Unlocking the Value of Healthcare Data

Q&A with Wally Gomaa, CEO, ACAP Health
By Katie King Posted on May 31, 2019
You recently unveiled SimplePay Health—a health plan that aims to streamline the customer experience—and you’ve described it as akin to the Amazon experience. How does the “Amazon experience” translate to healthcare?
We have combined this powerful dataset with a simplified insurance design and experience for patients. Healthcare now works like purchasing any online consumer product. Patients know the provider quality displayed in a 5-star scale and have a single out-of-pocket cost—we call it a SimplePay—that is fixed and never changes. Gone are surprise bills to patients and all the confusing insurance terms like deductibles, coinsurance, etc.

Patients pay a lower SimplePay amount when they seek care from the highest quality providers. By providing simplified transparency on the highest quality providers, we improve outcomes and lower cost for employers and patients by up to 20 %.

Finally, we have completely transformed the massively wasteful claim billing process within our industry into a new retail model. Patients will never receive bills from providers and statements from insurance companies again.

What makes SimplePay’s dataset unique? What does this dataset reveal about the changing workforce demographic?
Scott Schoenvogel (formally the CEO and founder of Compass) is really the country’s foremost expert in this space. As co-founder of SimplePay Health, he developed the dataset we use to support our clients. We now have the ability (based on one of the country’s largest claim and quality databases—data on over 80 million Americans) to identify from national networks of doctors and hospitals the providers who deliver the highest quality and most efficient care. The difference in cost for high-quality care translates to around $5,000 in savings per patient per year.
Can you speak to the difficulties of leveraging data in the healthcare sector?
We spent so much time and energy in our industry working to get our hands on the data over the years. But leveraging that data to create true insights is really a much bigger lift. To accurately measure the relationship between cost and quality we must think of healthcare as a team sport that involves multiple providers along an episode of care. The PCP, specialist, facility and everyone in between, all play a vital role. Provider practice and referral patterns are incredibly predictable and those patterns must be analyzed to accurately assess the relationship of quality to cost.
What motivated you to create SimplePay?
After years of developing and distributing point-based solutions for employers, we felt burdened to create a model that would truly transform and simplify employer-sponsored health insurance. Obviously, health insurance is far too costly and complicated and we wanted to develop a new model that would deliver “savings and simplicity.” SimplePay Health is really the first major update to plan design since 2003 when HDHP (high-deductible health plan) legislation became law. We think this is the way that health insurance would look if we were starting from the beginning.
There’s been a lot emphasis on consumer-driven innovation. Where do you see the role of the employer moving forward? The role of the broker?
We believe that simplification is the next frontier for employer-sponsored health insurance. Only 4 % of employees can accurately match on the four basic insurance terms of deductible, coinsurance, copay and out-of-pocket max. Employees don’t generally use their insurance often enough to get good at it. By getting rid of all of those insurance terms in the design, we have found that employees lean in and make good decisions just like they do in any other consumer transaction.

We believe it will be important for brokers to continue to advise their clients on ways to simplify the insurance design. This includes looking carefully at what has worked and what has not in the past. Americans are really good at being consumers. We just haven’t had the tools to support them until now.

What’s next for SimplePay?
We launched SimplePay Health on January 1 with an initial wave of early adopting employers to prove our ability to deliver savings and simplicity. We are now working to expand our movement nationally by partnering with insurance carriers, networks and claims administrators. We have received an enthusiastic response from many and are working rapidly on the rollout around the country.

We think this is our chance to create needed transformation in our industry and are incredibly grateful for the many that have joined our simplicity movement.

Katie King Vice President, Health Policy & Strategy, The Council Read More

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