NASHVILLE — A panel of top executives, including a major provider, payer and former CMS chief opened America's Health Insurance Plan's annual meeting with some soul searching and a call for the industry to disrupt itself.
"Unless we have the will and we are willing to break some real glass, that is not going to happen," Stephen Klasko, CEO at Philadelphia-based Jefferson Health, said at the insurance trade group's conference Wednesday, concluding a discussion on the biggest barriers to fixing the cost and quality challenges within the U.S. system.
Disruption is needed across a range of areas, from fixing financial incentives to the need for partnerships across the sector, between providers and payers but also with genetics companies and those focused on home health, panelists said.
"Even when you own the hospital system, it is a challenge," Highmark Executive Vice President Brian Setzer, whose employer is currently locked in a high profile legal battle with rival UPMC, said.
Blue Cross Blue Shield's Highmark is making a "massive investment in anchor partners," and health systems should focus on what they know best and work with specialists in other areas, he said. "We need to figure out where we are going to make a few bets. You can't have 87 bets going on," he said.
Othman Laraki, CEO of Color, touted the genetic testing company's recent analysis of population-level data in Alaska seeking to identify patients who are at risk for heart disease before they get sick. "We assume capacity is fixed," Laracki said, "[but] we can change the mix of people going through the system."
Disruption is also needed the within home health sector, Seth Sternberg, CEO of home health startup Honor, said. "Today, a whole bunch of customers pay us for time they really shouldn’t be paying us for," he said. "They don’t really need us ... while they are sleeping."
Former Acting CMS Administrator Andy Slavitt, who worked under President Barack Obama, said health executives need to tamp down the relentless focus on revenue. Slavitt has called for capitation or other measures to limit costs.
"We can't have a conversation without having a conversation about unit cost," Slavitt, who worked in the private sector, including at UnitedHealth's Optum unit, before taking the CMS job, said.
Slavitt added: "The problem with the premise of growing at inflation is that people can't afford the system today. If they could, we could grow at inflation."