Not much new has come out about Revolution Health, Steve Case’s effort to bring consumerism, education, information, and innovative insurance products to the world of health care. Since the splash of the initial announcement two months ago, the silence has been noticeable, despite the inclusion of such notables as Colin Powell, Jim Barksdale, Steve Wiggins, and Frank Raines.
A front page for a website exists, although it indicates it is coming in 2004. Beyond that, nothing beyond a few brief follow ups to the initial USAToday article.
While it is somewhat of a mystery why there would be such a big splash followed by dead calm, perhaps it is due to the difficulty Case might be having in coming up with a business that actually adds real value. Because all the information to date does not describe a business that is materially different, compelling, or even very interesting.
According to an article on Revolution Health authored by the conservative Heartland Institute;
“RHG plans to acquire controlling interests in promising, innovative health care companies and build them for long-term growth.
Areas to be developed include affordable nurse-provided care at retail locations; health information to help people find a doctor or other health care provider and to learn more about medical issues and conditions; tools for managing health care finances, especially to help small and mid-sized employers help their employees; secure, easy-to-use personal health records; and innovative health coverage offering consumers new choices in how to pay for their health care.
“We will put consumers back in the center of the system by giving them more choice, control, and convenience while building the first comprehensive, consumer-driven health care company,” said Case.”
Leaving aside the obvious error – Definity Health and others have already laid claim to that hype-laden first – let’s deconstruct the business development plan.
1. Nurse provided care at retail locations – sounds like many ER departments, some occ health, company run, and local storefront clinics. Nurse care is almost always under the direction of a physician, and billing usually reflects physician charges. If Case has figured out how to have nurses work differently than they do today there may be something here. Otherwise, nothing new.
2. health information to learn more about conditions – that’s all consumers need, yet another site to go along with the 23 million websites that now offer health information. WebMD, the Centers for Disease Control, Kaiser, Aetna, Intelihealth, familydoctor.com and millions of other sources provide detailed information on everything from drug interactions to arthritis medication to cancer survival rates to new treatments for AIDS. That’s not to mention the thousands of web “businesses” based on health information that have failed over the past five years.
3. information to help consumers find a doctor or other health care provider – again, nothing new here – states are building extensive capabilities to report on hospital quality; health plans have long experience in this area; clinics, professional societies, commercial web sites, and the Yellow Pages all have a substantial head start, a customer base, and experience.
4. tools for managing health care finances for use by smaller employers – sounds like a combination of health information and insurance benefit plan design – yawn.
5. secure easy to use personal health records – Many already exist, including http://www.telemedical.com/records.html, http://www.phdtogo.com/ , your personal health record, and http://www.doctorsforpain.com/capmed.html. And some of these are free, targeted to specific patient populations, and gaining traction. For an excellent summary and more information, see http://www.myphr.com/,
6. new innovative health insurance programs – as much as I’d like to see something new and innovative, and as much press as these “consumer directed health plans” (CDHP) have generated, the reality is they are old wine in new bottles.
CDHPs are simply health insurance plans that marry old-line benefit design based on marrying high deductibles and co-pays with newer HMO delivery systems, coupled with a tax-advantaged personal health account. What’s innovative here? Not the cost-sharing, the delivery system, or the tax-advantaged account, nor the combination of all three.
At their core, CDHPs are cost-shifting from employers and other payers to the insureds. I don’t say that as a value judgment but simply state the facts. They are a reaction to employers’ frustration; after twenty years of HMOs, POS plans, capitated programs, closed and open panels, PBMs, PPOs, and the rest of the answers in the form of managed care, employers adopting these programs are throwing up their hands and saying we just can’t afford double digit increases, so employees will have to pay more.
So let’s stop all the hype and nonsense, and call them what they are. CDHPs are simply a way to get employees to pay more for their health care. And given health care trend rates, that’s not necessarily a bad thing.
