“The next step,” added Christine Wilson, “is to make sure that the information is in a format that it can be given to a patient or to a caregiver, so that they can make an informed decision with their physician.”
Chuang worried openly about the buzz-words of cost transparency. “In our purchasing patterns,” he said, “we don’t usually want to buy the cheapest, because we know there’s something you give up.”
“I think we would like to be physician-driven,” said Kevin Sparks, group executive for internal operations at Blue KC. For his organization, innovation means keeping the provider at the heart of the patient care. He conceded, though, that the industry is in something of a market shift, with the consumer now in the middle and the provider circling the periphery of the universe.
After Fee-for-Service
“What opportunity exists,” asked Rick Kahle provocatively, “for moving away from fee-for-service to something else?”
Stephen Salanski sees some movement away from this traditional fee arrangement, given the emergence of the patient-centered medical home concept and other innovative arrangements. Physicians who are doing more work by e-mail or by phone and proactively caring for patients when they transition from the hospital back to the office are performing services that defy traditional fee arrangements. If providers and payers begin to acknowledge and provide incentives for these kinds of practices, Salanski believes, higher-value care should follow.
“We’d like to see more insurance companies focus on shared savings models and care-coordination fees,” affirmed Lori Mallory, CEO of Kansas City Internal Medicine, “because we believe that if [all parties] are in the room together that we can, in fact, reduce the cost and improve the quality.” Added Mallory to general approval, “Obviously, I prefer a market orientation to government authority on this issue.”
Chris Hansen expressed provider frustration with the fact that each in-surer has a distinct reimbursement model. “We can’t have eight different care models reimbursement-wise or PCMH-wise,” said Hansen. “We’re just going to kill ourselves.”
“It’s not just the different insurance companies,” said Mark Laney. “Physicians don’t want to have two classes of patients. They don’t want to be in a fee-for-service mindset with Mrs. Smith and in value-based mindset for Mr. Jones.”
As Rick Kahle observed, there is talk now within the IRS that the affordability test would be based upon family coverage. This means that an individual could pay no more than 9.5 percent of his or her household income towards family coverage. If more, it would not be deemed qualified affordable family coverage, in which case the individual could go to a health-insurance exchange. Of course, this whole concept could be undone soon by the Supreme Court.
Wellness
“One of the things that we know is that employers don’t like increased regulation and complexity,” said Carolyn Watley, president of CBIZ Benefits and Insurance services. The role of CBIZ and other consultants, Watley explained, is not just to get the information out to clients, but to get it out correctly, so that clients can plan with at least some confidence. One area that has enthused CBIZ is the employer’s embrace of wellness as a way to improve worker health and productivity.
