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