An interview with Bill Georges: When agile meets waterfall: how startups and established healthcare organizations can collaborate
As competition increases in the healthcare space with new entrants offering unique patient experience and virtual care capabilities, how can health plans build partnerships – or new internal capabilities – to keep up? Bill Georges, SVP and Chief Strategy Officer of Horizon, discusses just that.
In his role at Horizon, Bill leads the company’s Strategic Initiatives Group, which develops and implements key business programs. He also leads the Enterprise Project Management Office and Business Process Improvement functions, and manages Horizon’s private equity fund investments. Prior to this role, Bill served as the VP of Business Development and the VP of Marketing and Product Development. Bill also formerly served as VP and Senior Analyst at J.P. Morgan Securities, where he covered the managed care industry as a sell-side analyst.
The competition from more nimble startups and apps has heated up over the last few years. Can you tell us about how Horizon has looked at trying to compete against these solutions in creating a new member experience?
The pace of change in our industry is unbelievable. Just when you think it couldn't get any faster or more chaotic, it does. This is a trend that has continued for a solid decade.
It's hard for a large, deliberate, insurance company to stay on top of all of the moving pieces. It's even harder for that type of company to build homegrown solutions. The biggest challenge is access to capital and to talent. Yet, there is an elegant solution for that in the startup community.
Both capital and talent are attracted to solutions that move the needle. So in the world of consumer experience, we've relied on partnerships with startups and commercial partners to impact some critical pieces of the consumer journey. Pager one of those biggest pieces.
For us, Pager and other nimble innovators represent an ability to tackle the dynamic environment of consumer healthcare in an efficient way, both in terms of capital and personnel.
“It’s hard for a big, relatively slow-moving insurance company to stay on top of all of the moving pieces. It’s even harder for that type of company to build homegrown solutions. Yet, there is an elegant solution for that in the startup community.”
On the other hand, what do you think are some of the advantages of being a big health plan, particularly in terms of the ability to bring innovation to the table?
The most obvious benefit is scale. We're a massive hub with a significant amount of momentum. We’re also a massive hub of systems integrations which – if solved for correctly – can efficiently bring together many services that no one else in healthcare is well-positioned to bring together.
There’s a benefit for startups to work with health plans such as Horizon as well. It’s difficult to connect with us and sell to us, but once you crack that code, you immediately have access to a very meaningful market, both in terms of size – 3.6 million members for us – as well as cachet. Working with a major Blue Cross Blue Shield plan is important for startup companies to establish their legitimacy.
Then there's the derivative impact. If you work with us, you're establishing yourself with other health plans, but also with our contracting parties. That could include hospital systems, health insurance brokers, and even large employers.
You mentioned the power of flexible platform capabilities, like Pager’s, where it may be enticing to try to do everything at once. How does Horizon prioritize where to start and how do these partnerships evolve?
The utopic state is to have a fully baked capability that spans a huge portion of the value chain, and then you simply push the ‘start’ button. But most of the time in healthcare, it doesn't work that way.
We're on the cutting edge of innovation in the work we do with Pager, which means we're doing a lot of market sensing as we build. Sometimes the things we've tried haven't worked, other times they really succeed. You need to be nimble and fleet-footed to adjust. With Pager – as with any partnership – there needs to be a fair amount of co-design and co-development. And not simply surrounding software development, but also product development and market approach.
With Pager, we started with what we intuitively knew would be a good first step – to deliver easy access to clinical care via chat. Then, we wrapped appointment scheduling around that because that was a close adjacency.
Once that ecosystem was stable, we started to explore other, more complex uses of the Pager platform. One of those products, which we recently launched, was moving our customer service teams and other service providers onto chat and video based interactions, with an emphasis on agent-to-agent, internal collaboration.
When you're in this ecosystem as a member and you're getting care, the next question is always, “is this paid for?” That is a benefits question – and unfortunately, the person who holds that knowledge is not the same person who is delivering care. So ensuring that a customer service representative is available in the same place clinical care is delivered is the next evolution of this product.
The main lesson we’ve learned is that you step into the product build, and you step into the market expansion, and you try not to get ahead of your skis – but you have to strike a balance of pushing the limits of innovation while you're doing it.
“For us, Pager and other nimble innovators represent an ability to tackle the dynamic environment of consumer healthcare in an efficient way, both in terms of capital and personnel.”
When a startup and a large health plan work closely together, how can the teams compliment and learn from each other?
That's a highly variable answer. Since we’ve begun this partnership, there have been times Pager has taken the lead and times Horizon has done so, depending on the project at hand. Sometimes one party is pushing the other party from behind or pulling as from the front. And then sometimes we're sitting in the room as co-equals chewing over a problem and trying to figure out the best path.
In general, we try to bring in startups that help fill in gaps where we aren’t strong, and where we can balance against our own expertise. For example, going way back to the RFP that led to the selection of Pager, I think Horizon is unquestionably the subject matter expert on the delivery of health insurance products to the marketplace. And Pager is unquestionably the expert on cutting-edge technology as well as designing user interfaces.
Then it’s a co-learning process. We brought a full breadth of knowledge regarding the wholesale distribution of healthcare and the payer model of care. Pager explained to us the value of elegance, the flexibility of platform design, and how to leverage that to design and deliver new services. You need to have that back and forth for any partnership to be successful – both on a human relationships level and organizationally. That’s what gets partnerships off the ground and succeeding.
Now we're entering into new territory where we're laying the foundation for more forward-looking innovation – for example, the opportunity for value-based reimbursement.
Where do you see the healthcare industry moving over the next few years?
We continue to believe that the healthcare system nationally needs to move to a value-based structure. There remains a lot of work to be done to enable ease of access, information, and even rethinking the dry accounting systems that will reconcile a value-based payment. For example, how do we know that better care has been delivered – and who was responsible for that? Was it the doctor? Was it a technology platform, like Pager? Was it a nurse, who helped deliver better care? And ultimately, who gets compensated for that? These are huge questions, but it’s where the market is moving.
The other place we see is major changes is on the regulatory front. When Republicans are in charge, the regulatory pendulum swings in one direction, and when Democrats are in charge it swings in another direction. But on average, there's a continued push for coverage expansion – both covering more people and providing more robust benefits and access for the people that are covered. The question for health plans is how we respond to that.
The best answer we have right now is value-based care and all that is required to deliver that effectively. So for technology platforms, population health management, analytics, and data, that's where the industry and innovation as a whole have to go.
Bill Georges is the SVP and Chief Strategy Officer of Horizon and also serves as a Pager Board Member.
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