National Affordability Summit
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Below you will find information and recordings related to our National Affordability Summit held in September 2017.
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Visit the forum to find insights and connections from those who attended the live event as well as contributions from those who joined the conversation virtually.
A shared urgency to reduce health care spending while improving quality recently brought together health policy experts, physicians, employers and regional health care leaders from around the country for a National Affordability Summit convened by the Network for Regional Healthcare Improvement (NRHI), with support from the Robert Wood Johnson Foundation.
NRHI works with national thought-leaders and with those who provide, pay for, and use health care in regions from Maine to Hawaii. Its members and their partners are the “HealthDoers” addressing these problems through shared community action in each of their communities. Many NRHI members serve as data stewards for their states and regions, aggregating and sharing claims and/or clinical data or data reflecting experience of care. NRHI members also are leaders in quality improvement, population health management, and practice transformation. In leading innovative transparency and payment reform efforts, they see firsthand what works and what needs to happen next.
At the National Affordability Summit, participants spent the day in deep, often pointed, discussion centered on the changes needed to achieve affordable care and how payment models must continue evolving to support more effective care, reduce avoidable harm to patients and decelerate price escalation.
Access video recordings, slide decks, and join the conversation around various panels by selecting the corresponding button.
Better Care, Less Spending
Arnold Milstein, MD, MPH, Stanford University, Clinical Excellence Research Center
Redesigning Healthcare Delivery and Payment for Higher Value
Harold Miller, President/CEO, Center for Healthcare Quality and Payment Reform
What Needs to Change?
Harold Miller, President/CEO, Center for Healthcare Quality and Payment Reform
Frederick Isasi, JD, MPH, Executive Director, Families USA
David Lansky, PhD, CEO, Pacific Business Group on Health
George Isham, MD, Senior Advisor, HealthPartners
Aparna Higgins, Senior Vice President, America’s Health Insurance Plans
Grace Terrell, MD, CEO, Envision Genomics
Elizabeth Mitchell, President/CEO, NRHI (Moderator)
The Oregon Trail to Cost Transparency
Mylia Christensen, Executive Director, HealthInsight Oregon and Oregon Healthcare Quality Corporation
Katie Dobler, Portland Coordinated Care Association/The Portland Clinic
Amit Shah, MD, Care Oregon
John Santa, MD, MPH
Robert Gluckman, MD, Providence Health Plan
What Can You Do with the Data You Have?
Niall Brennan, President and Executive Director, Health Care Cost Institute
Joshua Rosenthal, Chief Scientific Officer, RowdMap
Craig Brammer, CEO, The Health Collaborative
Alan Gilbert, Director, Global Government and NGO Strategy, GE healthymagination
Elizabeth Mitchell (Moderator)
Navigating Cost Transparency- Don't Go It Alone!
Cecilia Ganduglia Cazaban, MD, DrPH, Asst. Professor, Management & Policy Sciences Co-Director, Healthcare Data Center, University of Texas
Jonathan Mathieu, PhD, VP for Research and Compliance, Chief Economist Center for Improving Value in Health Care
Meredith Roberts Tomasi, Senior Director, HealthInsight Oregon and Q Corp
Dolores Yanagihara, VP of Analytics and Performance Information Integrated Healthcare Association
Daniel Wolfson, Executive VP and COO, ABIM Foundation
Voices From the Field
A RHIC’s Perspective- Craig Brammer, CEO, The Health Collaborative
A Physicians Perspective- Grace Terrell, MD, CEO Envision Genomics
How Primary Care Physicians Can Lead the Charge For All Stakeholders - Arnold Milstein, MD, MPH, Clinical Excellence Research Center, Stanford University
A Health Insurance Plan's Perspective on Affordability- Aparna Higgins, Visiting Scholar with the Heller School of Social Policy and Management at Brandeis University, and former Vice President with America's Health Insurance Plans (AHIP)
Better Care Less Spending
Voices From the Field
A RHIC’s Perspective
Craig Brammer, CEO, The Health Collaborative, discusses RHICs involvement in affordability; America's needed shift in thinking about healthcare costs.
A Physician's Perspective
Grace Terrell, MD, CEO, Envision Genomics, shares a physician's perspective on making healthcare affordable.
