The new role of health insurance

Patients should be at the center of the health care universe, America’s Health Insurance Plans President and CEO Karen Ignagni told stakeholders gathered at AHIP’s Ops/Tech Forum last month in Phoenix. Insurers, which serve as the gateway to care, are uniquely positioned to bring order to that universe, Ignagni said: “That is the new role of health plans, to help consumers navigate the health care system.” Here’s how they’re doing so: Transparency: By necessity, health insurance is more complicated than nearly every other product people buy, and Ignagni emphasized the importance of helping consumers understand how their care and finances will be affected by provider networks, metal levels (bronze, silver, gold and platinum plans), cost sharing and more. Answers must come in real time when people are shopping for insurance, a task that is increasingly occurring around kitchen tables, Ignagni said. Affordability: Without affordable insurance, most people can’t access appropriate care. But insurance can only be affordable if care is, Ignagni argued, noting that conversations around this sensitive topic are growing more productive — as they must if the access to health care that has opened in recent years is to be sustained, she said. Ignagni discussed what she called “buckets of change” being advanced by health plans: Medical homes, care bundling, accountable care and financial risk management. But problem areas continue, including rapidly escalating treatment costs, persistent fee-for-service care models and costly consolidation among health care providers. “We can’t continue to have a health care system that is 50% higher in cost than any other system in the world,” Ignagni said. Collaboration: Nearly every speaker at the forum mentioned fast-growing specialty drug prices, and Ignagni said there’s no question the trajectory has to be shifted. “The input prices, the unit costs have to be moderated, and they have to be brought down,” Ignagni said She argues that collaboration – not regulation – is the solution: “We think there are opportunities for health plans and pharmaceutical companies to work together.” Ignagni argued collaboration is also key to optimizing use of provider networks, which she says have been misrepresented by advocates of “any willing provider” laws that would restrict those networks. Such laws represent “the quickest way to stop progress to the affordability that the American people want and need,” Ignagni said, arguing that partnerships between insurers and like-minded providers are a solution to many problems in health care, even though navigating those partnerships requires time and experimentation. “What is a challenge has also become an opportunity.” That may hold true for many of the big problems in health care today.