Payers focused on solving the primary care problem

Insurance carriers can become a key distribution point for emerging technologies such as wearables, which in turn can play an important part in emphasizing primary care over costly specialty care as payers seek to drive healthcare costs downward.

So said a host of insurance experts speaking at MedCity New’s CONVERGE conference in Philadelphia, among them: Anthony Coletta, CEO of Tandigm Health; Jaja Okigwe, vice president of strategic development for Premera; and John Montgomery, vice president and medical officer of Humana.

Simply maintaining the status quo of managed care won’t be enough, and a concerted effort must be undertaken to stem utilization rates, the panel said.

“Insurance companies all over the country are realizing that managed care simply isn’t doing it,” Dr. Coletta said. “If you really wanted to make an impact, you need to address the utilization rates.”

In detailing a 50-50 joint venture between Davita and Independence Blue Cross to create Tandigm Health, Dr. Colletta stressed that primary care must shift to the forefront of payers’ priorities in order to stem hospitalizations and to make the healthcare system more navigable for patients.

“Our customers are primary care physicians – period,” he said. We don’t want to be ambiguous. No one can drive down costs better than our customers, primary care physicians. There’s tremendous, pent-up demand for our customers to access this kind of network.”

In order for that to happen, a premium has to be paid for primary care, not just specialty care, he said, by engaging, enabling and empowering primary care physicians. That includes financial incentives, tools that allow them to better understand population health, and empowering through data, clinical resources and and up-to-date facilities.

“We need to move them up in the food chain from being the truly lowest paid doctors to being fairly paid,” he said. “If the way the money flows is heads in beds, or not something new, it won’t work.”

Disruptive technologies should also be on the radar for any healthcare payer, Okigwe said, and insurance companies need to be asking themselves what should be paid for going forward. He described a possible growth area for insurers that included new-to-market technologies, such as wearable devices

“We are actively seeding ideas to the market,” he said, creating platforms for more sharing and encouraging competition. Increasing access to developing technologies will likely increase healthful behaviors.

“If we can make a healthier environment, that rubs off on us,” he said. “Take wearables, for example, or cancer care, where they take the blood out of the body to fix it. If that’s the world where we’re going, how are we going to pay for that? I think insurers are very interested in that. Our value proposition in that world would need to be the distribution – provide access as a value.”

Dr. Montgomery of Humana also touched on primary care and on maintaining an evolving continuum of care that emphasizes wellness and prevention – both culturally among providers and patients and monetarily.

“It’s time to close the gaps between health and care,” he said, describing the frustration felt by consumers trying to navigate a once-disparate health system.

There are opportunities for health insurers in three main areas, he said – the consumer-driven shift, technology and accountable care, which is palpable and long overdue.

“For me as a clinician, accountable care is responsible care,” he said, adding that many new resources are available now that have never been before.

“The traditional healthcare system has always been fragmented. I think where we’re moving to is a really integrated system. The individual is proactive and connected. The data analysis we’re bringing to the table are just phenomenal. This is innovation.”

He also noted that the split between payers and providers will soon be a relic of a bygone, fractured health system.

“The payer is a partner with you all. It’s no longer the payer and provider on the opposites sides fighting each other,” he said. “We’re changing that paradigm and realizing how valuable those partnerships can be.”

Asked about how the current primary care physician shortage might impact any forthcoming emphasis on primary care, all three insurance executives said increased financial reimbursement rates will help tilt the scales in the coming years. They also said technologies such as telemedicine, and better analytics for managing population health, would help offset at least part of the shortage while the workforce is rebuilt.

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