1. Danette Wilson says Blue Cross is hearing executives from other companies expressing support for employee plans; they just need help figuring out how to keep them in place. | 2. When dealing with the health of employees, especially at large companies, blanket approaches don’t work, said Steve Best. | 3. Employers, said Judy Worrall, are going to want more accountability built into the system, especially from employees. | 4. Larkin O’Keefe stressed the need for processes to ensure that patients on subscription medications are following the correct dosages.

Kahle asked Bruce Bagley, medical director for quality improvement at the American Academy of Family Physicians, whether there would be enough providers to handle the surge in demand. “There has to be,” said Bagley. “We need to pay doctors and hospitals in a different way. That’s the only thing that’s going to save us.”

Bagley expects to see more “non-visit-based care.” He believes that’s the only way to maintain the capacity on the primary care side is to de-link health care from doctor visits and devise a team approach to health care.


Benefit Innovations

“Employers expect a different way of bringing benefits to the marketplace,” said David Gentile. He then asked. “From a broker’s perspective, how can the market bring benefits in a different way?”

Danette Wilson, group executive for external operations at Blue Cross and Blue Shield, noted that many of her company’s customers were interested in value-based benefits. “ ‘Our objectives are to continue to offer a health plan,’ we hear our clients say, ‘but affordability is an issue, so what can you do, Blue Cross, to help us contain costs?’”

Steve Best, director of compensation and benefits for J.E. Dunn Construction Co., observed that all employees have different barriers as to how to address their respective conditions. “It can’t be a blanket approach,” said Best.

“The value-based designs are very important,” confirmed Larkin O’Keefe, president of MedTrak Pharmacy Services. He agreed that value requires a good deal of “one-on-one” interaction with employees to make sure they are following the appropriate medical regimen. “Unless you actually sit down and talk with a patient and find out why they’re not complying,” he added, “it is almost impossible to fix the problem.”

Jill Watson, executive director of the Metropolitan Medical Society, believes that reform, whether fully implemented or not, does offer the opportunity for providers, employers and patients to align their incentives. “Even if there ends up being no government mandate,” she argued, “everybody wins. The movement is taking shape on its own.”

Watson cited as example an uninsured patient who needed a new knee. Her organization found a surgeon who volunteered to do the surgery for free—if the patient would lose 20 pounds. Grateful, the patient did just that and then discovered that his pain had disappeared; he no longer needed the knee surgery. “That was almost a zero cost other than the consultation time,” Watson added, “and the patient had to do the work.”

“We have acted strategically incrementally, making change over the last 20 years,” said Gentile. “What this law has done is create a catalyst for us to think differently, act differently, respond differently.” He added that the impending reform is the result of a bad bill, and he would just as soon it went away, but it still might force the health-care community to get accountability aligned properly in the marketplace.

“That’s employer, broker, provider, carrier accountability,” Gentile explained, “It all has to fit together, and the consumer has to be held accountable to a new level.”

“I think the employers are going to want this” accountability, said Judy Worrall, director of client services at IMA of Kansas. “Even the large employers are going to stay in the system.” As she sees it, the smaller employers and the people who do not currently have coverage will also want to know that they are getting the best value for their dollar.