Accountable care organizations are taking hold across the country, blurring the line between healthcare insurers and providers so that payers as we know them may not exist a decade from now, according to a panel discussion this morning at the ACO Summit in the District of Columbia.
In fact, as many as 50 percent of delivery systems say they will be in the insurance business in the coming years.
Despite these new entrants into the market, WellPoint Chief Medical Officer Samuel Nussbaum, M.D., said payers will continue to exist, but in a different form due to the transformation of the healthcare industry. They won't go off the map completely as there's still a gap in providers' ability to manage population health, have the necessary data analytics and coordinate comprehensive care, he said.
So what could payers look like in the blurred future? Aetna pointed to its strategy of virtual integration. "You won't see Aetna buying groups or hospital systems," said Joseph Zubretsky, senior executive vice president of national businesses at Aetna. Instead, the insurer will partner with providers in collaborations.
Nussbaum also touted the use of vertical integration to provide the data foundation, advanced analytics and reporting needed for ACO success. He also highlighted WellPoint's pyramid of payment innovation and provider partnerships. "Partnership means each organization contributes what they can do best and what they know best, and they work together to educate each other," Nussbaum said.
He added that payers can play a role in the nexus of information and care, given they can best know which patients receive various pharmaceuticals as well as lab information. UnitedHealthcare CMO Samuel Ho, M.D., agreed, saying the role of the health plan and provider will remain distinct because each makes key contributions.
"As a health plan, we can help patients navigate the system, help them find the right financing mechanism, but we can't take care of people," said Aetna's Zubretsky.