At the annual assembly of America's health insurance leaders, the need for better consumer experiences and more affordability goes without saying. The trouble is transcending the inertia of the old ways.
"I don't care about the fee-for-value and fee-for-service continuum," said Rodney Hochman, MD, the president and CEO of Providence Health & Services, a five-state integrated delivery system on the West Coast.
"We will sort out this movement," Hochman said at America's Health Insurance Plans in Nashville. "It's an inexorable movement."
In the short term, Hochman is more concerned about the experience for the patients being treated at Providence hospitals and clinics--so much so that he hired a dozen technology professionals from Amazon, including one of the Kindle developers.
"They are shocked at our lack of consumer focus," Hochman said. "Everything is going digital. The last two bastions have been healthcare and higher education."
Most Americans cannot make doctors appointments online or get a price quote on diagnostic services. But Hochman is trying to change that. Providence built a self-service website for Boeing employees, who are covered in an accountable care network contract with the health system, in 41 days, which once would have taken a year.
"We have to disrupt our own organization," Hochman said. "Innovation over scale is the way we're going to solve some of the healthcare issues." He added, "We've got to bring our administrative costs down, as well as both unit and utilization costs."
Across the country, Highmark Health is trying to take a similar, patient-consumer-focused path, albeit amid more friction and with an emphasis on empowering physicians and clinicians.
"I like to think we're the largest start-up in America because we're taking the risk-sharing model to a new level," said David Holmberg, CEO of Pittsburgh-based Highmark Health. Holmberg describes Highmark, as an integrated delivery and finance system--Pennsylvania's largest insurer and as of 2013 the owner of a health system, the Allegheny Health Network.
"If we're going to change things, we really have to do things differently," Holmberg said, pitching Highmark's strategy as a differentiator and competitor with the University of Pittsburgh Medical Center, western Pennsylvania's largest health system and second largest insurer.
"Our customers need things to be different: 'Take care of me when I'm sick and keep me healthy,' which means not focusing on filling hospital beds."
On this front, Highmark is trying to chart a course of affordability--refusing to pay facility fees for UPMC oncology practices--and it has led to a market war that shows no signs of abating.
"The biggest challenge we face is legacy investments ... a model that isn't sustainable," Holmberg said. "A health system buying an oncology practice doesn't change the quality but it does triple the price."
Holmberg maintains that Highmark is also addressing costs by empowering the physicians and clinicians at the Allegheny Health Network. "The providers felt that the insurers were the stoppers of innovators," Holmberg said, so Highmark and AHN started a program called Vitality.
Docs and clinicians can bring ideas for new practices, devices or drugs. "Once an idea is presented, we will vet it within 60 days and either fund it or reject it outright," Holmberg said.
One example is the LINX Reflux Management System, a magnetic device that treats extreme gastric reflux. "It costs $10,000. Our docs at AHN wanted to use it, because they believed it could make a difference," said Holmberg. Whereas some health plans might be skeptical, Highmark ended up embracing the idea because it could be replacement for a $100,000 procedure that was covered more than 300 times in the past year.
The goal is to "take cost out of the system, take a little bit of risk, without having 10,000 other people having to do it first," said Holmberg.