By Natalie Wilson
On Tuesday, May 5, Maureen O’Connor, a retired executive of Blue Cross Blue Shield of North Carolina who was named as one of 12 “People to Watch” in 2014 by Triangle Business Journal, one of the nation’s “100 Women to Watch” in 2009 by Diversity Journal and one of 10 “Women Extraordinaire” in the Triangle by Business Leader Media, shared insights about how startup companies could impact pain points in the healthcare industry today.
Although her presentation, “Healthcare is Complicated – Opportunities and Challenges for Entrepreneurs” was intended for those on the business side of healthcare, she noted that it was relevant to everyone in attendance.
“We are all healthcare consumers,” O’Connor said. “And we can all agree that our healthcare system isn’t working like it’s supposed to.”
O’Connor likened her own dynamic career path to that of an entrepreneur. Although O’Connor worked in healthcare for 35 years, initially on the legal side, her role in the industry shifted numerous times—from policy to strategy and innovation and finally to venture investing through the investment arm of Blue Cross Blue Shield of North Carolina, Mosaic Health Solutions. “I’m very curious. I like learning. That doesn’t change with age,” said O’Connor, who now also serves in retirement on the advisory board of five early-stage startups.
At Blue Cross Blue Shield, O’Connor said she had a chance to see how the dominant stakeholders in healthcare — including insurers and healthcare delivery systems — wanted to change the current state of U.S. healthcare but were at a loss as to how to do so, being heavily entrenched in the status quo.
“Our country is the best at lots of things, but when it comes to healthcare, we are so average it’s depressing,” O’Connor said. “In fact, by many metrics we are below average. … We spend double on health care what is spent by the next developed country, yet we aren’t getting value for our spend.”
O’Connor identified key areas of opportunity where startups could focus to begin shifting the paradigm, including:
Simplifying billing, collections, or scheduling processes for payers and providers;
Offering more affordable delivery channels;
Introducing new, cheaper, faster technologies for health care diagnoses;
Bringing healthcare closer to the consumer and closer to home;
Designing systems around patients;
Addressing social factors such as access to adequate nutrition, transportation and housing when delivering care and
Remembering the “human element to healthcare.”
O’Connor also described some of the challenges to reaching the consumer directly as startups do in so many other sectors. The presence of numerous “middlemen” in health care make it difficult for consumers to self-select the specialists and doctors that are the best or most affordable options for them. Instead, their choices are driven by insurance benefit design, provider networks and physician referrals to each other. Even when O’Connor invited startup founders in attendance to share their business models and ideas with the crowd, she pointed out that while their solutions impacted consumers, they still didn’t directly engage with them.
“The healthcare norm is to be one step removed from the consumer,” O’Connor said. “That has to change. Always bring yourself back to the human.”
Finally, in response to a question from an entrepreneur in the audience, O’Connor pointed to data portability efforts as a key area for change. “We have lots of data but haven’t been using it to leverage insights,” O’Connor said. “People are really worried about privacy, but with financial services the same was true, and they figured it out.”