AHIP Institute: Delivery system reform key to lower healthcare costs

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LAS VEGAS--Better healthcare at a lower cost is indeed possible--but only if payers and providers collaborate and embrace the potential of technology-driven care models, panelists said at the 2016 AHIP Institute on Wednesday.

For Sentara Health, an integrated health system in North Carolina and Virginia, collaboration between health plans, hospitals and physicians is “absolutely essential” as the system moves from fee-for-service to value-based care, according to CEO Emeritus David Bernd.

“In the past, there’s been too much head-to-head combat between providers and health plans,” he said.

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But collaboration isn’t enough--there must be aligned incentives for all partners across the healthcare system, he added, as well as economic models that support high-quality, low-cost care.

Bernd’s organization has had success furthering these goals most recently through the Sentara Quality Care Network--which aligns its health plan, Optima Health, with physicians--thanks primarily to the sharing of health data that helps to manage patients across the continuum.

Reimagining the system is also the goal of well-known payer-provider hybrid Kaiser Permanente, according to Chairman and CEO Bernard Tyson. In an era of healthcare reform, he said, one of the primary challenges for the industry is to connect the two main parts of the Affordable Care Act--insurance reform and delivery system reform.

“We are a big believer that the chassis of fee-for-service is not the right chassis for the healthcare system,” he said. “But we’ve designed the healthcare system around that chassis, so it’s not just about changing the economics.”

Thus, Tyson said, Kaiser Permanente is “reimagining ambulatory care” by creating new ambulatory centers where the aim is for people to linger and educate themselves about maintaining health, as well as turning to technology. Last year the system had more than 23 million virtual e-visits, and the organization is in the midst of building a new digital platform for telehealth visits.

Indeed, to former U.S. Sen. William Frist, M.D., telehealth is one of those few solutions that increases the capacity of the system by improving access to care while also driving down costs.

There is “no question” that payers will embrace access to telemedicine, he added, but in doing so health plans must insist on quality measures and achieve patient buy-in.

“Unless patients actually engage and use the system, “he said, “it does you no benefit as the payer, it doesn’t do the patient any good, and it doesn’t do any good for society.”

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