We pay about $1600/month for family health insurance. It’s a pretty good HMO plan from Blue Cross/Blue Shield of MA (BCBSMA), and we’ve been generally happy with their benefits. However, we miss ten years ago, when it was $600/month, with better benefits.
Of course, rising health costs is a national debate topic, and BCBSMA prides itself in paying out relatively a high percentage (90%) of premiums for member medical services. However, a limited administrative overhead is misleading: they’re just pushing administrative burden out to providers. I’ve seen my doctor’s sizable back-room staff, and I know his billed procedure rates have to pay for that. It would be interesting to see the “total overhead” factor for an insurance company, though it’s impossible to measure.
I know from my member experience that BCBSMA has been extremely slow to adopt technology to streamline and automate processes and interactions. Technology won’t solve everything, but it can help drive out inefficiencies.
Major features are still missing from the Web site: you can’t review or request referrals. Claim are only summarized; details are not available. You can’t check to see if a specific procedure is covered (e.g. by billing code). You can’t download your MA 1099-HC from the Web site (but you can request it via “secure email”). There’s no mobile app. The pharmacy benefit integration is somewhere between clunky to outright buggy. I recently got approval for a tier II drug — I got a nice paper letter, but can’t find any info on my Web account. Etc., etc.
Even worse, BCBSMA don’t provide any help for primary-care physicians. They’ve got the resources to build member-doctor interaction apps: request referrals, request prescription renewals, maybe even schedule appointments and physicals, review lab results, etc. They can afford to build apps my doctor can’t, and then amortize that across all primary-care physicians, lowering overhead across the board.
Why is this so hard?
I’m wondering now if it’s impossible to fix this from within. What would an “Amazon” health insurance company look like? Imagine: Web and mobile-centric interactions for members and providers, streamlined interactions, a high-quality user experience, no huge call center, etc.
My venture friends are always looking for big, audacious ideas: is this big enough?