators
● e-SG & Individual Insurance Companies
● New Paradigm Companies
E-Health Insurance Sales/Marketing
B & M Health Insurance Companies
●
●
●
●
●
●
●
●
●
Aetna
Cigna
United
Kaiser Permanente
Humana
WellPoint
Pacificare
HealthNet {formerly FHS}
Anthem
www.aetnaushc.com
www.cigna.com
www.unc.com
www.kp.org
www.humana.com
www.wellpoint.com
www.pacificare.com
www.health.net
www.anthem-inc.com
E-Health Insurance Sales/Marketing
e-Large Group Benefit Administrators
● eBenx.com
● Sageo.com
● eBenefits.com
● iBenefits.com
● employeelife.com
● employease.com
● benefitmall.com
E-Health Insurance Sales/Marketing
e-SG & Individual Insurance Companies
● eHealthInsurance.com
● quotesmith.com
● eBix.com
● Insweb.com
● healthextras.com
E-Health Insurance Sales/Marketing
New Paradigm Companies
● Vivius.com
● HealthMarket.com
E-Health Insurance Sales/Marketing
Barriers to Growth
●
Dominance of “no-choice” employer insurance
●
State and federal insurance laws
●
Personalized nature of health products
●
Complexity of products
●
Adverse risk
E-Health Insurance Sales/Marketing
Opportunities
●
Growth of defined contribution
●
Co-branding/marketing
●
More competition
●
Consumer convenience
●
Lower administrative costs
Agenda
● Overview of e-Health Insurance
● E-Health Insurance Sales/Marketing
● B2B Administrative Transactions
B2B Administrative Transactions
Electronic Submissions in 1999…
●
HMO claims
18%
●
Medical claims
64.5%
●
Of all hospital claims
84%
●
Pharmacy claims
89%
4.6 billion medical claims processed by private & public health insurance plans
Source: Jeff Goldsmith, “The Internet and Managed Care: A New Wave of Innovation: Internet Tools Promise to Restructure
Health Insurance,” Health Affairs - Volume 19, Number 6, November/December 2000.
B2B Administrative Transactions
Key Players
• WebMD.com
• MedUnite
●
Smaller and Upcoming
• Proxymed
• Claimsnet
• NDC
• AllScripts
• TriZetto
• CareData
• Drugstore.com
• Pocketscript Inc.
B2B Administrative Transactions
Barriers
●
Physicians aversion to information technology
●
Fragmented market of practice mgmt systems
●
Conversion of legacy to web-enabled systems
●
Mis-alignment of economic incentives
B2B Administrative Transactions
Opportunities
● Paper to Web claims
● Provider eligibility/benefit queries
● Electronic RX - provider to plan to pharmacy
● E-referrals/authorizations/pre-
certifications
Agenda
● Overview of e-Health Insurance
● E-Health Insurance Sales/Marketing
● B2B Administrative Transactions
● B2B2C Care Management
B2B2C Care Management
Key B2B2C Functionalities
●
●
●
●
●
●
●
●
Disease management
Case management
Utilization management
Data mining/risk assessment
Decision support systems
Remote monitoring
Self-care
Quality monitoring
B2B2C Care Management
Key Players
● Lifemasters
● HealthHero
● GlobalMedic
● Confer
● LifeMetrics.com
● Phycom.com
B2B2C Care Management
Barriers
● Privacy/security
● Managed care backlash
● Legacy systems
● Medical language standards
● Lack of EMRs
● Cultural
B2B2C Care Management
Opportunities
● Lower administrative costs
● Error reduction
● Improved patient compliance
● Greater patient convenience
Agenda
● Overview of e-Health Insurance
● E-Health Insurance Sales/Marketing
● B2B Administrative Transactions
● B2B2C Care Management
● Consumer/Patient Health Information
Consumer/Patient Health Information
Consumer Health Web Sites by Unique Users
1. WebMD.com
2. nih.gov
3. drkoop.com
4. healthandage.com
5. allhealth.com
6. healthscout.com
7. mayohealth.com
8. intelihealth.com
9. medscape.com
10. merckmedco.com
Source: PC Data Online, December 2000
9,393,000
1,710,000
1,262,000
1,258,000
1,193,000
1,148,000
963,000
832,000
795,000
715,000
Consumer/Patient Health Information
Key Facts
●
By 2005, 88.5 million adults will use the internet to find
health info6
●
2/3 of physicians report that patients use internet info to
question treatment
●
21 million American adults cite that Web health info has
an influence7
●
40% of subscriber activity on portals is associated with
medical content7
Consumer/Patient Health Information
Barriers
●
Privacy
●
Security
●
Quality of data
●
Lack of revenue sources
●
Liability
Consumer/Patient Health Information
Opportunities
● Empower consumer
● Improved outcomes from self-care
● Customer loyalty
● Consumer convenience
● Improved decision-making with more info
● Improved quality/fewer errors
Agenda
● Overview of e-Health Insurance
● E-Health Insurance Sales/Marketing
● B2B Administrative Transactions
● B2B2C Care Management
● Consumer/Patient Health Information
● Conclusion/Predictions
Conclusion/ Predictions
●
●
●
●
●
●
●
E-Health insurance here to stay and grow
Connecting the 4 P’s will have profound $ impact
Wireless appliances/applications growth
New paradigms will challenge B&M
New apps will dramatically lower errors
Consumer empowerment will continue to grow
Increased government role in privacy/security;
sales/marketing; and transaction standards