Photo by Jonah Comstock/HIMSS
Employer-sponsored healthcare spending is at an all-time high, begging the question: Does all this money equal high-quality, high-value care?
That was the topic of discussion for an HLTH convention panel on Oct. 18 in Boston moderated by Paige Minemyer, senior editor of Fierce Healthcare, that included Dr. Rhonda Randall, executive vice president and chief medical officer of UnitedHealthcare Employer & Individual; Fay Rotenberg, president and CEO of Firefly Health; Jaja Okigwe, CEO of First Choice Health; and Patrick Quigley, cofounder and CEO of Sidecar Health.
With a focus on high value care solutions and technologies such as telehealth, along with the creation of new benefit structures to reduce costs and increase value, industry innovators are working to align incentives across the system and reduce the inefficiencies that have plagued healthcare for decades.
“If you put aside the excellent innovation that’s happened around care and you focus on what is the innovation that’s been happening on the payer side, there’s been a lot of inertia on the model that we all use,” Quigley said. “We have this baseline of the way we pay for care and then we have all these innovative solutions on top of that; telehealth is great. We have all these point systems on top of it to make up for the deficiencies with the model that we’ve all been very accustomed to.”
From his perspective the question is, he said, where is the breaking point where the overall care model needs to be re-evaluated?
“From our perspective, there’s too much inertia, there’s too much complexity,” Quigley said. “We need to go back to simplicity. Our perspective is that you can deliver a tremendous amount of value if you’re not constrained by the existing system.”
Rotenberg agreed, calling the complexity inherent in the process a kind of snow-blindness.
“I think that employers are just blinded by, you know, snowfall of point solutions and having a hard time figuring out what to use and what to adopt,” she said. “Already we see lots of navigators popping up. But then that just creates another point of friction for both employers and employees because it’s one more step removed from the actual care delivery.”
Okigwe added that while large employers can navigate this complexity, the smaller employers don’t have a lot of options available to them.
“I feel like if we could create something really simple and straightforward for them, there’d be real takers,” he said. “But nobody’s working on that.”
The panelists agreed that a lot can be done by building on top of existing structures, but they also speculated about the need for a systemic, transformative change to steer healthcare payment toward real value. All said, there is a bright future ahead for virtual care as a way of empowering individuals to access care where it works for them.
Randall agreed, pointing out employers are in a unique position to nudge their employees to make better choices and to get them interested in their healthcare.
“We’re all well aware of most of our health – 80% or more – happens outside a doctor’s office or in the healthcare system,” she said.
From Quigley’s perspective, it’s about how you deliver care for people the way they want to get it.
“If we can just lean into that direction and we can break down the barriers of restricted networks and just simply focus on the delivery of quality care, we can make more progress as an industry with that,” he said.
Rotenberg agreed, adding that she feels it’s essential to start considering virtual care as the central technology that can improve the quality of any employee-sponsored care plan going forward.
“It’s really about putting virtual care at the core,” Rotenberg said. “I think that you can do a lot there and a virtual-first care model that is all about high member experience. Clearly, we’ve all seen a massive acceleration in the adoption of virtual and virtual first telehealth.”
However, Rotenberg noted there still needs to be a more decisive shift away from an online version of the fee-for-service model.
“We all want to move toward the value-based care model and actually begin reshaping the way that care is delivered and taking out unnecessary visits, replacing them with other modes,” she said. “The next step is actually taking that value and packaging it in a way that we’re able to pass it back to the small and medium businesses that aren’t currently realizing those savings and then eventually to employees as well.”
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