Now that the future of health care reform has been settled by the U.S. Supreme Court (at least, for now), what will the law and the changes it is already bringing mean for the health care industry over the long term?
After attending the meeting of America's Health Insurance Plans (AHIP), an industry trade association, Jane DuBose, principal director, advisory services for HealthLeaders-InterStudy, discussed the key changes that are afoot in the industry. These changes have significant implications for how employers manage their health plans and their approach to employee health and well being.
Overall, DuBose believes that the industry faces a significant transformation. Perhaps the most important trend she notes, from an employer's perspective, is the renewed focus on cost control. "Health plan managers—including everyone from CEOs of major, national plans to product directors at regional HMOs—all said that talking about controlling health care costs has definitely given way to doing something about it," states DuBose.
The health plan industry really does not have much of a choice. The industry given current cost trends is at a point where no one is really happy with it. "The government... is definitely living on borrowed time in making its health care system work, while employers are fed up with the continual cost increases," says DuBose. According to Jay Gellert, CEO of managed care plan Health Net, "We don't have another 25 years on this. In 2020, we'll either be great or extinct."
To enable the necessary changes, DuBose notes that the industry is likely to transform itself in several ways. For one thing, she predicts that health plans and managed care organizations will begin designing health plans themselves with wellness, prevention and treatment in mind. For example, plans will offer lower deductibles to individuals in exchange for desired behavior, such as following an exercise plan, and create incentives to reward individuals for preventive care physician visits or drug compliance in the form of gift cards or cash. Although some employers have already begun offering some of these types of approaches, having health plans on board can make it easier for both self-insured and fully insured employers to leverage these tools.
Employers will also be glad to hear that health plans are focusing on individual accountability when it comes to health status. Noting that employers are getting increasingly frustrated by the fact that they are "footing the bill for employees who don't take care of themselves," DuBose expects health plan "product design, care management and even network delivery are being constructed with member accountability at the foundation."
Other innovations could also be coming, including do-it-yourself health care. Pointing to the trend in self-service dialysis in Europe, DuBose suggests that extending this approach to asthma, diabetes and cardiovascular care could reduce costs considerably by reducing reliance on more labor-intensive care.