Get Ready for a Real Revolution in Healthcare

In an illuminating Modern Healthcare article titled “The health insurance industry’s identity crisis,” AHIP Chairman Mark Ganz stated that the industry was undergoing extraordinary change. Ganz, who also serves as CEO of Cambia Solutions, cited his own company’s mission to be less of a claims processor and more of a care facilitator. 

 

A quick observation about change. Cambia Solutions is the parent company of Regence Blue Cross Blue Shield—about as establishment as it gets. And historically, the establishment has a hard time with change. It’s certainly rarely associated with leading it. While the big health insurers may been reluctantly on board with the sweeping reforms of the Affordable Care Act, their actual contributions have not necessarily led to better and more affordable care for all—the original and still elusive goal of healthcare reform. 

 

In fact, some of their own products actually work against any meaningful paradigm shifts. Take high deductible plans. While they are less expensive for premiums, mounting evidence indicates that the high deductibles actually often compel people to delay care instead of seek it. That’s one way to curtail claims processing…and care facilitation. 

 

Further, all signs point to a revolt among the commercially insured and their employers to the historic meddling “facilitation” common with many big insurers. What people want, pure and simple, is easy and quick access to quality, affordable care. It’s what employers want to offer their employees, too—and they’re not waiting any longer for such a plan from the big insurers who for years have been raising the rates on employee coverage. Instead, employers are creating their own self-funded plans. 

 

These plans are a radical change in healthcare, in that they look to include only the best hospitals and physicians in the employer’s area. And they do it at a lower rate—by 20 percent or more—than the old PPO plans that allowed almost any provider into the network, no matter how high their complication, readmission and mortality rates, or how low their patient satisfaction scores. 

By contrast, the growing presence of self-funded employer plans offers something no less than revolutionary in this modern era: quality outcomes with affordable care. In short, employers—not the insurance industry establishment – are poised to become healthcare’s true revolutionaries.