Few, if any, industries affect all companies, employees and families like health care. And as the health care industry undergoes seismic changes on numerous fronts — new laws, new levels of transparency and new technological advancements — we are all forced to find our footing on the altered landscape. Below and on the following pages, health care and insurance leaders offer insights on the new landscape and what it means for your business, co-workers and family.
How has the Affordable Care Act (also known as Obamacare) most affected health care in our region?
Jack Barto: Several agencies in this area have done an admirable job signing up patients for insurance plans on the federal exchanges, and we have reason to believe that the number of uninsured patients has declined some. We have seen a decrease in the number of cases classified as charity care.
However, we have not seen the promised gain in revenue from more insured patients that was supposed to offset losses hospitals would take from substantial cuts in Medicaid payments. Because North Carolina chose not to expand Medicaid, there are still many patients who do not have insurance.
Additionally, many newly insured patients chose low-cost insurance plans with high deductibles. Our experience has been that many patients cannot pay the out-of-pocket expenses, so they wind up as “bad debt,” which is another category of care we are not paid for. Overall, largely because of this bad debt issue, the value of care we provide without compensation is higher under the Affordable Care Act (ACA) than it was before.
There are some positives with the ACA. There are now incentives and rewards built into delivering high quality care, which are driving innovation and improvements across the industry. And there are more patients with access to health care. But the ACA, for a variety of federal and state policy reasons, has been a significant cost to us.
Jeff James: The biggest affect the ACA has had on healthcare in our region is similar to its affect across the country. It has helped bring healthcare to the forefront of discussion and debate. The act was designed to ensure that more Americans had coverage and that the focus of providers was on improving the health of populations, reducing the per capita cost and improving the patient experience.
It has also dramatically increased the level of transparency in the Medicare system. This added transparency, will translate into greater levels of competition among providers and the ability of patients to consume services in the same way they consume all other products and services. For the first time, patients can actually become consumers. They can make educated choices about where they receive care.
The ACA stresses the importance of collaboration and physician leadership to the success of the healthcare delivery system. This region has tremendous physician leaders that are also starting to embrace the concepts of physician-led healthcare.
If the ACA assists the physician community in harnessing its collective intellect and passionately pursuing the goals of increasing the health of the populations we serve, reducing the per capita cost of care and improving the patient experience there is little doubt that the patients served in our communities will reap the benefit.
Adrienne Moore: What we know has happened is that more people have been provided the means to purchase a health insurance policy. This gives these people the ability to get preventive care from a primary care provider compared to seeking care from the emergency room. It also provides coverage for prescription medicines, which many people have done without, therefore, causing their medical condition to worsen and force them to return to the emergency room for further care.
We also know that some people have seen their premiums increase while others have seen theirs decrease because of subsidies. What we don’t know yet is the actual effect these things will have on the overall cost of care (including premiums). But, theoretically, health insurance premiums will be less than they otherwise would have been for many reasons, including lower use of emergency rooms, prescription adherence and earlier treatment.
Brad Wilson: Across North Carolina, the ACA has worked well by one measure. More people than ever are covered, including 460,000 additional people in our state. A large portion of these had been uninsured. But by another measure, it has not worked well. It has done little to address rising health care costs. This is one reason why so many insurers across the nation are requesting higher rates for ACA coverage for individuals. State regulators are approving much or all of these rate increases.
Garland Scott: Employers are turning from a heavy focus on compliance with the requirements of the ACA to a renewed emphasis on core benefit objectives, especially engaging employees to make more informed decisions that improve health and lower costs.
Cost pressures related to the ACA have helped accelerate demand for lower cost benefits, including consumer-directed health plans, and interest in new network configurations with lower costs, as well as more convenient care options like telehealth.
Our newest products increasingly use configured networks that improve care quality and total costs and embed complimentary services to further strengthen value to the consumer. Our combination of informatics and dedicated local market clinical staff help us find people and engage them in the healthcare system to get the care they need at the right location at the right time.
What are the most promising efforts underway locally to help contain health care costs?