How Primary Care Physicians Can Lead the Charge for All Stakeholders
Arnold Milstein, MD, MPH, Clinical Excellence Research Center, Stanford University, discusses how primary care physicians can lead the affordability charge for all stakeholders.
A Health Insurance Plan Perspective
Aparna Higgins, Visiting Scholar with the Heller School of Social Policy and Management at Brandeis University, and former Vice President with America's Health Insurance Plans (AHIP) offers perspective on how health insurance plans can work with other stakeholders to make healthcare more affordable.
Regional Recaps from the National Affordability Summit
In September, CIVHC staff, along with representatives of four key Colorado stakeholder groups, had the great privilege to attend a National Affordability Summit hosted by the Network for Regional Healthcare Improvement (NRHI) in Washington, DC. The event drew more than 200 people from around the US to discuss why health care costs so much and what can be done to control spending. Key objectives of the Summit were to:
- Gain a deeper understanding of health care cost drivers and innovative approaches to reducing spending, and
- Learn how to leverage cost information to enable key stakeholders to take actions that contribute to greater health care affordability.
Colorado stakeholder attendees included: Adela Flores-Brennan, Executive Director, Colorado Consumer Health Initiative; Chris Klene, Project Coordinator, Center for Health Progress; Janet Pogar, Regional Vice President - Network Management, Anthem Blue Cross Blue Shield; and Sara E. Miller, Chief Executive Officer, Trailhead Institute. CIVHC staff attending the Summit included Ana English, Jonathan Mathieu, Kristin Paulson and Tamaan Osbourne-Roberts. Several members of the Colorado contingent were able to attend thanks to financial support from the Robert Wood Johnson Foundation.
Much of the early discussion focused on themes that will not surprise those familiar with the US health care system and its many challenges. Presentations in the morning sessions emphasized that we are on an unaffordable, unsustainable and potentially ruinous path when it comes to health care spending. A common message throughout the Summit was that greater transparency, access to data and actionable information are fundamental to realizing meaningful health system change.
It’s the Prices!
Several presentations highlighted research indicating that health care cost and spending increases are mostly driven by price increases that greatly exceed the overall rate of inflation. Industry consolidation and lack of meaningful markets and competition, particularly in rural areas, were cited as contributing factors. The words “price gouging” and “extortion” were used in the course of these discussions. One stakeholder noted that practices such as balance billing for out of network services, unknown to the patient when those services are delivered, drive costs and spending increases and undermine trust in the system.
Others highlighted that healthcare costs are the largest single factor contributing to a lack of growth in wages and incomes for working families. Importantly, these presenters also noted that less spending necessarily means less revenue/income for many health care providers and payers. This reality must be recognized and meaningfully addressed in policy discussions and through thoughtful system redesign.
There is No Magic Solution
Incentives built into the current health care system encourage inefficient, ineffective and unnecessary use of many services. One presenter noted that incentives under pay for performance (P4P) programs are not really any different from traditional fee for service (FFS) going on to say that, “we have studied P4P to death and it does not reduce overall costs.” Other themes that emerged from this discussion included:
- We cannot be afraid to try new things
- If something is going to fail, let it fail fast
- It is important to understand what didn’t work, and why
- A mix of innovative approaches is necessary.
How do we get to Affordability?
- Through a health system that creates incentives for providers to deliver the right care, at the right time and in the right place. Appropriate incentives would help to decrease the amount of low value care delivered and reduce spending. Such a system would pay providers for keeping people healthy and improving their overall health.
- Implement policies that encourage payers to support innovative, patient-centered care delivery models through financial incentives to providers who are in the best position to try new things.
- Don’t let the perfect be the enemy of the good. One panel emphasized the importance of starting with the data we have rather than waiting for all that might be useful. Many successes in creating disruptive innovations in health care have leveraged existing, free and publicly available data sets.
NRHI members, or Regional Health Improvement Collaboratives (RHICs), are well positioned to leverage their unique data resources and trust relationships in local communities to help inform development of innovative approaches to reducing spending. Actionable analyses highlighting variability in health care utilization, spending and quality, can highlight opportunities as well as provide insights regarding which innovations generate the greatest impact in terms of better care and lower costs.
Last month, the Washington Health Alliance (the Alliance) was fortunate enough to receive a scholarship through the Network for Regional Healthcare Improvement’s Getting to Affordability initiative, funded by the Robert Wood Johnson Foundation, for registration and travel to the National Affordability Summit in Washington, D.C.
