AUSTIN, Texas—Despite all the steps that the healthcare industry has taken to change with the times, to Anthem CEO Joseph Swedish, it still must do better.
“The industry that we all know and love has tremendous shortcomings,” he said in the opening general session at the 2017 AHIP Institute & Expo.
Easily the biggest and most pressing of these issues is rising costs, he said. In addition, too often the quality of care is less than optimal—it is delivered too late, not well coordinated and in some cases, not effective.
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What’s more, even though the industry is on the right path in the move to value-based care, it is still coming up short when it comes to delivering truly holistic care, Swedish said. Insurers, he said, must do more to meet members’ growing need for preventive and wellness services.
For its part, Swedish said, Anthem is tackling these myriad challenges by embracing four strategies:
- Collaboration: A major trend in the healthcare industry is a blurring of the lines between provider and payer, Swedish said, noting that “creates a new norm with respect to how we do business.” To respond to that new norm, Anthem is building deep connections with the provider community through collaborative arrangements like one it pursued with Connecticut-based Hartford HealthCare, which focuses on providing enhanced care management for the chronically ill. Overall, he noted, Anthem is now paying 58% of reimbursement to providers through value-based models.
- Managing the total cost of care: Consumer research shows that affordability is the most important factor guiding customer decisions about their health plans, Swedish said. To Anthem, the best way to improve affordability is by focusing on cost of care at both individual and population level. It achieves this by interacting with members to better manage care, leveraging data to better support members’ needs, monitoring abuse and reducing drug costs through formulary management, among other strategies. The overall effort to better manage the total cost of care, Swedish said, helped the company achieve $1.9 billion in savings in year.
- Consumer centricity: In addition to partnering with external technology companies, Anthem created its own innovation studio that helps the company better understand the needs of customers, how to model innovations that are applicable to those needs, and how to bring them to market rapidly, Swedish said. One example of a consumer-focused initiative that emerged from the studio is a notification tool called “What’s My Status?” which proactively sends updates to members about the status of their claims and authorizations.
- Quality: “We don’t see quality as just a clinical goal," Swedish said. “It’s an enterprisewide priority that encompasses customer service, compliance and wellness.” In Medicare Advantage, for example, Anthem’s decision a few years ago to make a "rigorous" effort to boost the quality of its plans is demonstrating results. Now more than half of the insurer's MA enrollees reside in 4-star plans, compared to just 22% the year before.
Looking toward the future, Swedish acknowledged that the daunting challenges that the healthcare industry faces won’t be solved quickly. However, despite the fact that some would say the industry is facing the “worst of times,” he took a more optimistic view.
“I really do remain encouraged about what lies ahead,” Swedish said, adding, “I’m a great believer that all these uncertainties will create great outcomes for us moving into the future.”