James: Developing a healthcare network that is optimized can have a tremendous impact on premium cost without sacrificing a quality healthcare service or experience. Evaluate these key areas:
• Site of service – Moving healthcare delivery out of the hospital and into the office setting has proven to impact both quality and cost. For the first time ever, you have a real chance to review the differences thanks to a more transparent healthcare system. One of the easiest tools to use is Blue Cross’ Healthcare Cost Estimator Tool (available at www.letstalkcost.com). This tool provides actual cost comparisons on a variety of healthcare services from providers throughout the region.
• High-performance/narrow networks – Fewer options generally drives up costs. In healthcare it can actually work in the reverse. By being more selective in choosing provider networks that are higher performing on quality and cost measures, you can actually reduce premiums without compromising your employees’ care. Commercial insurers have already begun this process by providing more selective networks options, such as the Blue Cross’ Blue Value plan
• Centers of excellence – Centers of excellence typically focus on providing a certain type of care: breast health, heart and vascular, or orthopedics. These centers have done all of the heavy lifting in terms of evaluating best practices; offering the best technologies; and, through their improved outcomes and more efficient use of time and resources, having the best costs
• Provider accountability via performance payments – Accountable Care Organizations (ACOs) assist their providers in keeping their patients healthy and out of the hospital more than those who don’t. By working with ACOs, you have healthier employees who access their healthcare less because they are healthier and in turn create lower health insurance premiums.
• Pharmacy management – Prescription medications are a major component in managing many diseases and keeping us from developing more severe health conditions that often require higher cost procedures or hospital stays. Every pharmacy charges differently for medications. A simple review of a sampling of individual medication charges from a variety of pharmacies can easily determine where some cost savings can be found by simply changing pharmacies.
Barto: Containing healthcare costs has become a part of New Hanover Regional Medical Center’s daily operations. Through Lean methodology, we have challenged all 6,000 staff members to become problem-solvers working to help us become more efficient and productive. In the last four years, these efforts, all of which center around improving the patient’s experience, have been worth $90 million to the organization, which is re-invested back into patient care.
Particular projects include those that improve how we manage the care of our patients. One of our more innovative programs is Community Paramedicine. We are able to send specifically trained paramedics through our hospital-owned EMS operations into the homes of patients who are frequent users of the system or are at high risk to readmit to the hospital. We have learned we can address many issues proactively in the home and save the expense of an emergency room visit or inpatient admission.
Building on the success of Community Paramedicine, we have also started a Community Pharmacist program, which features a pharmacist dedicated to the care of recently discharged patients, ensuring they have their medications and know how to use them. As with the Community Paramedicine program, this prevents unnecessary use of the healthcare system.
Scott: Improving health outcomes and more effectively managing costs are important goals. To help enable that, United’s new online resources are providing consumers with unprecedented access to medical quality and cost information, including the ability to comparison shop for health care services.
For example, providing people with easier and more convenient access to information about their health benefits through an app such as Health4Me helps consumers manage their health care costs. Health care costs can vary significantly for the same service within a city or state, so making this information available is important, especially for people enrolled in high-deductible health plans. All consumers can benefit from public transparency resources, such as United’s “guest version” of Health4Me or Guroo.com, a website created by the nonprofit Health Care Cost Institute (HCCI), in which United participates.
Greater price transparency for medical services could help make healthcare more affordable. By providing healthcare prices to consumers, healthcare professionals and other stakeholders could reduce US healthcare spending by more than $100 billion during the next decade, according to a 2014 report by the Gary and Mary West Health Policy Center.
Wilson: Blue Cross and Blue Shield of North Carolina is partnering with Wilmington Health and New Hanover Regional Medical Center on what’s known as an Accountable Care Organization. This is an exciting development that will make a difference for patients in terms of quality, and we think it will help address the cost issue. So far our data shows the ACO is helping patients get quality care using lower-cost services. And they’re experiencing fewer hospital admissions and lower use of the emergency department.
How will the disclosure of cost and quality ratings affect health care?
Moore: Where else do we walk in to make a purchase and not know the cost? I think it is important for people to know the true cost of health care so they can make more informed decisions about quality of care and cost. It really comes down to the overall value that is being offered. Technology has enabled consumers to have this data readily available. Ultimately, more knowledge on the part of consumers usually increases competition and creates better products at a lower price. Whether we will get this result in the healthcare field remains to be seen.
