Voluntary Benefits: Pet Health Insurance

By Clive Riddle, April 27, 2011

The lack of an Affordable Care Act for Pets hasn’t held back the pet health insurance industry. Voluntary benefits in general enjoy popularity with larger employers, who can offer a discounted perk without paying for it. While the recession bit into sales for pet plans and other voluntary benefits as discretionary income and the number of eligible employees took a dip, the outlook for pet health plans remains strong.

Veterinary Pet Insurance (VPI), the nation's oldest and largest provider of pet health insurance, just issued a statement that during 2010 “the company added nearly 400 large companies and associations to the list of more than 2,200 groups that offer pet insurance as a voluntary employee benefit. The addition of these group accounts made VPI Pet Insurance available at a discount to a record 13 million people for the year.”

Under the voluntary benefit agreements, employees receive a 5% discount on insurance premiums, and many may pay via a payroll deduction.

Deana Single, director of group accounts for VPI tells us "when it comes to health insurance benefits, many companies are having to deliver bad news. These costs are continually increasing for many companies and their employees. Fortunately, VPI Pet Insurance can be added to a company's benefits package at no cost to the business."

VPI listed national firms that added their voluntary benefit in 2010 included: Kohl's Corporation; Morgan Stanley; Hewlett-Packard Company; BMW North America, Inc.; McDonald's Corporation; The Boeing Company; Quiksilver, Inc.; and American Eagle Outfitters, Inc. VPI notes that “at the end of 2010, one out of every five Fortune 500 companies offered VPI Pet Insurance as a voluntary employee benefit.”

Laura Bennett’s Embrace Pet Insurance Blog on Pet Business Trends 2011 cites that national pet insurance “gross written premiums (GWP) reached $290 million in 2009 and are projected to reach $327 million (12% growth) at the end of 2010. The three largest pet insurance companies in the US, Veterinary Pet Insurance, Hartville Group, and Pet Health Inc, together representing 78% of the market, will show modest growth of 5.5% in 2010 compared to 16.5% in 2008. The remaining companies will report growth of 47% in 2010 compared to 82% in 2008.”

Laura predicts that “overall premium growth in 2011 will be pulled in two directions. Two factors will drag down GWP growth: the slower growth of the top three pet insurers as they work to offset a more mature book of business; as well as the inevitable decline in sales and renewals from 30% (and higher) premium increases that are being implemented by some of the younger, faster growing companies.”  Her overall assessment of the pet market? “Pet-related spending in 2011 will show an increase over 2010 levels but not at the robust rates we saw prior to the recession.”

Thus for voluntary pet insurance, and other voluntary benefits, the increased popularity from employers clears one hurdle, but the individual purchase hurdle still remains an obstacle that only an improved economy might fully remedy.


Researching the Real

By Laurie Gelb, April 25, 2011

While the rest of the social Web is constantly redesigning itself based on user context and needs, the health Web lags. Personalization, filtering, sorting, non-linear exploration and other “Web-standard” capabilities on sites like Amazon is lacking as yet.


One possible reason is that surveys of health Web users commonly manifest a “how much” obsession, neglecting the who, when, where, what, how and why. This creates misleading constructs for action, which we will continue to explore in future posts.

Let’s examine on just one question that Pew asks [not picking on Pew, just that its survey is widely quoted]:

Q32 Overall, who do you think is more helpful when you need... [INSERT FIRST ITEM] – health professionals like doctors and nurses, OR other sources, such as fellow patients, friends and family?  And who is more helpful when you need... [INSERT NEXT ITEM; RANDOMIZE]?  AS NECESSARY: Professional sources like doctors and nurses, OR other sources, such as such as fellow patients, friends and family?  

a. An accurate medical diagnosis

b. Emotional support in dealing with a health issue

c. Practical advice for coping with day-to-day health situations 

d. Information about alternative treatments

e. Information about prescription drugs

f. A quick remedy for an everyday health issue

g. A recommendation for a doctor or specialist 

h. A recommendation for a hospital or other medical facility


1 Professional sources

2 Other sources

(VOL) Both equally

(DO NOT READ) Don’t know

(DO NOT READ) Refused

Beyond the ambiguity ("day to day health situation") and heterogeneity in some of these question items (you might have a different process for researching someone/ somewhere to remove an ingrown toenail vs. a CABG), we can summarize the problem here with two words: false dichotomy. 

How actionable can these answers be, even when tracked over time? The answer items are all binary, they relate to categories rather than actual resources and the unaided “both equally” option is a copout/source of social bias rather than a reality. 

What Pew could be asking:           

Have you or anyone whom you help make health decisions, such as a family member, ever faced  [specific situation]?