I attended the summit with a Washington state delegation, which included representatives from The Boeing Company, Health Care Systems Research Network, King County, MultiCare Connect Care, and Kaiser Permanente Washington.
Having returned from the summit I am eager to share some of our key takeaways. I left the conference feeling optimistic and even more convinced of the importance of the work that regional health improvement collaboratives are engaging in across the country. It was heartening to be in the same room with people from different regions who are passionate about improving the affordability of the health care system, knowing that we are all fighting the same battle.
The overarching goals of the summit were to gain a deeper understanding of why health care costs so much and discuss actionable strategies that can move the market to value. The summit prompted a number of great discussions within our delegation and there are several focus areas and takeaways we wanted to share:
- The meeting started with a story from Families USA about Alma, a young girl and her family who battle cystic fibrosis and the insurmountable costs of care. It was a compelling reminder to all of us that health care is personal, and that it is about individuals.
- Harold Miller, President and CEO of the Center for Healthcare Quality & Payment Reform, gave an insightful talk in which he discussed how the health care payment system is a barrier to finding a solution, because providers aren’t paid for many high-value services. He promoted a bottom up approach where payers adequately compensate healthcare providers who are on the front line of care and hold them accountable for quality and efficiency. Our delegation felt that progress depends on a multi-stakeholder approach, including a top down and bottom up approach.
- Panelists and speakers discussed the importance of local benchmarking and public reporting, including of cost data. They deemed these highly important to move forward toward affordability. I appreciated a quote from Dr. Arnold Milstein of Stanford, who said, “Granular cost data is like a targeted drug on the path to better and less costly care.”
- Niall Brennan, president of the Health Care Cost Institute, said, “Translating data into action is really hard. People can be seduced by organizations that make this sound easy.” This is an area of focus for the Alliance and we are moving toward including “Action Steps” in our reports that can help people move from knowledge to behavior change. However, we know this is a long-term endeavor and requires the participation of many stakeholders.
- Along with reports being actionable, they must be accessible. Our audiences may not have the time to dive in, digest, and discern key takeaways from complex reports.
- One of the broader themes was that we all need to reframe the national health care conversation from one centered on insurance to one focused on the actual cost and quality of care. The public narrative sometimes overlooks the fact that the cost of insurance won’t go down until we tackle the root cause. While this is not new information to those of us in the field, it was a good reminder that we need to do a better job of getting this message out to the general public.
Overall, the summit was a valuable learning experience for our delegation. We were exposed to new ideas, were reminded of the breadth of organizations that are concerned about health care costs, and came away with actionable ideas that we can implement in our work.
Healthcare leaders and policy experts gathered in Washington, DC at the National Affordability Summit hosted by the Network for Regional Healthcare Improvement (NRHI) to discuss the rising cost of healthcare and its growing threat for patients, employers, Government, and the U.S. economy. Themes that emerged from the Affordability Summit are the healthcare payment system is a problem, necessary services are not covered, fee-for-service fosters unnecessary and wasteful care, and over/avoidable spending on healthcare is the biggest driver of cost.
Scholarship funding awarded to the Kentuckiana Health Collaborative by the Robert Wood Johnson Foundation allowed us to assemble a team of regional champions from various stakeholder perspectives for attendance at this summit. The KHC team consisted of Amanda Elder, LG&E-KU (employer), Shelley Gast, Norton Healthcare (health system), and Michael Lorch, Anthem (health plan).
National thought leaders Arnold Milstein, MD, Harold Miller, Elizabeth Mitchell, David Lansky and others shared their views about the healthcare problem, alternative solutions to improve quality and reduce cost, how employers can shape the healthcare landscape and actions that we can take in our communities to promote affordability.
Harold Miller, President and CEO, Center for Healthcare Quality and Payment Reform (CHQPR) spoke on Redesigning Healthcare Delivery and Payment for Higher Value. He stated the biggest driver of health care cost is hospitals followed by insurance administration/profits. The Institute of Medicine estimates 30% of spending is avoidable and 25% of avoidable spending is excess administrative costs. By focusing on spending that is unnecessary and avoidable you can get to better care at lower cost. Barriers in the present payment systems create a win-lose for providers. Barriers are no dollars or inadequate dollars for High-Value Services. The system won’t pay for office services delivered outside of face-to-face visits with clinicians, e.g. phone calls, e-mails, etc. but will pay for an ER ambulance or hospital stay. Harold’s path to affordability is redesigning health care from the bottom up instead of from the top down to achieve better care at lower costs through patient-centered payment. Bottom up Payment Reform asks physicians and hospitals to identify ways to improve care for patients and eliminate avoidable costs → Payers provide adequate payment for quality care & providers take accountability for quality & efficiency → patients get good care at an affordable cost and independent providers remain financially viable. Harold provided examples of healthcare leaders who have successfully implemented this approach for Crohn’s disease, joint replacement, cancer, and Emergency Room patients.