Wilson: Consumers will certainly benefit from having access to cost and quality information. In fact, they already are. At Blue Cross we launched a consumer transparency tool early this year that allows anyone – you don’t have to be a Blue Cross member – to see what average costs are for 1,200 procedures at hospitals and doctors’ offices across the state. For too long the health care system has shielded consumers from the cost of medical goods and services. They need this information in order to make good decisions about their care.
James: It’s really all about Transparency, and it has long been overdue in the healthcare arena. When you purchase a new computer, you instantly know the price and you have the opportunity to research the quality of the computer compared to the other computers you could purchase. This allows you to make a “value decision.” You can weigh a given level of quality against a given level of cost and make a decision at the intersection of cost and quality where you find value.
Through some new tools that Wilmington Health, insurance carriers, and the government have created, you now have a good deal of information at your fingertips as to both the cost and quality of the service you receive from many healthcare providers in our area. This change will create a more informed patient and drive providers to be more cognizant of cost structure, focused on quality of care, and improved in the patient-provider relationship.
Barto: The market, led by major employers and the public insurance exchanges, is changing how it will pay for health care, leading patients into higher-deductible health plans that will force them to become consumers in ways they never were before.
In other words, when you pay 100 percent of the cost of a physician visit or a procedure, rather than a $20 co-pay and have insurance pay the rest, you become much more interested in cost. We know we need to eliminate costs, decrease prices when we can, and be transparent about these changes so that patients know the cost they are signing on for.
A trend toward transparency extends to public ratings of our quality on many crucial matters. We’re ready for this – we’re proud of where we stand on every quality metric and are engaged in continuous improvement. We have won major national and state awards and designations for our cardiac, oncology, orthopedic, stroke and bariatric programs, and for our overall patient experience and patient safety.
These trends will almost certainly improve quality of care and cost, but with some qualifiers. Publicly reported quality trends do not always tell the story that is intended. We have to be sure we are reporting the right quality markers that help patients make the best decisions.
What progress has been made on electronic medical records locally and what more needs to be done?
Barto: Since June 2012, NHRMC and its providers have been on the Epic medical record system, and this transition has proven to be beneficial to providers and patients. We have 41,000 patients signed up for MyChart, a service for patients to access their own medical records. The Epic record helps providers more easily gather patient medical histories, pharmacological histories and notes from other care providers – all leading to more coordinated patient care.
Our hospital co-founded the Coastal Carolinas Health Information Exchange, which pulls together patient data from a number of hospitals and physicians in this region. Physicians have quick and ready access to more data about their patients than ever as the community quickly moves toward one database with a significant percentage of patients’ medical information available.
With every patient in the community still not part of the Epic system, the next step is for all electronic medical record systems to work together so that we can track patients’ medical activity anywhere they go and coordinate their care regardless of where they need it. In an optimal system, your vital medical information would be available wherever you sought care.
One frontier we’re beginning to explore through electronic medical records and patient claims data is predictive analytics. By properly analyzing the data, we can learn which patients will need certain types of preventive care or education to possibly head off a larger medical problem, such as a hospital admission.
We already use this technology, for example, for the after-care of orthopedic patients. We know from basic demographic data which patients will likely have the most trouble following their after-care instructions, so we can respond accordingly and ensure these patients continue to recover at home.
James: In 2008, only about 30 percent of our community’s office based practices were using an Electronic Medical Record (EMR). Today, nearly all of our community’s practices and acute care hospitals are using EMRs, storing standardized healthcare information, and working towards effective preventive health measures. We should now focus our efforts on securely sharing this valuable data with health care providers outside of our own organizations.
One valuable tool in our region, the Coastal Connect Health Information Exchange, has had great success in connecting providers and enabling us to share health information timely and securely. It is in this collaboration that we as a community have the opportunity to transform the healthcare delivery system and truly reduce the cost of care while demonstrating quality and improving the patient experience.
On average, what increase in health insurance premiums should companies expect in 2016?
Moore: Our agency focuses on companies with less than 100 employees, and we are seeing renewals from Blue Cross and UnitedHealthcare (the two largest players in our market) range from flat to 30 percent. A few of my groups are even seeing rate decreases!
