marketing & insurance strategic management in healthcare 24 march 2009
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MARKETING & INSURANCE
Strategic Management in Healthcare
24 MARCH 2009
MARKETING
• ESSENTIAL TO IMPLEMENTING STRATEGY AND FULFILLING MISSION
MARKETING
• “MARKETING IS AN INTEGRAL PART OF STRATEGIC PLANNING”
• DO YOU AGREE?
CENTRAL CONCEPT OF MARKETING
• VOLUNTARY EXCHANGE OF SOMETHING OF VALUE - CONSIDERATION
• DETERMINE WANTS, NEEDS, EXPECTATIONS, DEMANDS
• DELIVER GOODS OR SERVICES
ELEMENTS OF MARKETING
• PRODUCT SERVICE
• PRICE CONSIDERATION
• PLACE ACCESS
• PROMOTION PROMOTION
TARGET MARKET
• PHYSICIANS
• PATIENTS
• INSURERS
• EMPLOYERS
• GOVERNMENT
• CHARITY GROUPS
EPIDEMIOLOGIC PLANNING MODEL
• DEMAND = POPULATION x INCIDENCE x USE x MARKET SHARE
• INCIDENCE– NUMBER OF NEW CASE OVER A PERIOD
OF TIME
• PREVALENCE– NUMBER OF CURENT CASES AT A POINT
IN TIME
SOCIAL MARKETING
• USE THE TOOLS OF MARKETING TO INFLUENCE VOLUNTARY BEHAVIOR FOR SOCIAL BENEFIT INSTEAD OF PROFIT
• HEALTH CARE ORGANIZATIONS?
• GOVERNMENTS & CHARITIES?
PAYORS
• FEDERAL GOVERNMENT
• STATE GOVERNMENT
• EMPLOYERS
• CHARITIES
• INDIVIDUALS
INSURANCE
• ARE THEY PAYORS?
• SINGLE PARTY PAYOR
• NATIONAL HEALTH
INSURANCE IS A CONTRACT
• PARTIES TO THE CONTRACT– THE PATIENT AND THE INSURANCE
COMPANY
• HOW IS THE DOCTOR INVOLVED?
• HOW IS THE EMPLOYER INVOLVED?
INDEMNIFICATION INSURANCE
• WHAT MOST OF US THINK OF AS INSURANCE
• YOU HAVE A LOSS - THE INSURANCE COMPANY FIXES IT OR PAYS FOR IT
SELF INSURANCE
• GENERALLY INVOLVES THIRD PARTY ADMINISTRATORS
• LOOKS JUST LIKE INSURANCE
• USUALLY INCLUDES SOME TYPE OF CATASTROPHIC REINSURANCE
DIRECT CONTRACTING
• TAKES OUT THE INSURANCE COMPANY
• SAVES MONEY
• CREATES ISSUES FOR FOLLOW-UP
GOVERNMENT MANDATES
• PREGNANCY
• SCREENING PROGRAMS
• DIALYSIS
MANAGED CARE ORGANIZATIONS
• INTEGRATION OF FINANCING AND SERVICE DELIVERY
• INSURANCE COMPANIES WITH CAPTIVE PROVIDERS
• USE SOME SYSTEM OF GATEKEEPING
TYPES OF MCO
• HMO - HEALTH MAINTENANCE ORGANIZATIONS
• PPO - PREFERRED PROVIDER ORGANIZATIONS
• POS - POINT OF SERVICE PLANS
COST CONTAINMENT
• THE PURPOSE OF MANAGED CARE
• HAS IT WORKED?
• ACCESS TO CARE
• CONTROL OF PHYSICIANS
• PREVENTION
MEDICARE
• SINGLE PARTY PAYOR
• VERY EFFICIENT AND EFFECTIVE
MEDICARE COST CONTAINMENT
• DRGs
• PAY FOR QUALITY
• INCREASING NUMBER OF LIVES
• INCREASING SERVICES
NATIONAL HEALTH
DO YOU WANT HEALTH CARE THAT RUNS LIKE THE POSTOFFICE?
Takes a note from my hand in New York on Monday and puts it in my sister’s hand in California on Wednesday for 42 cents.
CASE STUDY # 3
• GEORGE – pharmacist in rural Alabama for 40 years – lunch counter & sundries
• Mrs Murden – expensive arthritis medicine
• Options– Stay with her pharmacy– Local drug discount card– $4 plan at Wal-Mart or Walgreens– Mail-order