The Affordability Summit was enlightening and a call to action. There is an urgency to reduce healthcare spending and make healthcare affordable. The KHC will work with our members and partners to improve healthcare cost. One initiative we have begun is to develop a common measurement set across all payers.
The KHC team that attended the summit thought the conversation was interesting. Michael Lorch is looking forward to further discussions on affordability. Amanda Elder, LG&E-KU, said “she was very pleased to see transparency is making headway within the industry. Health care can be overwhelming and confusing, even to those who work in the field, however, I think the industry and all players are making strides in this area. A common theme I heard throughout the entire summit was there are various ways to achieve improvements in cost and outcomes”. Shelley Gast, Norton Healthcare, said “What most were proposing sounds good; it may not work in all markets but best quality care at an affordable price is reasonable. What wasn’t talked about at all was the payor. It seems to be more around what the providers can do to eliminate waste and reduce cost of care but they really didn’t mention the payors. That surprised me. All in all I do believe the KY market wants to work on innovative ideas and provide the best care to our consumers. In order for us the provider, to continue to provide this, the physicians and systems need to maintain their margin of 2%. I think it’s going to take everyone making changes, consumers, employers, providers and payors. That’s not easy nor is it something that can happen overnight. We all have the same goal, now we just all need to work together to get there.”
At the Network for Regional Healthcare Improvement National Affordability Summit on September 27, 2017 the conversation focused on the importance of affordability in health care. Many of the panelists spoke about the urgent need to use data to reduce the cost of health care spending. It struck me that many panelists and attendees feel it is imperative that changes be made, and quickly, to address health care spending in the United States.
Harold Miller, President and CEO of the Center for Healthcare Quality and Payment Reform, started the morning by pointing out the ways in which the current payment system has perverse incentives which do not provide patients with the best care. Harold’s insights and suggestions for improving the affordability of health care, while somewhat controversial, were quite insightful. The amount of money which is wasted on health care is shameful and an area ripe for reductions. The health care system, and the larger economy, simply cannot continue to maintain the current cost growth. Health care spending is dragging down the rest of the economy and will continue to do so.
But how do we fix it? Dr. Grace Terrell presented on the work of Cornerstone in North Carolina, which was ahead of its time. Cornerstone is a wonderful example of what can be done, using data and focusing on patient’s needs. It is also a cautionary tale about moving too quickly when the rest of the sector is not ready to make changes. Dr. Terrell’s story of improving care and lowering costs is both inspiring and disheartening. Cornerstone did the right thing, had a primary focus on patients, and was still not able to survive because of the entrenchment within the health care system as a whole. They planted the seeds and saw them grown, only to run into a spate of bad weather, the outcome of which is still to be determined.
A panel from Oregon focused on the importance of working collaboratively. Mylia Christensen, Executive Director of HealthInsight Oregon and Oregon Health Care Quality Corporation, made the case quite elegantly for spending the time to sow the seeds. It takes months, and sometimes years, to make changes and prove they are effective in health care. The willingness to put in the time and effort, in the end, can have big rewards. Oregon has been able to voluntarily collect data and report on Total Cost of Care. While Oregon may be unique in its dedication to collaboration, it offers lessons learned for other regions looking to replicate the success. The seeds have been sown for further change to the delivery system to improve affordability.
Josh Rosenthal, with RowdMap was a provocative speaker on the need to use the data that is already available. His work with claims data is a testament to its usefulness in a time when people are constantly looking for the next best thing. Health care data, and claims data in particular, is available and in some cases freely provided by the Centers for Medicare & Medicaid Services. These large datasets are a valuable resource to identify trends and improve care. Data is inherently messy and difficult to work with, but the time put into using data can pay dividends down the road. It is one seed that should be tended to carefully and nurtured to grow.