I know companies, and insurance agents, get very frustrated when trying to forecast and budget for health insurance premiums, but the renewals are inconsistent across market segments. With medical cost increases ranging from 8 to13 percent, it is very hard to advise a company on their premium exposure for the next year, much less three years out.
This is one reason many agents, like us, are focusing on other variables during our strategy and planning meetings with customers.
Wilson: Premiums vary greatly depending on the size of the business, whether it’s self-funded, benefit design and other factors. Of course, premiums are a reflection of underlying health care costs. For example, when prescription drug costs go up 13 percent in one year, like what happened nationally last year, it has a big effect on premiums.
Scott: Premium rates are based on a number of factors including medical costs, utilization, plan design, new taxes and fees and mandated coverage required at the state or federal level, among other things. UnitedHealthcare continues to look for ways to restrain increases in health care costs and to ensure consumers have access to affordable coverage.
How are health insurance options changing for small businesses?
Barto: One trend we’re seeing nationally is that employers are moving to high-deductible plans that place more of responsibility for controlling utilization on the patient. This will force employees to become educated healthcare consumers.
Many small businesses also can opt out of health insurance coverage and have employees buy on the federal exchange. We’re not sure this is a positive, as many employees buy plans with high deductibles that they eventually cannot afford.
Moore: In southeastern North Carolina we have not experienced any changes in the insurance companies providing coverage for small business groups (under 50 employees). We are seeing more creative plan designs as well as plans that include a two-tier network (a network within a network) that steers consumers to preferred providers. Nationally, there have recently been more mergers and acquisition among health insurance companies so consumers will be affected by this reduced competition.
Wilson: The small business market is a challenging one. Small businesses do have options, but we encourage them to talk to us or their insurance broker about their decisions on health coverage. Recently Congress showed a willingness to help small businesses in a bipartisan fashion by voting to eliminate the part of the Affordable Care Act that would have expanded requirements for businesses with 51 to 100 employees.
Scott: Small businesses are looking for a way to offer their employees the health care benefits they need while at the same time managing their own costs. By defining their contribution but allowing the employee to choose the plan that meets their needs, small business employers can help their employees stay healthy while managing their own costs. For example, we have found that small businesses are looking for a group product that provides flexible health care plans with robust wellness programs using the industry’s most comprehensive provider networks at a truly affordable cost to our clients.
What can companies do to minimize increases in health insurance premiums and improve employee health?
James: Sometimes people just need a little motivation to start living a healthy or healthier lifestyle. By engaging your team in healthy lifestyles, you can see the benefits in a number of ways. In addition to reduced healthcare premiums in general, employees who are held accountable for their health, work harder to better manage chronic conditions like diabetes or heart disease. That can turn into a healthier, more productive employee, getting off daily medications, driving down healthcare usage, and the final win is lowering premium expenses.
Here are a few ideas that have worked for other businesses:
• Discounted healthcare premiums rewarding healthy lifestyles (reporting BMI, weight, cholesterol, etc.)
• Incentives for participating in preventive health screenings and educational programs
• Reward points for attending onsite nutritional, fitness classes, and weight management programs
• Reimbursements for gym memberships or fitness classes
• Premium discounts for non-smokers
• Extra time off for meeting health goals
Barto: At NHRMC, we created a health insurance option allowing employees to choose significantly lower payments – and in return agree not to smoke, to participate in diabetes classes if necessary and make other choices to keep them healthier.
We also offer a fitness center for our employees and their dependents at a very low cost. Many of our employees who have little or no history of regular exercise now work out regularly in our gym, and they are becoming healthier and more productive workers. Overall, the health costs of our 6,000-plus workforce has, on a per member, per month basis, been remarkably flat over three years, a remarkable ratification that incentivizing employees to make positive changes can make an impact.
This allowed us to keep our health insurance rates for our basic insurance plan flat for eight consecutive years before a small increase last year.
Wilson: One place to start is by promoting health and wellness in the workplace. There are studies showing that workplace health promotion makes a difference in employee health and may have an impact on health costs. We are seeing more employers getting into workplace wellness and offering incentives to encourage their workers to engage in healthy living.
