Article originally published in Health Insurance MarketPlace News.
Nichol is a healthcare business and technology executive who’s been recognized for digital innovation by CIO100, MIT Sloan, Computerworld, and the Project Management Institute. He’s a managing director at OROCA Innovations.
- Nichol is an innovative revenue growth expert and futurist who consults widely with healthcare leaders on innovation, platform monetization, strategy, growth realization and digital for large, complex innovation
- He advises companies on the potential of blockchain and platform growth strategies leveraging consumptive collaboration and the benefits of multisided
- He pioneered and delivered the first digital platform for health insurance Exchanges, an industry-leading platform transforming consumerism and retail-oriented services for the health insurance
- He’s also is a nationally recognized speaker at, among other venues, the MIT Sloan School of Management and the Yale School of Management, and at major industry events covering digital, innovation and
- He’s an author and active contributor to industry publications on health, technology, and innovation, including CIO.
Health Insurance Marketplace News: How has the concept or definition of health insurance Exchanges changed over time? What has changed most about them?
Peter B. Nichol: The first open enrollment focused on enrollment, the second open enrollment shifted the priority to retention and the energy of the third open enrollment was centered around sustainability. Current Marketplace incentives have failed to establish price and premium stabilization, and this will be the ongoing priority until achieved.
HIMN: What will Exchanges look like five years from now? Will public or private Exchanges dominate?
PBN: Eventually, regulations will allow private Exchanges to offer subsidies. Once this happens, this will be the end of public Exchanges. Healthcare.gov will wind down, and a natural market balance will be established with genuine consumer choice. Regarding private Exchanges: The shifting regulatory guidance and direct contracting with providers have resulted in lower- than-expected growth for private Exchanges. Employers are exploring solutions for declining population health, an aging workforce and massive inefficiencies in the existing healthcare system not addressed by private Exchanges. Private Exchanges do provide employers value, and once proof of cost savings is clear, employers will act quickly. Offering subsidies would be a big step for private Exchange growth.
HIMN: Where do you see the biggest hurdles for state or federally-facilitated Marketplaces in the future?
PBN: Hospitals have been the subject of substantial performance-based payment reform, most recent of which was MACRA, enacted in 2015 to replace the Sustainable Growth Rate for physician payment. The fundamental pillars of any healthcare ecosystem begin and end with incentives. Understanding how to improve performance and avoid penalties has resulted in more sophisticated hospital governance models. This shift to outcome-based reimbursement is changing how physician practices conduct financial planning and how care is managed. Patient care is affected, and these changes are not always in the best interest of the patient.
New partnerships and collaborations are required for long-term success. The increasing cost pressures will encourage co- invention and the formation of clinically integrated networks, later maturing into “super CINs” that span multiple regions and eventually evolve into borderless medical practices. The question then is what the role of the Exchanges is in this new care delivery model. Individual health insurance Exchange enrollment has plateaued. CO-OPs are folding and insurers are leaving the Exchanges because they can’t make money. Not a single Exchange is 100% self-sustainable without state Medicaid subsidies and chargebacks. Eventually, state governors will catch on and press Exchanges to present sustainability plans that don’t obfuscate Exchange financials. Once this happens, the likely outcome will follow the lead of Gov. Matt Devin, with kynect transitioning from a State-Based Marketplace to HealthCare.gov. Even Oregon decided to continue to use Healthcare.gov when it determined that switching would cost $3 million more than what it is paying ($30 million) with Healthcare.gov and require adding 80 additional staff to support operations. There will be a dramatic consolidation of the Exchanges if prices and premiums do not stabilize.
HIMN: What’s new since we last checked in? What have you been spending your time doing?
PBN: The last year has been outstanding! In 2015, as CIO, my team was recognized with the CIO100 Innovating in the Digital Economy 2015 Award. In the summer of 2015, I was honored to be selected as an MIT Sloan CIO Leadership Award Finalist and to be standing among such prestigious leaders. I’m proud to be at the forefront of digitizing healthcare — one consumer at a time.
In 2016, I was excited to be invited again to the MIT Sloan School of Management as a speaker at the 13th Annual MIT CIO Symposium, “Thriving in the Digital Economy.” This event draws the greatest minds in the world tackling innovations challenges for CIOs. This is the one event I look forward to every year. This innovation event is extremely well-organized and continues to be the most respected CIO event in the country. I was recognized as a Computerworld Premier 100 Technology Leader in 2016. This lifetime achievement award for innovation meant a lot. It’s inspiring when fellow leaders see the value in your unique leadership, inspiration and innovation strategies.
Most recently, in the fall of 2016, I co-authored a proposal paper with Jeff Brandt, an expert in mobility, security, and healthcare. Our blockchain paper is titled “Co-Creation of Trust for Healthcare: The Cryptocitizen Framework for Interoperability with Blockchain.” The focus of the proposal paper is on blockchain health ecosystems and the patient-centric interactions that underpin the co-creation of trust, balancing the pluralistic morality of identity exploring blockchain. (http://doi.org/10.13140/RG.2.1.1545.4963)
Last month, I also co-authored a second research paper with William Dailey MD, a practicing physician and Chief of Medical Information at Golden Valley Memorial Healthcare. Our blockchain paper is titled “Micro-Identities Improve Healthcare Interoperability With Blockchain: Deterministic Methods for Connecting Patient Data to Uniform Patient Identifiers.” The drive behind this paper was to present a hybrid model, integrating the Fast Healthcare Interoperability Resources (FHIR, pronounced “fire”) interoperability and blockchain. Think micro-identities that travel with you, and providers who leverage new patient matching logic to remove the need to transfer sensitive demographic information when validating a patient’s identity. (http://doi.org/10.13140/RG.2.1.3118.3605)
I’m also wrapping up my MBA from Quinnipiac University and will complete the program by January 2017. From all these amazing experiences, my best advice is that collaboration is the key to everything.
To view the print interview, Catching up with Peter B. Nichol CIO 2016 click the image below.
Peter B. Nichol, empowers organizations to think different for different results. You can follow Peter on Twitter or his personal blog Leaders Need Pancakes or CIO.com. Peter can be reached at pnichol [dot] spamarrest.com.