The day was a rousing call to action on many of the issues surrounding affordability. The chance to connect with colleagues from across the country and learn from each other was invaluable. In Oregon, we will continue to tend to the seeds that have sprouted and make strides to improve affordability in health care.
It’s October. That means Halloween and something even scarier — insurance premium increases. This year, people in the individual market will face hikes even higher than usual thanks to the federal government’s concerted effort to undermine the marketplace. Small businesses in New Jersey also feel the fright. Plans now offered in the Small Employer market have fewer out-of-network options, and higher out-of-pocket costs. We all know that ever-rising health costs have a dampening effect on wages and economic growth. These are real concerns. Yet despite the challenges, small businesses in New Jersey still want to provide quality health insurance to their employees. The answer is for all of us to get real about reducing the total cost of care and improving health care quality. These are not opposing goals. Recently I attended the National Affordability Summit sponsored by the Network for Regional Healthcare Improvement and brought along some New Jersey leaders in health care:
- Jennifer G. Velez, JD, Senior Vice President, Community and Behavioral Health at RWJBarnabas Health
- Dan Fabius, DO, Vice President, Clinical Informatics at Continuum Health and a practicing physician
- Mary Ann Christopher, MSN, Chief of Clinical Operations and Transformation at Horizon Blue Cross Blue Shield of New Jersey
- Carl Rathjen, MPA, Director of Value Based Transformation at Horizon Blue Cross Blue Shield of New Jersey
We traveled to Washington, D.C., and met at the Ronald Reagan Building, down the street from both the Capitol and the White House. Other multi-stakeholder groups from around the country joined us to focus on the affordability conundrum. One of the many topics explored was the enormous variability on prices. A simple X-ray can cost triple the amount at one setting versus another. And changing the venue for a procedure from in-patient to outpatient can save untold millions. At the summit, experts spoke about what’s driving costs and what innovations are really working. We discussed which of the new models of care are showing better results for patients and saving money. Experts spoke about how we can leverage health care cost information regionally and nationally to achieve affordability. Just sharing the data we have, however imperfect, highlights the differences in clinical practice patterns and the vast waste in the system. Throughout the day, our Garden State contingent talked about the need to wring out the 30 percent of waste in our health care system — money spent on care that does not help patients and sometimes hurts them. We acknowledged this approach, though necessary, will have very real and unwanted repercussions to some communities.
What happens to jobs when hospitals close? Hospitals often are the largest employer in some cities and communities. They provide sought-after jobs. We will need strong leadership and focused jobs programs to retrain and deploy today’s health care workforce to provide community-based care or other services. To advance this critical discussion, the Quality Institute’s winter conference will focus on: “Getting to Affordability — Is Data and Transparency the Answer?” I’m excited to tell you that our keynote speaker is Niall Brennan, BA, MPP, former Chief Data Officer at CMS and now Executive Director of the Health Care Cost Institute, an organization that uses large payer data sets to create cost and quality insights and research. Invited guests and members of the Quality Institute are welcome to join us as we discuss the road to affordability
Massachusetts has long been a leader in health care delivery and innovation. In addition to world-renowned medical schools and nationally ranked hospitals, in 2006, Massachusetts enacted legislation, entitled An Act Providing Access to Affordable, Quality, Accountable Health Care that provided coverage to all state residents. When the Affordable Care Act was signed into law in 2010, 98% of Massachusetts residents already had health coverage.
Managing health care costs, however, has proved a more difficult. Massachusetts has historically had among the highest health care costs in the nation. To address spiraling health care costs, the Legislature enacted Chapter 224 in 2012, entitled An Act Improving the Quality of Health Care and Reducing Costs through Increased Transparency, Efficiency and Innovation. This legislation, among other things, created organizations and processes to set targets and measure health care spending across the state.
Affordability is at the heart of what needs to be done with health care costs in Massachusetts. High spending on health care not only crowds out spending on other needs (such as education and transportation) but also places an increasing financial burden on individual consumers, particularly those with increasingly common high-deductible health plans. The most economically vulnerable among us are forced to make difficult choices between health care and other necessities for themselves and their families.