Scott: Employers expect measurable improvements in health quality to advance population health and health outcomes and significantly reduce costs associated with poor outcomes, waste and rework. We draw from our foundational evidenced-based inpatient and outpatient management programs and policies, augmented by readmission prevention programs, complex population programs and multidisciplinary team management for our most complex members.
The UnitedHealth Premium® designation program assesses quality of care for more than 330,000 physicians in 25 specialties, using more than 330 evidenced-based, medical society and national standard quality measures. Using this foundation, evidence-based clinical criteria are embedded into innovative benefit plans, reimbursement models and consumer engagement approaches. We continue to believe that the future of quality health care will be based on next-generation clinical design, consumer-oriented tools and alignment of incentives that drive purchasers, physicians and consumers to identify and choose quality and cost-effective health care first.
Moore: Companies must educate themselves and their employees. At this point the assistance of a knowledgeable insurance broker is almost essential. A knowledgeable broker can, among other things, assist with plan selection, evaluate wellness areas, help with the implementation of impactful programs, and promote employee education on how to best utilize the benefits of their plan.
For example, many people have formed the habit of using the hospital for most of their care rather than primary care providers. As a broker, we spend a lot of time educating employees in why they should change these habits. This small change can have a large impact on total health care cost.
Another thing that is already happening is that some medium and large companies are establishing corporate fitness centers and classes. This new trend is gaining traction; more and more employers are using these wellness perks as part of their recruiting and retention plan.
What recently approved or pending legislation in North Carolina is likely to most impact health care in the state? What effect will it have?
Scott: Governor Pat McCrory recently concluded a two-year debate by signing into law legislation to modernize the North Carolina Medicaid program. The new law creates a hybrid model of statewide managed care organizations (MCOs) competing with regional Provider Led Entities in the Medicaid program.
This hybrid legislation provides UnitedHealthcare with the opportunity to be part of the solution to improve the health care of Medicaid recipients in North Carolina. Our ability to provide solutions to the state Medicaid program complements the great work we are doing to support the more than one million customers and members UnitedHealth Group currently serves in the state.
Barto: The Medicaid reform plan will have a significant impact on the care of these patients, though we aren’t sure at this time how that will look.
The state has created capitated networks for Medicaid patients, which means there are a fixed number of dollars to treat these patients, who are often, for a variety of reasons, the most expensive to care for. Hospitals and physicians will have to find ways to keep these patients healthy rather than only treat them when they are sick or injured.
While we have many concerns about how private insurance companies will manage this process, this concept - providing population health rather than services for individuals - will become more common within Medicare and eventually among private providers. We believe something resembling this system is the future in health care.
Moore: ICD 10 codes started on October 1. These are the codes that providers use for reimbursement. This change adds some 50,000 odd codes into the already complex billing system. And, yes, there really is a code for being struck by killer whale and a code for activities involving yoga!
The “Cadillac Tax” will be effective in 2017. This tax, in its current form, will levy a 40 percent tax on qualified plans whose premiums are above a certain threshold. Most employers who potentially face this tax are making plans to avoid this tax by increasing employee exposure through higher deductibles, co-payments, co-insurance and/or out-of-pocket maximums. I think this tax will probably be changed in the near future.
Also, hot off the press as of October 1, the House and Senate have passed the Protecting Affordable Coverage for Employees (PACE) Act and President Obama is expected to sign it. This Act has to do with the definition of “small groups” which, in turn, dictates the requirements imposed on these groups. This legislation will give North Carolina the option to continue to define small groups as those having fewer than 50 employees, and I expect we will do that. If this legislation is not enacted, employers with between 51 and 100 employees will see dramatic changes as of January 1, 2016.
Why have we seen consolidation among Wilmington-area health care providers? What effect will this have on local health care quality and availability?
Barto: As reimbursement continues to dwindle, especially from Medicare and Medicaid, and regulatory requirements are added, physicians practices – essentially small businesses – are more squeezed. Many physicians find they are more engaged in running a business than taking care of patients. So the ability to align with a larger entity – sometimes a hospital such as NHRMC – that has business and billing offices as well as human resource functions is attractive.
