Employer Marketplace | Claims Data Analytics
You have a product or solution that you think has traction in the self-funded employer marketplace. You're hearing about successful entrants into this marketplace often. You know that the opportunities are considerable and growing . Does your healthcare innovation have what it takes?
Some of the leading areas of innovation include:
Healthcare innovators (and their investors) recognize the enormous potential of the self-insured employer marketplace. This is where innovation and disruption in health care access, medical care delivery and health outcomes often originates.
Self-insured employers are a natural market for many healthcare innovations. Navigating this landscape, however, requires familiarity with stakeholders, channels of influence, speaking the language, understanding the value drivers and the practical requirements to be successful in this space.
210 pages of charts and graphs......but what is this telling you? Employers and their trusted advisors increasingly require a clinically-trained data expert to find genuine meaning and actionable recommendations from their claims data.
Employer-sponsored insurance covers almost 155 million people in the U.S.
It is estimated to be a $1 Trillion marketplace.
For every employer the business stakes around health outcomes, medical costs and access to medical care are extremely high.
You have a product or solution. It's innovative. Is this something employers would consider buying? Do they need it? Do they want it? Can you provide the level of service the will be looking for? How does this fit in with their other Point Solutions? Why doesn't their medical carrier or their TPA cover this innovation?
Second medical opinions, virtual centers of medicine and specialty telemedicine are revolutionizing how employer health plan members can access top medical expertise. Think about how plan members would connect into your solution? Who pays for what, when? How is that administered? And what happens when an expert opinion is rendered?
Members with diabetes need specific solutions for diabetics. Members with cancer need cancer-specific strategies. Likewise for orthopedic surgeries, behavioral health conditions, cardiac care, asthma support and reproductive health. Every successful entrant needs to understand how they fit into their employer-client's vendor ecosphere.
Just because you've build an app doesn't necessarily mean you'll be successful in this space. Some stand-alone apps actually do translate into a subscription business that employer's sponsor on behalf of their employees. Most, however, need to go beyond a minimally viable product and integrate with employer processes and vendor systems. How plug and play are you?
Care management carve-outs are increasingly in demand for high cost claims, rare diseases, chronic conditions, post-op care; high-risk pregnancies; pre-term infant home care; cancer hospice and many other clinical scenarios. Deciding if your solution has traction, here, has more to do with your willingness to integrate into the self-insured employer's systems, than vice versa.
There's a lot of interest in jump-starting how self-insured employers might adopt some of the new molecular diagnostic testing capabilities. Pharmacogenomics brings tremendous potential value to employers. Polygenic Risk Scores represent a whole new category for population health risk selection. Genetic counseling is becoming a defect strategy to mitigate the high costs of congenital anomalies in high cost newborn claimants.
Regulatory incentives to promote employer wellness programs ignited an entire industry- the field is crowded and we're seeing horizontal integration of traditional wellness players into other spaces, such as patient advocacy and nurse help lines. This is a popular space that requires vigilant competitive analysis to determine how are you really different.
How do you cut through the noise and get to the decision-maker? Do you speak the language of the self-insured employer world? What are the best channels for your healthcare innovation? What kind of employers are you targeting, and why?
You have to speak the language to be successful with self-insured employers. This isn't hostile territory but it often requires native guidance and interpretation. Entering the self-insured (also known as self-funded) employer market space requires a keen appreciation for the buyer (who usually works with a broker or consultant), the landscape they inhabit, and the many moving parts they deal with to make decisions. Genuine value will be determined by savvy decision-makers. Demonstrable results, service excellence and coordination with other benefits need to be considered.
What makes your innovation stand out? Why doesn't the employer's medical carrier already cover your service? Success in selling to the employer marketplace requires speaking their language and knowing the stakeholders. What ROI do you bring to an employer looking to lower medical costs, improve engagement and performance, impact worker productivity and mitigate health risks. You need to be familiar with plan design, medical necessity and scope of coverage.
Your playbook needs to carefully consider how employers think, what drives THEIR success, their business environment, the regulatory requirements they face and what will stand out from the crowd.
How do they determine what Point Solutions are worth considering? This is a large and potentially lucrative marketplace and more healthcare innovators are recognizing the opportunities. Ron Leopold Consulting is all about helping those innovators grow in this market space.