WASHINGTON – As the industry anticipates major changes from Washington, D.C., payers are forging ahead with their own healthcare reforms.
Healthcare IT and the introduction of products targeting subgroups of the uninsured are two common initiatives being pursued to address quality, affordability and access issues.
“At the core, meaningful healthcare reform must focus on the underlying costs in the system,” said Brad Fluegel, executive vice president of WellPoint.
WellPoint is using IT initiatives such as e-prescribing and access to electronic medical records to lower costs.
Paul Keckley, executive director of the Deloitte Center for Health Solutions, said payers should leverage their data management capability and national efforts to develop data standards and create tools to support provider network performance and members’ health.
Blue Cross Blue Shield of Massachusetts is focused on payment reform, said Andrew Dreyfus, executive vice president of healthcare services. BCBSMA has developed a new payment model to reward its physicians for quality over quantity.
“We believe that by taking real, concrete steps to improve the quality of healthcare, we can slow the growth in medical trend,” he said. “If we can change the way we pay for care, we can change the care itself, paving the way for a high-quality, high-value healthcare system.”
“From a short-term perspective, health insurers need to work relentlessly at keeping costs down to help people who are currently insured stay that way,” said Vicky Gregg, CEO of Blue Cross Blue Shield of Tennessee.
BCBST partnered with the state of Tennessee to offer more basic and limited benefit plan options for small groups and individuals. “For the first time in many years, our state has seen a decline in the number of uninsured citizens,” Gregg said.
She said payers must also get the estimated 11 million uninsured people to enroll in public programs for which they are eligible.
In addition to supporting fact-based discussions on underlying drivers of rising costs, spokesman Christopher Curran said that Cigna supports individual choices. “Any individual mandate must offer strong provisions to protect consumer choice and accessibility of care, as well as financial assistance as needed, to make mandatory insurance affordable to those in need,” he said.
“An individual mandate would have to be truly universal, with an agreed-upon ‘floor’ for benefits that ensures real care and a binding requirement on all insurers to offer access,” he added.
Payers need flexibility to provide solutions to meet the diverse needs of healthcare consumers, said Mark Bertolini, president of Aetna.
“These solutions must not only meet the needs of the uninsured but must also ensure that those who currently have insurance can afford to keep it,” he said.
Aetna has developed products that cover different groups such as college students, who can afford to purchase insurance on their own, as well as Medicaid plans for those who cannot.