From the hospital’s perspective, we believe we are preserving access when we add physician offices to the network, or when we partner with some of our regional hospitals. But there are numerous ways to work with providers beyond consolidation. We partner with physicians on joint ownership of a number of services – NHRMC Atlantic SurgiCenter is one, and radiation cancer services is another. Other services we co-manage with physicians, such as orthopedics. And in our Accountable Care Organization, we partner with Wilmington Health and Blue Cross/Blue Shield.
What are accountable care organizations (ACOs) and what do local ACOs mean for people in our region?
James: An ACO is a partnership of providers dedicated to the coordination of care toward improving the health and well-being of the patients and communities they serve. Locally, Wilmington Health and its affiliated providers are a part of Physicians Healthcare Collaborative. A primary objective of our ACO is to create financial savings within the healthcare system through the improvement of the quality and delivery of healthcare to patients. Through the monitoring and communication of our efforts, we have already been able to save the Medicare system millions of dollars and are working diligently to provide our commercially-insured patients the same kind of savings through the coordinated efforts of our providers and the health insurance carriers.
Scott: Our traditional health care system is giving way to a new model that places consumers squarely at the center, promoting higher quality, lower cost and better health. UnitedHealthcare is leading the way in value-based care by reimagining how we collaborate with and pay doctors and connecting consumers with tools to find the right care. Value-based care is health care that works harder and better to help people live healthier lives.
Value-based care puts consumers at the center of the health care experience and strengthens their connection to the health professionals who are supporting their care. It makes it easier to have a complete view of the patient by sharing important health information among each of the care providers involved in their treatment. And it pays doctors based on a person’s actual health outcomes and encourages services that are proven to deliver consistent, high quality care – better care, better health, lower costs.
Wilson: ACOs are arrangements where providers and health plans work together to meet quality standards for patient care. The payment model focuses on the quality – not quantity – of care. As I mentioned earlier, we’re seeing some promising results so far in the Wilmington ACO, which is one of five ACOs across the state that Blue Cross is a part of. Patients may not know that they’re in an ACO but they do see the benefits of fewer duplicated tests, fewer hospital admissions and improved overall care.
Barto: As substantial numbers of patients are enrolled in ACOs, they will find their providers have more interest in preventive care, as well as life and exercise habits that will keep them healthy. In our ACO, we are working on initiatives to ensure patients get just the care they need and that it’s what is best for them, for physicians to have access to clinical best practices and low-cost alternatives, and for patients and families to be able to choose palliative or hospice care at the appropriate time.
Hospitals and their providers will focus more on managing care, even after the patient returns home. Programs such as Community Paramedicine, Community Pharmacy and follow-up phone calls are part of our more recent efforts to become more engaged with the management of the patient’s overall care.
How can companies work with health care providers to decrease expenses and improve employee health and productivity?
James: Companies should take a systematic approach that requires looking at multiple aspects of their plan and how they support their employees’ abilities to achieve better health and remain there.
We’ve seen the opportunity to affect real change fall into four major areas of their health insurance benefit:
• Creating targeted employee programs
• Restructuring healthcare benefits
• Optimizing your health plan network of providers
• Developing incentive programs for healthy living
Each of these items can have a major impact on the resulting health plan utilization and future premium expense to both the employer and the employee. I’ll be writing in future Insights articles about how you can address each of these items related to making changes to your health insurance benefit, so keep an eye out for those.
Barto: Providers, especially those participating in ACOs and other population health efforts, will be more willing to partner with employers to offer care management, classes, education and other tools designed to keep patients healthy at home and decrease unnecessary use of the healthcare system. This includes New Hanover Regional Medical Center, which is open to partnerships with employers, insurers or other groups of patients to work together to keep populations or groups healthy.
We have had considerable success with smoking cessation programs, diabetes classes and positive encouragement for physical fitness, and we could replicate this in partnership with others. By engaging employees in their own health and investing in preventive measures, we have been able to change behavior – a key factor in managing care – and have had a measureable impact.
Moore: Partnering with health care providers mainly applies to those larger companies who are self-funded. These companies are trying to promote transparency so their employees and members can see the actual cost of care. Most insurance companies provide cost tools which allows members to compare a specific type of service between two providers. All members should have access to these transparency tools. Blue Cross and UnitedHealthcare have these tools available for all of their members. Some large companies encourage biometric screenings to help identify health issues early and eliminate future expensive acute care costs.
