AHIP18: CEO warns payers of urgency for 'change and innovation'
SAN DIEGO — The annual meeting of America’s Health Insurance Plans kicked off with a warning.
AHIP CEO Matt Eyles said that consolidation and rising healthcare costs are reaching a breaking point.
“The urgency for innovation and change is accelerating,” he said.
The gathering comes on the heels of big news from a potentially fierce competitor — one that could seek to cut payers out of the healthcare equation. Amazon, J.P. Morgan and Berkshire Hathaway tapped a CEO for their new joint venture aimed at tackling employee healthcare costs.
Their choice, New Yorker staff writer and Harvard Medical School surgery professor Atul Gawande, is scheduled to address the conference Thursday morning.
While the exact nature of the new company isn't clear, insurers are clearly keeping a close eye on its progress. Eyles message to the cohort was simple: “Bring it on.”
But those big names and deep pockets may further push payers to focus on how to improve in a few key areas, including customer service, data analytics and patient engagement. Early conversations at AHIP touched on all of these issues, and more.
Managing chronic diseases, complex care
Chronic diseases are difficult and costly to treat for a number of reasons. Effective treatment is important, catching them early is even more key and preventing them in the first place is ideal. Some emerging avenues for accomplishing those goals include population health management and motivating patients to understand and act on personal best practices.
Personal responsibility can go a long way, but Leana Wen, health commissioner for the city of Baltimore, said it isn't that simple.
“Any time we talk about choice we have to recognize that choice is predicated on privilege,” she said, adding that in Baltimore one in three black people live in a food desert compared to one in 12 white people.
Payers must understand the culture and communities surrounding their members if they are going to engage them and help them access the most appropriate and effective care.
Esteban López, chief medical officer at Blue Cross and Blue Shield of Texas, said he knows he can often engage a Latina woman, for example, by appealing to a strong sense of family and her desire to be healthy so she can spend time with her children and grandchildren. Such cultural competency is key to knowing how to drive behavior, and that presents a hefty challenge in the U.S. “We don’t live in a homogenous society,” López said, so treating everyone the same won’t produce equal health outcomes.
Payers and providers are homing in more on the health effects of factors like loneliness and toxic stress, which can exacerbate opioid abuse, heart disease and numerous other long-term conditions. As the industry understands more about these topics there is potential for major headway, but it won’t happen through purely traditional methods.
A case for optimism
Ezekiel Emanuel, former health policy adviser to President Barack Obama, said there are tried and true methods for reducing costs while improving care quality and health outcomes.
Practices across the country are using these ideas, many of them successfully, if not comprehensively.
Emanuel said he’s seen this while traveling to doctors’ offices across the country in the past several years. “I’ve been wildly impressed, and it makes me very optimistic about the American healthcare system,” he said.
The best path involves using bundled payment models for specialty care and capitation for primary care. “The further we get toward bundled payments and capitation, the more empowered we are to decide how care is best designed for our patients,” Emanuel said.
Bundled payments save money by shifting post-acute care to the home; reducing prices for implants and inputs; increasing efficiency through shorter procedures; and moving care toward lower-cost facilities like ambulatory surgical centers and physician offices. These changes bend the cost curve, but can also give doctors more autonomy in determining the most effective care for a patient, he said.
Emanuel isn't, however, running eagerly toward the latest in high-tech medical tools. The evidence just isn't there for concrete benefits from mobile apps, wearables and the like. The studies have been done, but the results aren't impressive. “Over and over they come to the same conclusion,” he said. “It makes no difference.”
Virtual medicine has promise for some specific applications, but it can’t — and shouldn't — replace the traditional doctor-patient relationship. It can supplement that relationship, but the effect is limited. “Virtual medicine cannot change behavior by itself,” he said.
Emanuel also cautioned that new payment models and other changes take time to show results. “Transformation happens over the course of time,” he said, adding: “We need to be patient and not bury things prematurely.”
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