Showing posts with label healthcare reform. Show all posts
Showing posts with label healthcare reform. Show all posts

Friday, November 18, 2011

Reform Through Cultural Transformation

Last Tuesday, I had the pleasure of participating in the Philadelphia Business Journal’s inaugural “Health Care Innovation Awards” program. The event not only recognized some of the most innovative thought leaders in the area but hosted one of the most engaging health care panels I have heard in a long time.

When we talk about fixing the health care system, we often hear about innovation and technology driving change, but the panelists discussed a novel concept for the health care industry – the need to change the health care culture.

The main premise – to achieve long-lasting positive change, we need a culture in which ideas, visions and responsibilities are shared across all key stakeholders. When we can do that, we can break down barriers, develop multi-faceted approaches to solving problems and take advantage of opportunities to improve health care in this country.

But, cultural change is slow. It will require hard work and investments on many levels. Will it be worth it? The panel of experts said, “absolutely,” identifying five areas in which health providers, insurers and regulators could come together now in a “culture of collaboration” to improve our health system:

• Establish universal access to electronic health records;
• Improve coordinated care;
• Make hospitals safer;
• Share outcomes data and develop best practices to improve quality of care; and
• Enable nurse practitioners, pharmacists and other medical experts to practice to their fullest training.

I draw on the insights of one of the panelists, Rich Miller, CEO of Virtua and the Philadelphia Business Journal’s 2011 Health Care Innovation Awards’ “CEO of the Year,” to illustrate the concept. In the past, hospitals set goals based on occupancy rates – “heads in beds,” as he described it. Today, hospital leaders are discussing the need to keep patients out of those beds. Physicians will need to change their practice patterns, providing greater focus on wellness than sickness. Patients must change how they think and act when accessing the health care system. For example, non-critical care and preventive care services can be performed outside the hospital or doctor’s office – at their local pharmacies, for example.

Insurers will need to move away from their fee-for-service model, which rewards activity without regard to outcome. It will require that insurers become less transaction oriented and engage more as an insurer-activist… embracing sophisticated technology that leads to more and better data that is shared broadly to improve the health of the system and society as a whole.

Our collective goal should be a culture of care in which the five improvements mentioned above play a critical role, where patients receive the most clinically efficacious, cost-effective care in the right setting and at the right time by an appropriate medical professional to ensure the best clinical outcome.

We have learned from cultural changes of the past that results come from actively working together toward common goals – in the case of health care, an economically stable health care system and healthier Americans.

To learn more about the Philadelphia Business Journal’s Health Care Innovations Awards and the 2011 winners, go to http://www.bizjournals.com/philadelphia/news/2011/11/11/business-journal-healthcare-innovation.html.

Friday, October 21, 2011

Evolving Role of the Broker

As temperatures begin to cool and the days get shorter, thoughts turn to the holidays and the hope for some time to reenergize before kicking off a new year.  However, at UnitedHealthcare, we are busier than ever helping businesses find high quality, affordable health benefits solutions options for 2012.

But I did take time out of this hectic schedule to pause and spend some time looking beyond January 1, 2012.  Recently, I had the pleasure of joining leading health insurance executives at a panel discussion hosted by the Greater Philadelphia Association of Health Underwriters.  I thank GPAHU president Jerry McGlone and all GPAHU leaders for once again hosting a lively discussion on the issues impacting health care coverage today and in the future, including the evolving role of technology to empower consumers, the increasing focus on evidence-based guidelines, the heightened emphasis on wellness and the post-2014 benefits plans mix.

We also spent some time talking about health care exchanges and the ever-changing role of the broker.  I have a special place in my heart for health insurance brokers since I spent about half my career working as a broker.  A lot is being made about the imminent demise of the broker, but as Mark Twain once said “reports of my death are greatly exaggerated.”

Brokers are needed more now than ever before… and that will only increase as health care reform continues to roll out throughout the states. Brokers already have a “trusted adviser” status with many of their client businesses yet must evolve even further. 

Employers will still play an integral role in either offering plans themselves or helping employees navigate as-yet developed health care exchanges.  Businesses, especially smaller ones, will not have the time or resources to wade through the myriad of plan options, reform regulations and business incentives that will continue to roll out across the states and/or through federal health care reform… and this will be to their detriment.

Brokers can help employers take advantage of certain changes but must shift away from low-value tasks to make time for ones of greater importance to clients, such as helping create health and wellness solutions to address unique health and affordability needs.  For example, our brokers have played an important role in helping us develop new plan designs and wellness programs and we stand ready to partner with them as we continue to meet the benefits needs of businesses.

And, brokers will become the “consumer educators.”  Consumers who traditionally have been given one benefit plan – or maybe two options – will now have many choices especially when exchanges roll out in 2014 – and many are ill-prepared to make the best choice for themselves and their families.  Who better to help them make those decisions than someone who has a unique vantage point on health benefit offerings?   Enlightened brokers may become the best stewards to help clients and their employees navigate the ever-more turbulent health care market.

We look forward to enhancing our relationships with brokers and playing a vital part in their transformation – as we all hopefully share a goal to help individuals live healthier lives.





UnitedHealthcare is bringing Health Care Lane to Philadelphia on Tuesday, November 8.  We look forward to seeing you there!