Scott: We recommend employers and their employees play an active role in their own health and health care choices. By seeking out high-performing doctors and other care providers who demonstrate a commitment to quality and evidence-based medicine, for example, employers and their employees are putting their health first. Also, researching health care quality and costs helps consumers make thoughtful choices about care providers and services. By living a healthy lifestyle, seeking preventive care and actively managing chronic diseases, employers and their employees can get the most value from their health care dollar and improve their health and productivity.
What will be the “new frontier” in health care? What are the most promising developments in the industry that most people aren’t aware of yet?
Barto: We may be entering the era of the educated, engaged patient. Many will have insurance plans with high deductibles, which means they will pay large amounts out of pocket for their health care before insurance kicks in. This means patients will become educated consumers, looking for quality and value – and predictability – in their healthcare dollar.
As a result, providers will become more engaged in care management and programs that keep people healthy and meet their needs, providing the right care at the right time in the right place. This will range from relatively healthy people who need minimal instruction or education to remain healthy at home, to our most frequent users of our services. We have already found that by managing the latter group in a more committed way in the community, we significantly reduced their costs to the healthcare system.
Beyond the innovations we have already discussed – Community Paramedicine, Community Pharmacy and others – we expect an emerging frontier to be virtual health. This could be the next step in convenience for patients, as they can get the care they need from home on a timetable more convenient to them.
Technology already exists to allow a physician to get your vital signs and other key data via tele-health. We are already using it to monitor Congestive Heart Failure patients at home, both by telemonitoring and through scheduled follow-up phone calls. This technology can expand to routine physician visits or for visits to high-level specialists anywhere in the world.
One development that won’t change is that community hospitals will continue to serve as the safety nets for patients who have nowhere else to go and cannot pay. Our charge in the coming years will be to balance all the upcoming change while upholding that mission.
Moore: Telemedicine! This is actually already here and available. Today, a doctor can treat minor aches and pains and prescribe a prescription virtually. The next version of this is going to be services such as counseling and physical therapy. No wait times, no need to leave your home. Anyone remember the days of a doctor making a house call? Those days are back, in a modern way!
Also, we will see larger corporations developing their own health clinics, perhaps in partnership with other like-minded employers. This is called a near-site clinic solution. This clinic is located off-site, but close to the employer’s campus. Technology will continue to drive new developments and strategies to improve health (and in turn reduce cost). Think about how many apps are available now for health and fitness and how fast this market has energized and grown. We are seeing developments and advances faster than ever before!
Wilson: Certainly one frontier is the effort to trim rising health care costs. A lot is wrapped up in this, from how we pay for quality instead of the volume of procedures done, to giving consumers the tools and resources they need to make good decisions about their care, including the cost of care. What some people may not be aware of is how hard we are working alongside our provider partners across North Carolina to make sure patients get not only great care, but a good value out of the services they receive.
Scott: One new frontier in health care is increased quality and cost transparency, which is helping consumers make more informed health care decisions. By enabling people to review quality and cost information for specific medical services, we can improve health outcomes and make care more affordable for everyone. UnitedHealthcare fundamentally believes that all people should have access to accurate and actionable information about the cost and quality of health care services. We are advancing and supporting transparency, both internally and through external collaborations, in a variety of ways.
UnitedHealthcare has developed mobile and web resources, Health4Me and myHealthcare Cost Estimator, that provide cost and quality information to our plan participants, including health care cost estimates that are customized to an individual’s location and health plan. We continue to expand the number of services and improve the depth of information available to our members, with estimates available for more than 750 common medical services. Market average prices are available to all consumers through a “guest version” of Health4Me (available on iPhone and Android devices), while UnitedHealthcare members can access customized estimates that are based on the actual contracted rate with health care providers and facilities.
UnitedHealthcare also participates with the non-partisan, nonprofit Health Care Cost Institute (HCCI) in the public transparency tool, Guroo.com. Guroo is a free utility that anyone can use to access health cost estimates based on national, state and local averages for a number of common services and procedures.