The Affordability Summit provided a forum for exploring and sharing experiences from health cost reporting pioneers across the country and across the spectrum of health care. There were many speakers, but two really resonated with me. The first was Harold Miller, who discussed the strengths and weaknesses of current health care payment systems. Harold urged attendees to build a patient-centered healthcare payment system that meets patient needs, provides the resources to support care integration and coordination, and ensures accountability for results. Our President and CEO, Barbra Rabson, forwarded the link to Harold’s Report from the Center for Healthcare Quality and Payment Reform, Why Value-Based Payment is Not Working and How to Fix It, to MHQP’s Board and Physician, Health Plan and Consumer Councils.
Josh Rosenthal not only confirmed that healthcare data is indeed “sexy”, but that organizations can make highly creative use of publicly available data sources to create meaningful, actionable reports. In his words, “Use the data that you have!” MHQP has taken this thinking to heart. We hope to work with research, provider, government and other stakeholders to gain expertise in measuring costs and to use our in house provider, patient experience and quality data sets to support health care transparency and transformation in Massachusetts.
Finally, we look forward to working with the stakeholders who attended the Affordability Summit with us. We were pleased to share the day with representatives from the Massachusetts Hospital Association, the Massachusetts Medical Society, MassHealth (our Medicaid agency), and the Center for Healthcare Information and Analysis (CHIA), which is the source of health care data and analysis to support policy decisions in the State. One of the speakers, Arnie Milstein referenced a 2011 article by Peter Orszag “How Health Care can save or Sink America”. Clearly, the issue of healthcare affordability has been around for some time but the urgency to act is getting more and more compelling.
The Agency for Healthcare Research and Quality (AHRQ) recently ranked Wisconsin the number 1 state in the country for overall health care quality based on more than 130 performance metrics. Equally important is that Wisconsin has been ranked as one of the top four states in 10 out of the last 12 years. All health care providers, clinicians, health plans, employers, government agencies, associations, improvement organizations and others who have worked diligently to improve the quality of care provided in Wisconsin should be proud of this achievement.
How does Wisconsin rank in cost of care? The answer: we don’t know. Until recently, there has not been a consistent method for collecting cost data or standardized metrics to compare the cost of care across states or regions. Over the past three years, the Network for Regional Healthcare Improvement (NRHI), with funding from the Robert Wood Johnson Foundation, has collaborated with several of its members to advance cost of care evaluation using the Total Cost Index developed by Health Partners. The Total Cost Index includes two components, the Resource Use Index and the Price Index (Total Cost – Utilization x Price). By breaking total cost into these components, organizations can determine whether cost differences are the results of resource use, the prices paid for services or a combination of these factors, making this information actionable. Currently, the WHIO data mart includes a Standard Cost which derives an allowed amount and then removes the variation that exist across fee schedules. The Price Index used by other regions uses actual dollars so that the results are easier to understand.
Today, five regions including Utah, Maryland, St. Louis, Minnesota and Oregon have begun benchmarking their Total Cost Index and distributing this information within their region to drive informed decision making. Through this comparison, it was discovered that on average, there is a $1,080 yearly difference in the amount health plans spend per enrollee across these regions, with a high of $369 per-enrollee-per-month in Minnesota and a low of $279 in Maryland. If the two regions (Minnesota and Oregon) with the highest cost per enrollee reduced spending by as little as $9 per enrollee, per month, the savings would be more than $200 million annually, which could be used to meet other needs. Examples of this information can be obtained at the Minnesota Community Measurement (MNCM.org) and the Maryland Health Care Commission (healthcarecost.mhcc.maryland.gov) Web sites.
Wisconsin stakeholders recognize that standardized cost information, benchmarked across states, regions and organizations, has the potential to impact the decisions made by all health care stakeholders. We also understand that continuous improvement in all three components of the triple aim are needed to achieve the goal of better care and better health at a lower cost. As we continue this journey, we look to leverage the “lessons learned” by those who have gone before us and design strategies to address the factors unique to our health care eco-system.
On September 27, 2017, I was honored to attend NRHI’s National Affordability Summit in Washington D.C., along with a multi-stakeholder team from the Philadelphia area sponsored by the Health Care Improvement Foundation (HCIF). In my professional role as Senior VP, Health & Benefits Practice Leader at Aon Hewitt, I consult regularly with regional and national employers in understanding and managing their health benefit expense. Their goal right now is to find partners that can help them control health care cost growth and improve affordability. In my other role as Vice Chair of the HCIF Board, I enjoy the opportunity to partner with providers, payers and other stakeholders in our shared vision to create a responsive, coordinated health care community that fulfills the needs of patients and consumers, and achieves better health.
