Category Archives: Healthcare

Do you select an insurance company, or do you select a doctor/hospital? (Inova vs. Kaiser Permanente)

Having spent hundreds of hours in the last few months with three of the four largest health plans in the country, I am aware that the provider network is a significant aspect of their product design and marketing. Even when setting up a direct to consumer site, the health plans (also known as payers, issuers, or insurance companies) allow the consumers to see which doctor will participate in each insurance product so that consumers can make informed choices.

However, consider this notice from INOVA:

Inova Kaiser Fight

Since INOVA is one of the highest rated facilities in the northern virginia, it begs the question – can your hospital influence you enough to choose the insurance? Is this something that the issuers have considered while designing their provider networks, or does the extra dose of marketing from the provider facilities such as INOVA throw a new curve ball for the product design teams at payers? It appears that while overall KP may be well positioned, but in this specific case, INOVA’s marketing may have an effect.

Perhaps one of many payer-provider marketing conflicts to watch out for in the coming few months?

Insurance carriers (payers) connecting with multiple federally facilitated exchanges

A common misconception that I hear from the payers that are connecting to multiple exchanges is that they will be connecting with one FFE and a few different state based exchanges. In reality however, each state will have an exchange, whether it is an FFE or SBE or a partnership exchange. So, even if you are a payer is connecting with 3 states, such as Texas, Oklahoma and Illinois, all of which may be FFEs (at least for the year 2014), still you are connecting with 3 exchanges. They all might be federally facilitated, and they all may work largely the same way, but there are 3 end points nevertheless.