MCOs and Millennials
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MCOs and Millennials






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MCOs and Millennials MCOs and Millennials Presentation Transcript

  • Prepared by: Jay Chang June 11, 2011 The “Millennial Effect” on Boomers & MCOs *Millenials are the children of Boomers
  • Executive Summary MCO’s need to partner with Millennials as the Boomers move through a virtualized healthcare system Key Impact Change Function MCO’s need to defend itself from Millennials Legal & Regulatory Millennials are working to virtualize services Provider Contracting E-Services for Millennials will facilitate decision making for Boomers Member Services MCO’s need to demonstrate value to Boomers & Millennials Sales & Marketing Boomers will be influenced by Millennials to weigh cost vs. choice Healthcare Consumerism
  • Healthcare Consumerism Wealth Choice MA Private FFS 3% MA HMO 17% 1 1 Less affluent Boomers will move toward MA HMO and sacrifice choice of providers ~ 87% < $50k annual income at retirement Cannot rely on Millenials for financial support. Higher debt generation ~ $23k vs. $333 avg college debt 2 Affluent Boomers will move toward FFS w/Medigap or MA Private FFS to maintain choice Boomers currently prefer choice: 21% HMO vs. 58% PPO Medicare FFS 75% MA PPO 5% 2 2 Sources: NY Times Boomers will be influenced by Millennials to weigh cost vs. choice View slide
  • Value of Choice & Care Education
    • Future Trends
    • Payers will market and price their products based on outcomes
    • Evidence
    • Subtle difference between HMO & PPO regarding “Getting the care they need”
    • Future Trends
    • Channel 1: Payers will ramp up websites to target Millenials
    • Channel 2: Payers will create more large print brochures
    • Evidence
    • 64% of Boomers know “little or nothing” about Medicare
    • 32% of Boomers use the internet for health information
    • 85% of Millennials use the internet for health information
    Sources: California Healthcare Foundation Sales & Marketing MCO’s need to demonstrate value with a two-channel approach 87% 82% Aetna 87% 78% Anthem 86% 84% CIGNA 82% 83% Health Net PPO HMO Payer View slide
  • Member Services 75% of Millennial women enter the workforce Pressure on MCO’s Email for their parents Text messages for urgent notifications Portals to view lab and test results Benefits & eligibility to estimate costs MCO’s need e-services to partner with Millennials & Boomers for care Prescription mail ordering 60% of Millennials expected to coordinate care for Boomers 51% of Millennials live greater than 30 miles away from parents decision making
  • Provider Contracting MCO’s will help re-define or define new reimbursable services developed by Millennials Source: Gartner, CBS News, AMA Pressure to Virtualize for Boomers
    • Over 65 population to double by 2030
    • Projected shortage of 130,000 specialists, 60,000 PCPs and 220,000 nurses
    • Access to specialist services in rural areas & reduced travel
    • Closer patient monitoring
    • On-going need to lower healthcare costs
    • New revenue sources for providers
    secure messaging self-diagnosis & robotic surgeries home devices, etc.
  • Legal & Regulatory MCO’s need to increase utilization management & tighten compliance against Millennials Source: U.S. Government Accountability Office Utilization Management Compliance
    • CA appeal success rate = 54%
    • Increased burden for legal staff
    • Increased scrutiny for physician reviewers
    • Increased confidentiality concerns (e.g., PHI)
    • Increased workforce compliance needs (e.g., SOX)
    • Tighter IT security demands
  • Questions? Thank you!