The health insurance industry has some serious problems, from rising costs to lagging quality to political and business uncertainty. Payer executives and policy experts gathered in Austin, Texas, earlier this month to share their frustrations. But they also put the focus on strategies and solutions to navigate extraordinary change.
Speakers at the 2017 America's Health Insurance Plans Institute shared advice on how to combat rising healthcare costs, boost quality and address social determinants of health. They talked about how to use technology and data to transform patient-centered care. And they tackled payment reform and the power of collaboration.
Read on for a roundup of FierceHealthcare's coverage of the event.
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.
If you’re feeling worn down by the drama and uncertainty of a possible repeal and replacement of the Affordable Care Act and other changes in the healthcare landscape, former HHS secretary Michael Leavitt has some encouraging words for you: In the big scheme of the country’s evolving healthcare system, this is but one chapter in the middle of a 15-chapter novel.
And at the end of the book, there will be a “uniquely American” solution.
It’s “abundantly clear,” he said, that “we want to live in a country where people get care when they need it.” At the same time, he said, it’s clear that the healthcare system has an economic problem.
Eric Topol, M.D., has performed a full-body scan of himself using a smartphone and a mobile ultrasound device. He imaged his carotid artery, his liver, his kidney … even his left foot.
He calls it a full-body selfie and predicts that more folks will use these types of devices at home—no referral, doctor’s appointment or costly trip to the emergency room required.
“This is the modern stethoscope,” he said.
As health insurers seek to manage rising oncology costs, UnitedHealth executive Lee Newcomer, M.D., has two blunt pieces of advice. First, when it comes to the frustratingly high prices for cancer treatment drugs, accept that “you can’t do a thing about it,” Newcomer, UnitedHealth’s senior vice president of oncology and genetics, said during a session at the event. Second? Don’t bother with bundled payments.
As health insurers face increasing pressure to bring down costs, their focus naturally turns to working with high utilizers of healthcare. But given how much of one’s health is determined by social factors, this has proven to be no easy task.
During this year’s AHIP Institute & Expo, health plan leaders shared some of the innovative ways their organizations are tackling the steep challenge of helping members live healthier lives. Among them: “It is poverty that drives most of the social determinants of health,” said John Lovelace, president of UMPC for You and president of government programs and individual Advantage products.
While primary care doctors are far from the biggest culprits in terms of driving up healthcare costs, they are uniquely positioned to take the lead in payment reform efforts, two executives said at the event.
Primary care doctors do account for a small share of costs relative to specialists, said HealthPartners Health Plan Medical Director and Senior Vice President Charles Fazio, M.D. But they also wield considerable influence because they are often the touchpoint for a patient’s interaction with the entire healthcare system—including referrals to specialists.
“We put our bets on primary care and giving them the tools and resources to control the costs of care,” said Alicia Berkemeyer, vice president of enterprise primary care and pharmacy programs for Arkansas Blue Cross and Blue Shield.
The United States has a crisis on its hands when it comes to high drug prices, said Harvard Pilgrim Health Care President and CEO Eric Schultz.
However, the solution is not to “throw out the baby with the bathwater” and stop pharmaceutical manufacturers from creating new, innovative products that save lives.
That’s where value-based pharmaceutical pricing contracts with manufacturers such as Eli Lilly come in, as the goal is to tie payments to efficacy of drugs.
Many view the Centers for Medicare & Medicaid Services as the proverbial “800-pound gorilla” in healthcare, acting as the driving force for change in areas like payment reform.
But the reality is that private-sector payers are also major catalysts for innovation, said Patrick Conway, CMS’ chief medical officer and deputy administrator for innovation and quality.
And “if we go together in the same direction, that’s where it gets really interesting,” he said.
While the individual market is a hot topic in the industry these days, employer-sponsored insurance remains a vitally important—if less headline-grabbing—business line for health insurers.
To get a sense of how larger industry trends are affecting insurers that sell these policies, FierceHealthcare sat down with Adam Beck, AHIP’s vice president of employer health policy and initiatives, and commercial exchange policy and operations.
From care coordination to value-based payment models to scrutiny of risk adjustment practices, there's a lot going on in the Medicare world.
No one knows this better than the in-house experts from the health insurance industry’s largest trade group, America’s Health Insurance Plans. So FierceHealthcare sat down with Tom Kornfield, AHIP's vice president of public programs policy and federal programs, to pick his brain about the biggest issues and trends surrounding the Medicare and Medicare Advantage programs.
FierceHealthcare invited more than 20 payer and provider executives to dinner during the conference to talk about one of the biggest trends in healthcare today: collaboration. In the free-ranging discussion, they offered advice and strategies to help health insurance companies build better relationships with doctors.
It starts with recognizing physicians’ biggest pain point: The increasing weariness they feel over taking time away from their patients to fill out paperwork, dig through data and perform other administrative tasks to meet the obligations of their payer contracts and get paid for their work.
From large, risk-sharing financial arrangements to small pilot programs to improve the patient experience, payers and providers are increasingly collaborating to improve care, lower costs and engage patients.
But payer-provider collaboration is also a fairly new concept (at least in the slow-to-adopt world of the healthcare industry). Us-versus-them attitudes built sturdy walls between payers and providers long before value-based payment models and other market forces made collaboration an essential part of doing business.
The holy grail of data-sharing is integrated clinical and claims data. Executives who talked to us at this year's AHIP meeting said health information technology and data are key to collaborating across settings. But there are plenty of barriers, from cost to interoperability challenges to lingering distrust between payers and providers.
“The biggest problem at the operational level is sharing data that’s meaningful and digestible,” and that physicians can synthesize and use to make decisions at the point of care, one executive said.