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Jennifer-Leigh Oprihory/MEDILL

Nancy Turnbull, an associate dean at the Harvard School of Public Health, speaks with conference attendees following her keynote address at the Kellogg School of Management's "Transformations in Healthcare" Business of Healthcare conference on Friday night.

Dear Nancy: advice from Massachusetts’ adventures in health care

by Jennifer-Leigh Oprihory
Nov 20, 2012


Jennifer-Leigh Oprihory/MEDILL

Nancy Turnbull shares time-tested advice from her experience working with health care in Massachusetts with industry insiders and students at the Kellogg School of Management's "Transformations in Healthcare" Business of Healthcare conference on Friday night.


Jennifer-Leigh Oprihory/MEDILL

Kellogg graduate student and conference co-chair Lindsay Fujita hoped that the conference would spark strategic approaches to new challenges in health care.


Jennifer-Leigh Oprihory/MEDILL

Fellow Kellogg graduate student and conference co-chair Saurabh Shah shared Fujita's vision, looking forward to "creative solutions" to the problem of balancing quality care with corporate sustainability.

According to Nancy Turnbull, the federal government has a lot to learn.

About health care, that is.

Turnbull, an associate dean at the Harvard School of Public Health, shared insights from her experience working with state-subsidized healthcare in Massachusetts, passed when Mitt Romney was governor. Her goal was to help industry insiders and students ease the transition into the age of the Affordable Care Act.

Specifically, she tackled the dynamics of the health-insurance exchange, the state- or federally run marketplace where individuals or small businesses can shop for insurance.

First, she said, parties are screened for Medicaid or tax-credit eligibility and redirected accordingly.

Then, she explained, those who aren’t eligible for Medicaid are redirected to an online marketplace where they can shop for insurance plans, based on categories such as price, network physician availability and benefits provided.

As per the dictates of the Affordable Care Act, she said, any state that doesn’t implement an exchange by 2014 will be subject to federal intervention, wherein the government will either institute a federal exchange or a state-federal partnership will be put in place.

She spoke to an audience of about 100 Friday night as part of the Kellogg School of Management’s “Transformations in Healthcare” conference in Evanston.

“I’m an evangelist for expanding health-insurance coverage,” said Turnbull in a post-talk interview. “There’s been so much disinformation and misinformation and lack of understanding about the federal health reform law, that I wanted to … show them what we’ve achieved in Massachusetts and get them excited about the possibility of doing the same on the national level.”

The key to doing this, Turnbull told her audience, lies in remembering five things.

First, marketing is key.

“It’s not enough just to put in place new programs,” Turnbull said. “You have to actually find the people who are eligible for them and get them enrolled.”

According to Turnbull, these efforts should include (but not be limited to) grassroots, corporate and non-profit outreach, as well as marketing campaigns designed to appeal to both the already-insured and uninsured.

She said special attention needs to be paid to targeting young men, since research showed they were the toughest demographic to tap into when marketing insurance-related messages. One Massachusetts-born approach she shared with the crowd was doing a marketing campaign centered on mothers and grandmothers, since research showed that young men value their female relatives’ opinions when making insurance-related decisions.

Next, she said, don’t be surprised when people opt out of the system. Some may find it cheaper to pay fines than buy into a plan with their desired level of coverage.

Third, she said the increased transparency a health insurance exchange provides — by allowing for side-by-side comparisons of coverage plans — has impacted the public’s approach to choosing an insurer and, thus, led to the emergence of a sharper consumer.

Fourth, she warned that the process of selling small business owners on investing in a health-insurance exchange may prove difficult, explaining Massachusetts’ difficulty in marketing insurance to such parties.

Finally, Turnbull cautioned attendees to expect the widespread expansion of insurance coverage won’t end the dialogue on health-care cost, but, rather, amplify it.

But though she referred to what was achieved in Massachusetts as having been “hard work,” Turnbull used data charting Massachusetts’ achievement of the lowest rate of uninsured people in the United States. She did so to motivate the audience into realizing that the necessary effort will be worthwhile in the long term.

“The federal law, which is modeled after the Massachusetts law, can be enormously successful at increasing the number of people in our country that have health insurance, and, as a result, improving their health, giving them better access to care, and giving them better financial security,” Turnbull said.

Kellogg students Lindsey Fujita and Saurabh Shah, co-chairs of the conference, said this kind of dedication to motivating health-care industry players to meet change with strategic planning and innovation at heart drove their efforts.

“With the health-care reform, there are going to be many more people getting the health insurance, as well as coming into the delivery practice,” Shah said. “How do we deliver excellent-quality care to these people while maintaining sustainable organizations? I hope that the conference attendees and the speakers together could discuss what could be some of the creative solutions.”

Fujita agreed.
“I really believe that the people that are attending this conference will help shape the future directions of health care, and so hopefully they get inspiration to do that,” said Fujita.