At congressional briefing, health plan execs detail innovations

Health insurance companies are playing a major role in transforming the healthcare system--with innovative ideas from value-based payment models to establishing retail centers to serve members.

At a recent congressional briefing hosted by the National Institute for Health Care Management Foundation, healthcare leaders spoke about some of the new innovations transforming the industry. Patrick Conway, M.D., acting principal deputy administrator at the Centers for Medicare & Medicaid Services, said the agency will continue to tie Medicare payments to quality and value, efforts that have already reduced deaths, hospitalizations and costs.

Blue Cross Blue Shield of Massachusetts has been a leader in payment reform with its Alternative Quality Contract, president and CEO Andrew Dreyfus said at the briefing. The initiative establishes a global budget for provider groups that covers all medical services, provides quality incentives and includes long-term five-year contracts. The result has been medical cost savings and increases in quality, he said. Support for physicians and hospitals has been key, with the health insurer providing regular reports and quality data to physician groups and convening groups to share information about topics such as end-of-life care.

In fact, the future of healthcare is likely to see changes in the way payers and providers traditionally operate, with integrated systems and partnerships becoming more common.

In Florida, GuideWell and Florida Blue, which covers 7 million people in the state, is transforming from an insurance company to a health solutions company, said chairman and CEO Patrick Geraghty. For instance, the company has set up retail centers where customers can go to get a claim resolved on a face-to-face basis. Instead of a big building on a city skyline where customers never enter, "we've put ourselves on the front line," Geraghty said, with 350,000 unique member visits last year to its retail centers and a 92 percent customer satisfaction rating.

The company has also partnered with a South American company to create its CliniSanitas clinics in South Florida to provide one-stop shopping tailored to meet the needs of Hispanic members.

Startup companies such as Oscar and HoneyInsured also are increasingly disrupting the health insurance sector, FierceHealthPayer has reported.

To learn more:
- listen to the webcast of the briefing

Suggested Articles

Physician groups slammed a court ruling that overturns CMS' site-neutral payments rule for clinic visits.

Sixteen medical professionals, including six doctors and seven pharmacists, were among those charged in a Texas healthcare fraud and opioid takedown.

Blue Shield of California is piloting transportation benefits with some of its members in Sacramento.