Alan Murray on Affordable Health Insurance

As president and CEO of the North Shore-LIJ CareConnect Insurance Company, Alan Murray ensures that CareConnect remains focused on delivering personalized, integrated service to its customers. He recently discussed how to balance health care access with affordability in metropolitan New York’s diverse, challenging market.

This is the third part of Blog onHealth’s Health Care Leadership series.

Question from Interviewer: CareConnect is a unique model as a first provider plan in New York State. How did the idea come about and how did you get to this point today?

Alan Murray: The idea was many years in the making. At first, North Shore-LIJ’s own employee insurance plan focused care into the health system, its physicians and all of the great delivery systems it offers. It showed that a network that encompasses those entities could work. That was 50% of the puzzle.

The other 50% was the changing nature of health care--the reform on payment, the migration toward care coordination and risk. How do you get to a place where you can drive business toward the health system and coordinate it in a fashion that is meaningful to consumers? You can invest a lot of money in population health, analyzing risk and financial models. Or you can build an insurance company that offers all of that already, add a license and sales and distribution and get the best of both worlds. You then bring insurance products to the market that are unique and different. And you also get all of that intellectual property and human capital that allows you to manage care and do it differently. That is the rationale behind how CareConnect came to be and what took us to early 2013, when we started applying for our insurance license.

Q: Why would you now offer broader insurance?

Mr. Murray: North Shore-LIJ is known as a hospital system. But besides hospitals, it offers an immense, vertically integrated delivery system. There are almost 2,700 staff physicians and thousands more affiliated with North Shore-LIJ. The health system has laboratories, radiology, home care, hospice--everything you need. That type of network brings together everything necessary for integrated, coordinated care.

Q: Why should customers enroll in CareConnect versus a better-known insurance brand?

Mr. Murray: We thought very carefully about that question: Why choose CareConnect when you can come to North Shore-LIJ facilities through any insurance company?

Health insurance is incredibly complex. If you think about it, you have deductibles, co-pays, co-insurance, medical necessity. You have all of these acronyms that most consumers aren’t familiar with. They just try to get through it and there is nobody out there to help them. CareConnect is part of a trusted, integrated health system. We bring the two together to simplify health care, and provide an experience you cannot get in this industry. That is the reason why people would choose CareConnect.

Why would consumers buy CareConnect? You have to have the right pricing. Nobody is going to pay more for a smaller network. The North Shore-LIJ Health System anchors the network, with additional providers to complete the rest of our geographical area.

Standing Out in a Crowded Field

Q: What differentiates CareConnect from its competitors?

Mr. Murray: First, there is price. We are far more affordable than the established insurance companies. You are going to have more money in your pocket once you have chosen CareConnect.

Second, we interact on your behalf within our network. We will set up appointments, working with the customer through episodes of care. For instance, we schedule the MRI, the lab work and the surgery. We already have customers who say CareConnect has saved their lives as a result of these services.

More important than what we do, is how we do it. Of 100,000 incoming calls this year, our average answering speed was six seconds. CareConnect customers talk to a live human being, somebody who lives locally, who is on the phone to look after you. That is not something you get in health insurance. That is the real reason why you want to trust us.

Q: How many members do you have today? Where do you think that membership will be in two or three years?

Mr. Murray: We had just under 15,000 members in 2014—the first year we started. Which, by the way, is a great population. It allowed us to show that we can do everything we promise.

I expect CareConnect to enroll in excess of 100,000 within the next three years. That is plausible because of our affordability. And the way we interact with our providers would, I hope, keep the trend on medical costs down. More than that, once people experience CareConnect, they tell their friends, their families and their communities and we attract more customers.

Q: What are your growth plans?

Mr. Murray: We started from a growth perspective: Where are we today and where do we go? We started around the counties that North Shore-LIJ had a hospital--Suffolk, Nassau, Queens, Staten Island and Manhattan. For 2015, we will be in Brooklyn, the Bronx, Westchester, southern Connecticut and New Jersey.

The key point though is not just size, it is what you do with the network, even now that our geographic presence has enlarged.

Q: These kinds of plans seem to be becoming more popular. Why is that so?

Mr. Murray: CareConnect offers what is called an EPO, an exclusive provider organization, which means it offers only in-network service. The reason EPOs are popular is price. Once you start adding out-of-network service, the premium price goes up substantially to cover an unpredictable use of other providers. Current EPO products offer a lot more value.

Q: Who are your competitors? Will they change over the next two or three years?

Mr. Murray: CareConnect’s competitors are the traditional insurance companies in the employer group business --UnitedHealthcare, Wellpoint (Empire Blue Cross/Blue Shield), Cigna, Aetna. Individual market competitors include the Health Republic co-op and Oscar. We are driving such a different model and pricing structure that it is causing much larger, established entities to change the way they interact with the consumer. Over the next three years, we are going to be in a very different world.

To see more of this interview, go to: http://bit.ly/1xrzaDI