In addition to HCIF staff, our team included representatives of two local health insurance payers and an official of the Pennsylvania Insurance Department. The gathering was an extremely interesting and educational event.
My key takeaways included the following:
- The challenges of healthcare cost control, transparency, delivery, payment reform and quality are universal – shared by all stakeholders in the system.
- Many proposed solutions seem dependent upon simultaneously changing behaviors by multiple parties, and are also shaped by local conditions and varied cultural practices and attitudes.
- Not surprising, the conference participants share many common and overlapping goals and objectives, but their responses focus on development of narrow and very specific business models and strategies.
- Leadership of these initiatives varies across the country - some driven by employers, others by providers and still others by not-for-profits or some combination of each.
- Data is king (everybody agrees) but what data is used and for what purpose was debatable.
- Quality is the ultimate objective - but again as measured by whom and for what purpose is yet to be settled.
Employers clearly have a key role in the improvement journey – in using their market leverage to push for affordability, in providing data and information to their workforce for improved health care choices, and in working with providers (through organizations such as HCIF) to improve care and reduce waste. As HCIF embarks on a new cycle of strategic planning in 2018, we’ll look forward to integrating these trends and factors into our discussion and to explore our regional path to affordability.
Our Patriotic Duty: Affordable Health Care By: Grace Terrell, CEO, Envision Genomics
Many of us working in the healthcare industry feel frustrated and tired as we continue to fight the good fight to provide high quality, cost-effective care in our hometown communities, all the while watching the policy impasse in Washington seemingly thwart efforts to improve the health care delivery system. That’s why forums like NRHI’s National Affordability Summit are so crucial to rebooting the national conversation in a more constructive direction: by focusing a committed community of stakeholders towards the real health care crisis in this country –the high cost of care—we get beyond partisan politics and begin working together towards effective solutions.
On September 27 I was honored to be part of a distinguished panel of individuals who had a terrific conversation together about what needs to change to tackle the problem of unsustainable health care costs. Aparna Higgins, visiting scholar from the Heller School for Social Policy and Management at Brandeis University directed our attention to some of the perverse incentives in the current fee-for-service payment system. Harold Miller, president and CEO of the Center for Healthcare Quality and Payment Reform, was able to expand upon the incredible one hour and 120 slide presentation he had just given educating us on where the money is going currently. He emphasized the need for policy makers to reform payment to pay for the right kinds of services, such as a highly innovative care model for providing care for patients with inflammatory bowel disease proposed to PTAC (MACRA’s Physician-focused payment model Technical Advisory Committee) by a group of practicing gastroenterologists in the field called Project Sonar. Frederick Isasi, executive director of Families USA gave great data on the impact the current delivery system has on consumers and how families are impacted by the high cost of health care services. David Lansky, CEO of the Pacific Business Group made it clear that employers were seeking their own solutions to the high cost of care. George Isham MD, senior advisor for HealthPartners, a provider-based community health plan, discussed the role that integrated efforts involving providers and payers can play in solving some of the health care costs.
My contribution to this conversation was based upon my experience as a practicing physician, as a former CEO of a multispecialty medical group that was an early participant in the move to value-based payment arrangements, as founder of a population health management company that manages successfully several ACOs, and recently as a CEO of Envision Genomics, a company focused on markedly increasing the quality and lowering the cost of care for the one in ten Americans with a rare, undiagnosed, or misdiagnosed diseases. I believe the crucial components for solving the affordability issues in health care involve uniting care models and payment models in a unified design process. We have a lot of good work going on across the country in designing care in ways that lower cost, eliminate waste, and provide far better care, but payment reform efforts often have not been integrated into the design process in an effective manner. Likewise, many innovative payment reform efforts, such as bundled payments, often are focused on bundling the services of current care delivery methods rather than opening up pathways to innovation in care delivery.
Making health care affordable in a sustainable business model that encourages innovation and improves quality is perhaps the greatest patriotic duty we have right now. Our industry comprises one sixth of the economy and more often than not, the local hospital is the largest employer in the community. We need to be able to invest in education, infrastructure, defenses, and services that improve the social determinants of health in addition to providing great health care for all of our citizens. As I said at the summit, it is time to get on with it.