[if yes]

How recently did you or someone you care for face [specific situation]?

These decisions never stop [they don't, for someone w/ chronic illness/injury, often neglected in these surveys but also often your high utilizers]

Dealing with that now

Within the last month

A month or two ago

A few months ago

About a year ago

More than a year ago


When situation X most recently arose, from which of the following did you receive information before making a final decision? Please check all that apply. [randomize order w/ selected anchors]

  • Your or the patient's physician
  • A staff member in that physician's office or clinic
  • A brochure or video in a physician's office or clinic
  • The Internet
  • A magazine or newsletter
  • TV or radio program
  • Friend or family member who works in health care
  • Friend or family member who does not work in health care
  • Other (please specify)

Often, we then zoom in on that recent situation and dissect how well the search process (or lack thereof) worked out in terms of needs vs. outcomes.

What else can we ask Web users, that we don’t know the answers to, that we can actually use to design stronger decision support?  An example…when we look at choices that are being made NOW – which we will need to branch into – we can find out:

  • Who helps whom (for example, what percentage of the sample is currently influencing (1) health decisions on a child’s behalf (2) health decisions on an adult’s behalf other than themselves. This and the next item will aid subgroup analysis/tracking.
  • Is the current decision process around self-care or accepting a professional’s recommendation?
  • Where/how do they think they need to research, if anything before making or accepting a choice?
  • If the decision process is ending, is it by choice or necessity?
  • How well do they think they are succeeding in getting what they need? This is categorical like in real life -- not at all to it's done.
  • What else do they need to know, that they do not yet? This can be structured, open-ended or both.
  • What are the barriers to getting what they think they need? (e.g. not enough time, not sure how to search, overwhelmed with info, didn't have long enough chat w/ doc, not sure if insurance will cover…)

Does this sound really nitpicking? It’s really no worse than the research process we go through for cereal or paint – just that instead of keying on the purchase process, we are keying on information-seeking. User-driven branching and filtering moves the respondent through quickly. BUT – we should never assume prework. If I walk into CVS like a robot and walk out with my default OTC analgesic, you should know that as well.

It's always a worthy goal to keep your information specific, your verbs active and your sentences short. If you wouldn't say it, apart from legal disclaimers, why write it? 


Strategic Opportunity Index…On The Rise

By Lindsay Resnick, April 18, 2011

“Strategic planning is worthless, unless there is first a strategic vision.” (J. Naisbitt)

In healthcare and insurance, like many other industries navigating today’s economic and political woes, the future belongs to those best able to manage in markets characterized by intense competitive rivalry, continuous regulatory disruption, and information empowered consumers.

Developing a well-honed strategic vision works to anticipate change, focus on competitive threats, and assess long-term business implications. To be effective, it’s essential that your vision draws on sophisticated customer insight. The goal is to take an organization where it needs to be by creating a roadmap on how to get there.

At its core, a sustainable strategic vision is built around an effort that allows management to look deep within the organization, ask & answer tough questions, and make informed decisions about strategic options. The following questions provide a strategy “stress test” to help refine your planning process starting at the intersection of three key business drivers: competitors, customers and company.

  1. How are you different from competitors…comparative market advantages/disadvantages?
  2. Are you leveraging a sustainable Dominant Selling Idea that delivers customer value?
  3. How are you selecting new markets, products and services?
  4. Who are your top five competitors and why do you beat them…why do you lose?
  5. Have you developed proprietary insights and translated them into actionable strategy?
  6. Are you ahead of competitive trends and industry best practices?
  7. Where’s the customer in the marketing mix…product, price, promotion, and place?
  8. Have you identified and/or neutralized uncertainty in the decision process?
  9. Is there cross-management buy-in and commitment to addressing the future?
  10. Are you managing institutional bias to facilitate diversification and innovation?
  11. Is there a willingness to invest in execution…talent, capital, operations and distribution?
  12. Is strategy translated into an action plan…scenario planning, timing and accountability?

Smart companies are raising their “opportunity index” by thinking about their business in ways that look very different from today’s enterprise. They are embracing a strategic planning process that openly challenges leadership across the organization in order to pinpoint future direction—make data-driven decisions, embrace customer centric thinking, adjust business assumptions, and act with deliberate speed. After all, strategic vision represents the futurity of today’s decisions.


Cartoons for Health Care Professionals

by Clive Riddle, April 15, 2011

As a child I recall looking forward to Saturday mornings, filling a bowl full of cereal and sugar before my parents were awake, and plopping down in front of the television to view an endless parade of my favorite cartoon characters.

