Change Health Care Now
-
Upload
tobyoinit -
Category
Economy & Finance
-
view
995 -
download
0
description
Transcript of Change Health Care Now
Change Health Care Now
Mike McCallisterPresident and Chief Executive OfficerHumana Inc.
2
Pe
rce
nt o
f GD
P
Spending per capita
Japan ($2,077, 7.8%)
U.S. ($5,267, 14.6%)
spent in the U.S. economy will go for health care USA Today 2/22/06
every $5 $1 out of
Within a decade,“
”
Adapted from Anderson, GF et al. (2005) Health Affairs
We Are Spending Inefficiently
3
Employers’ number-one priority is to control health care costs
51%
16%
14%
10%
7%
Control health care costs
BRT Fourth Quarter December 2006 CEO Economic Outlook Survey
It’s Hurting The American Economy
4
We Must Align New Roles
5
All The Participants Must Transform
Employers Consumers Providers Government Health Benefits Companies
6
Incorporate best practices Turn loose smart health plans to lower costs and
improve experience (integrated solutions) Encourage engagement, not dependency Encourage adoption of tax-advantaged financing
mechanisms, like HSAs and FSAs
Employers
Consumers Providers Government Health Benefits CompaniesEmployers
7
Consumers
Be active consumers, not passive users Demand simplicity, transparency and guidance Be engaged, pursue healthy lifestyles
(behavior – 50%) Plan, budget and compare plan choice and financing
alternatives
Providers Government Health Benefits CompaniesEmployers Consumers
8
ProvidersAbandon the past 45% of doctors don’t practice
evidence-based medicine It takes an average of 10-15 years for new
medical discoveries to be routinely used by frontline practices
Be cost-aware, not cost-driven
Government Health Benefits CompaniesEmployers Consumers Providers
9
GovernmentEnable best practices and efficiencies throughout the system Partner with the private sector to solve the problem
of the uninsured Electronically connect the system under a uniform standard Base reimbursement on performance Release the Medicare claims database Give health insurers the option to compete nationally
Employers Consumers Providers Health Benefits Companies
Government
10
Put the consumer first Standardize for industry-wide efficiency Compete on value creation Invest in capabilities to inform and guide
Health Benefit Companies
Employers Consumers Providers Government
Health Benefits
Companies
11
Health care proposals are abundant Most are long-term, with little chance of being
adopted Centralized planning for 300 million Americans
is unrealistic– Doesn’t work anywhere else in the economy– Goes against the American grain
Programs for the elderly, children and indigent are needed
Combination of mandates likely required
The Big Picture
12
Standardization
Consumer responsibility
Business leadership
Three-Pronged Approach
13
Standardization can lead to value and efficiency
Encourage all payers to join Availity, a web-based information exchange system
Developed by Humana and BCBS of Florida in 2001 Designed to allow real-time administrative processing
– Eligibility, referrals,
authorizations and claims Adopted in Florida by 100% of hospitals and
93% of physicians Estimating more than 400 million transactions in 2007 Expanding into Texas, New Mexico and Illinois
Standardization
14
Evolving from administrative efficiency to consumer value Ongoing payer impact
– Reduced transaction costs– Call center savings– Medical cost savings
Growing consumer benefit– Transferability of comprehensive medical history– Real-time claims processing
HSA administration
Standardization
15
Become a passionate self-advocate– 45% of Americans get the wrong care –
don’t be one of them– Be skeptical, question everyone
Use a Family Health Budget tool– Gain control by knowing how much you spend
on health-related expenses (checkups, vaccinations, routine prescriptions etc.) Humana’s Family Health Budget tool is a
simple seven-step process
Guidance for Becoming a Better Health Care Consumer
Consumer Responsibility
16
Find health information online– Become proficient on a Website that can answer most
of your health questions
Take a Health Assessment– Analysis of your daily habits and family history
can provide you with clearer understanding of your health status
– Tool available to general population summer, 2007
Guidance for Becoming a Better Health Care Consumer
Consumer Responsibility
17
Leadership leads to value-creation Reward consumer engagement Insist on transparency and accountability Facilitate reform through business partnerships
and alliances
Business Leadership
18
Business Health Care Group of Southeast Wisconsin– Formed in response to Milwaukee’s health care
costs averaging 25% higher than comparable Midwest cities
– Includes 200-plus companies of all sizes and 75,000 members
– Exclusive use of Humana Preferred “high-performance” network
– ASO clients saw health costs decline by 15% in 2006 versus 2005
Business Leadership