Let’s face it. Selling to payers can be a slog. Decisions can take (seemingly) forever and require (ostensibly) more buy-ins and approvals than there are people in the company. In order to be successful and simultaneously maintain a manageable level of sanity and peace of mind, I find that you need to develop a zen-like state of understanding about your customers. And the best way I know of reaching a state of healthy consciousness is through perspective.
Here’s the simple fact: no matter how complicated and dysfunctional things may seem in your own company, they likely pale in comparison to the operating environment within the typical health plan. Why? It’s simple:
Big, complex organizational structures – Map out the org chart for your average payer and tell me it’s not a hairball of layers and interrelated functions. Getting anything communicated, let alone accomplished, is a feat.
Multiple, redundant, and antiquated systems –Tally up the number of different major IT systems, or try to get a coherent claim feed, or ask how their various medical management data sources get reconciled and you’ll start to get an appreciation of the difficulty inherent in doing anything new. (It’s been said that the best way to put a health plan out of business is to have them replace their claims engine…which explains why so many are still operating off of systems that are 10 and 20 years old.)
Regulatory complexity – The confusing morass of rules, regulations, standards(e.g.CMS, state, HIPAA, NCQA) in large part defines the operational behavior of payers. And this is especially true with Medicare and Medicaid plans.
The moral/human factor – Most businesses don’t have to contend with the moral complexity of determining how much care is enough, or weigh the cost of care against the potential benefit, or quantify the quality of a given doctor’s performance in treating your appendicitis versus every other doctor doing appendectomies. Wall Street, for example, didn’t let conflict of interest matters or fiduciary responsibility keep it from all sorts of very questionable business practices that are largely inconceivable in health care. Yes, there are the highly publicized stories about heartless health plans that withhold services to well-deserving members, but it’s hard to argue that they aren’t much more constrained by, and do more faithfully adhere to, a code of ethics than other businesses.
The status quo – Perhaps the biggest complication of all. Your customers are already busy doing analytics, medical management, provider file cleansing, utilization review, consumer content, etc. Which means they already have systems in place, people assigned, reports running, budgets approved, etc. Now you’re coming in and suggesting they disrupt all that. Imagine being deep in the midst of doing your taxes on the evening of April 15th and your nine year-old comes in and asks for help with some big school project…now you’re starting to get the idea of the havoc you’re wreaking inside a payer. I’m not saying you shouldn’t do it, just that you need to have perspective.
Here’s my perspective – You need to appreciate the complexity inherent in health plans, and understand that it’s hard for them to buy. They’ve got innumerable distractions and challenges competing for their time, attention and money. Their crazy, ‘irrational’ business environment has developed over years, even decades, as a response (or a defense mechanism?) to the very business factors listed above. In fact, you go a long way toward establishing your own credibility and industry knowledge by making sure your customer knows “you feel his pain.” Trust me, it’s there.
Perhaps counter-intuitively, the pain is the good news. Without the sea of troubles, the strum und drang, the agita and kvetching(enough yet?), selling to payers would be easy. Or at least a lot easier. And if it were easier, you might not be needed. And who doesn’t want to be needed? Instead, take a few deep breaths, practice your empathy and embrace the challenge.