The 2 Main Reasons Why PSHPs Fail

Last blog we talked about the potential of the provider-sponsored health plan (PSHP). Creating the next Kaiser or UPMC is a legacy that most health system CEOs would dream of building. Think about the reduced administrative complexity, opportunity to blend claims and medical information to better predict health outcomes, and streamlined member enrollment to reduce uninsured patients (also known as “charity care” or “uncompensated care”).

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What Are Provider-Sponsored Health Plans?

Throughout history, there have been many famous rivalries. Yankees v. Red Sox. Pepsi v. Coca Cola. UNC Chapel Hill v. Duke. But there is only one that stands above all the rest: University of Michigan Wolverines v. Ohio State Buckeyes. In college football, it is simply referred to as “The Game.” Now this is a healthcare innovation blog, so the equivalent to “The Game” in the U.S. healthcare system could only be between the two most important organizations, health plans and hospitals. One holds the money, the other delivers the care. Ardent supporters lob criticism towards each other’s stakeholders related to rising healthcare costs and insufficient innovation. The unstoppable force meeting the immovable object.

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Why Anthem + Beacon Health Options is a Gamechanger

Hi all you cool cats and kittens. Over the past month, I’ve heard of one mega deal in the mental and behavioral health space that has been overshadowed by COVID-19. It is my assertion that this lone M&A transaction will have longstanding implications on the healthcare startup ecosystem. Mental health is an aspect of health and wellness that I care deeply about. I previously served on the Board of Directors for a local mental health non-profit, NAMI Northern Virginia where I met some of the kindest humans helping individuals and families. It is there I realized that 1 in 5 U.S. adults experience mental illness each year and suicide is the 2nd leading cause of death among people aged 10-34 years old. We are suffering a mental health crisis in this country that requires continued innovation. And yet, psychiatrists and mental health providers are consistently underpaid relative to their peers, leading to further access to care issues (see below).

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3 Questions Every Startup Asks About Payers

I have recently seen a number of digital health startups recruiting for individuals to lead payer strategy and business development. This initially led me to two reactions. First, word of caution to those looking to fill the role, it is completely different to work for a payer versus successfully sell into one. Don’t just fall for someone who worked at UnitedHealthcare or Aetna, those are a very far cry from a startup (no offense). Ideally, you hire someone with experience from both. Second, far too many startups lack the robust understanding of the payer market in their existing leadership team, which could be eventually become their Achilles’ heel.

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Meditation Is A Billion Dollar Business

For today’s blog, let’s try something different. Instead of writing about a topic I already know about, I’m going to explore the wild world of Meditation Apps. Nearly a quarter of a billion dollars has been invested into this digital health market. And like Aladdin, let me take you on this magic carpet ride figuring out how and why.

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