Now, anyone involved in the business of health care can sort of re-experience this feeling (bowl of cereal and sugar optional) by consulting YouTube and browsing through an increasing stream of short animated features created to for the professional.

Of course you’ll have to wade through an even larger river of health care animation created by the masses to comment on health care reform, politics and hospital visits. But here are some recent mainstream efforts at delivering health care business information in a new format, often with a dose of humor:

Milliman calls the stars of their animated features “Droids” and offers three items so far in their Healthcare Town Hall:

  • Droids discuss health insurance rate setting process
  • Droids discuss cost shifting
  • Droids discuss individual mandate

Jeremy Engdahl at Milliman says they’ve “been exploring how animation can help educate people on misunderstood components of the health system in general and health care reform in particular.” He notes the videos have been peer reviewed by actuaries and are backed by published Milliman research.

Kaiser Family Foundation recently released Health Reform Hits Main Street which comes with the following description: “Confused about how the new health reform law really works? This short, animated movie -- featuring the ‘YouToons’ -- explains the problems with the current health care system, the changes that are happening now, and the big changes coming in 2014. Written and produced by the Kaiser Family Foundation. Narrated by Cokie Roberts, a news commentator for ABC News and NPR and a member of Kaiser's Board of Trustees.”

Accountable Care Organizations have perhaps been the topic of the greatest number of health care business animations. Leading the pack in viewership, with 77,000+ views,  is a piece by CenturaHealth entitled In Search of an Accountable Care Organization (ACO) which the hospital organization describes as: “Clueless health care executive tries to learn about accountable care organizations in the age of health care reform.”

The Disease Management Care Blog has a YouTube Channel featuring several animated pieces including “Setting Up An Accountable Care Organization” and “Disease management saves money.”

Alan Genicoff, MD JD who offers a Law Doc blog has a YouTube Channel which includes the “healthcare fraud cartoon parody: The Medicare RAC audit” in which we’re told to “watch Dr Abel squirm as the Medicare RAC auditor takes him to task about possible overbilling of Medicare.”

And of course I’d be remiss if I didn’t mention that MCOL has entered the fray, and features a number of animated pieces in it YouTube Channel: MCOLdotcom.

Now, does anyone remember the words to the theme song from Scooby Doo or the Banana Splits?


Life in the Web: What Page Are You On? (part II)

By Laurie Gelb, April 8, 2011

In our last installment, a typically-networked physician was driven to distraction by his patients’ reliance on the Internet for personalized health advice, and an MCO director struggled to understand why her network’s disease management materials were failing to influence member behavior.

Both might benefit from a better understanding of how, when, where and why members of the lay public utilize online medical resources. These questions have seemingly been the subject of much research. However, surveys have primarily focused on scope -- “how much”—rather than the deconstruction of how and why.

To put the question another way, what does the social Web (an umbrella term for social networks/the Web/mobile media) offer that a physician’s appointment or disease management brochure doesn’t?

Unlimited time and bandwidth. The ability to filter and search, with the hope of greater personalization. Diverse opinions. Colorful, unequivocal language. Identification of and interaction with trusted resources on demand 24/7 from any Internet-connected device. Hyperlinks to explore more quickly and less linearly. Ability to go from structured resources like encyclopedias to Facebook and back again. Social bookmarking that eliminates the need to “start from scratch.” If you have two more hours, we can keep going.

To what extent has research into health Web use helped us to better utilize the physician’s medical expertise and communication skills to design better health information portals and tools? Apply the MCO director’s knowledge of demography, utilization and trends?

Not so much.

And to what extent are social Web-savvy content developers in charge of creating health advice on the Net, self-help tools or member disease management communiqués?

Not so much.

Now, going back to our Net-savvy physician – how much money has gone into e-prescribing, clinical tools, formulary references that he uses every day…as compared with the resources that a patient would use? How much connectivity is there between MedicAlert or  Microsoft HealthVault and the answers patients get to their health questions on the Net?

Not so much.

In short, content and tool developers have pretty much failed to bridge the gaps between what their masters (us) want to convey and where their so-called audiences want to be. Is it surprising that people don’t particularly want to be “herded” into a maze for which they write none of the rules, that they would rather be setting the terms of engagement?

Yes, the process of accessing information, care and reimbursement for said care is currently perceived as adversarial. And battles lines are being drawn…from the receptionist’s window and business office to your Web site and shiny new brochures. And no one else gives a flip about your communication strategy. Most agendas read, “Pay less, get more and never have to say ‘I’m sorry.’”

So now what? If you want to play to win (i.e. to improve the odds that someone receives optimal care), you need to gather and then use some intel, some real insights, not the pablum of yesteryear. We’ll discuss how to do this, next time.