Providers aren’t the only ones embracing a higher degree of accountability when it comes to healthcare reform. Three major payers, Aetna, Humana, and UnitedHealthcare, have announced a partnership with the Health Care Cost Institute (HCCI) that will produce an online, consumer-focused tool detailing the prices and quality of healthcare services. The move is part of a larger push on the payer side to embrace pay-for-performance reimbursement, said Aetna President and CEO Mark Bertolini at the HIMSS National Healthcare Innovation Summit in Boston yesterday, and is intended to give patients the information they need to make smarter decisions about where they invest their money when it comes to their own care.
Aetna CEO: Accountable care requires payer transparency
“The ACA is an action-forcing event,” Bertolini said during a discussion with Susan Dentzer, Senior Policy Advisor at the Robert Woods Johnson Foundation. “It has exposed the black box of managed care and insurance. It may not have been elegantly designed, but it has happened. And if we went all the way with healthcare reform, we could move into real population health.”
Aetna has been investing heavily in technology in order to develop an underlying infrastructure that will shift the fundamental design of health insurance plans, Bertolini explained. Health plans should be provider-centric, he said, allowing patients to select “the most efficient and effective provider” and keep that provider regardless of what insurance plan they choose. This will foster true population health management while keeping care continuous, coordinated, and local.
The transparency tool is part of the overarching effort to embrace large-scale healthcare reform. “Consumers, employers and regulatory agencies will now have a single source of consistent, transparent health care information based on the most reliable data available, including actual costs, which only insurers currently have,” said David Newman, Executive Director of HCCI. “Voluntarily making this information available will be of immeasurable value to consumers and other health system participants as they seek to manage the cost and quality of care.”
“People are making some pretty tough decisions about what they’re paying for when deductibles can be thousands of dollars,” Bertolini added. With healthcare spending reaching a staggering $4.7 trillion by 2020, according to official projections, the need to spend wisely will only become more critical for patients, who are bearing an increasingly large percentage of that spend. Letting consumers see the real costs involved in their care, as well as the quality of the providers who deliver those services, will help patients make more informed decisions while rewarding higher quality providers with more business.
But Bertoli acknowledged that this shift may be tough for providers who are trying to invest in new health IT and adjust to increasingly difficult regulatory requirements while retooling their financial structures to embrace accountable care. “We want to make sure the revenue cycle isn’t damaged,” he said. “Because we recognize that providers have to live in two worlds, balancing fee-for-service and pay-for-performance.”
Additional payers have also expressed interest in the tool, HCCI says, which will be available in early 2015. “The HCCI governing board is pleased by the trust the participating insurers are placing in the Institute. The foresight and commitment of these insurers to create a national resource for consumers, employers and policy makers is without precedent,” said Stephen T. Parente, Chair of HCCI’s governing board. “This new transparency initiative seeks to ensure that every American gets the best value out of their national investment.”
Date: May 15, 2014