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AHIP chief Marilyn Tavenner is looking to the future of health insurance

Health plans need stability, the former CMS leader says, to be able to offer high-quality and affordable coverage.

Susan Morse, Senior Editor

Marilyn Tavenner, president and CEO of America's Health Insurance Plans, has an interesting job as the insurance market faces major regulatory changes in a post-Obamacare future.

Tavenner previously served as administrator of the Centers for Medicare and Medicaid Services and was Virginia's secretary of Health and Human Services. She became CEO of Hospital Corporation of America after starting there as a nurse for Johnston-Willis Hospital. But now she's the voice of the private insurance market.

As head of AHIP, Tavenner has been an outspoken advocate for insurers, most recently urging the Trump administration to continue the federal cost-sharing reduction payments necessary to stabilize the individual market.

We asked Tavenner about the future of the industry and how collaborations with providers will shape that.

Q. What do you see for the future of the health insurance industry over the next 10 years, apart from whether there is a Democrat or Republican in the Oval Office?

This is a great question, and even in our current environment, we must stay focused on how we deliver for the millions of people we serve daily.

That's why last year, our Board directed AHIP to assess what's needed to improve healthcare long-term. We found that our members are steadfastly committed to consumers and patients. They are embracing strategies and innovation that advance affordability, value, access and well‐being. Over the next 10 years, we will see them improving health, affordability and financial security by promoting consumer choice and market competition, simplifying the health care experience for individuals and families, supporting constructive partnerships with all levels of government, partnering with healthcare providers on the journey from volume to value, addressing the burden of chronic disease and social factors that impact health, pursuing the promise of clinical innovations while ensuring value and harnessing data and technology to drive quality, efficiency, and consumer satisfaction.

Q. What do insurers need to remain in the marketplace?

Most immediately, health plans need stability. As AHIP has engaged with Congress and the Administration in Washington, we have offered our experiences, recommendations, and lessons learned to help achieve that stability.

That means a stable, competitive market that delivers choice, high-quality, and affordable care to consumers. It includes guaranteeing access to coverage for all Americans--including those with pre-existing conditions – and pairing that access with strong incentives for individual to maintain continuous coverage.

It embraces tools and financial incentives to help people afford coverage now, such as tax credits, as well as health savings accounts specifically designed for this market.

We also believe that states have an important role to play. They know what their people need. They know what works for their market. They work with their plans, and they regulate these products. They should be empowered to have products that work for them, to innovate on new ways to care for their citizens, and to use their health care dollars in ways that will deliver the greatest returns for them.

We are committed to getting this right, and we are working with policymakers – from both parties – to deliver real solutions that work for the American people.  

Q. What do you see for the future of insurers on the health insurance exchanges in 2018 and beyond?

Our health plans are committed to the principle that everyone should have affordable coverage and access to quality care. Our focus immediately is to ensure there is a stable market for the 11 million people who buy their coverage through exchanges, and for the millions of people who rely on some form of subsidy or support to help them afford coverage and care. 

We need to ensure pathways to coverage for them, without creating additional burdens for taxpayers.

No one can say with certainty what the market will look like in two years. But we do know we need a solid transition that supports consumers in getting there.

Q. Beyond the ACA, what are the biggest challenges for insurers?

We still need to focus on the factors that continue to drive medical costs. Earlier this year, AHIP released research about where the dollars spent on commercial premiums go.

We found that prescription drugs are now the single largest expense in the commercial market. More than twenty-two cents of every premium dollar go to drug costs. Drug costs outpace physician services, outpatient facilities services, and inpatient facilities services.

Certainly, a lot is spent on care, and we are seeing promise in value-based care and other forms of collaboration with providers. We must ensure that people continue to have access to their doctors, to the services they need, and to the best kind of care available. Our industry can help ensure these are the best kinds of interactions.

Q. You mentioned that the high cost of prescription drugs continues to be an issue. How are insurers thinking about the issue of drug pricing?

If we want real change in healthcare, we cannot afford to put drug costs on the backburner. Drugs still comprise most our health care spending.  Specialty drugs typically cost $100,000 per patient per year. The price hikes are continuous. And no one has any insight into how drug prices are set.

Consumers are demanding greater transparency to understand why their medications cost what they do. Big Pharma can't keep distracting from the real issue. We need to continue to push for choice, competition and affordability.

Q.  Studies have shown that payers are ahead of providers in embracing value-based incentives. In what areas do you see insurers excelling in this area and where are they headed next?

Health plans continue to have the same north star that's guided our strategies and planning for the past 5 years or more –  protecting the health and financial security of millions of people, by advancing affordability, value, access, and well-being, so that every American has access to affordable coverage and quality care. The way we do that, has a lot to do with value-based care, as well as with population health. I believe we'll see continued emphasis in this area.

In our patient-centered medical homes, accountable care organizations, and other value-based care models, we rely on collaborations with providers, with federal and state governments, and with community organizations to improve access and outcomes, while improving costs.

There are great examples particularly in Medicare and Medicaid, where people are healthier, member satisfaction levels in many areas remain strong, and we're achieving a lower tax burden for Americans. A lot can be learned from these programs and applied to the employer and individual market. AHIP will continue to support policies that enable plans in all markets to innovate for better quality and value.

Q. What do you see as the future for payer and provider collaborations or partnerships?

The relationship between health plan and provider is more important than ever before. We have stronger partnerships than at any other time in our history. We have seen tremendous examples of successes, and we need to continue to learn from them.

When we do it right, patients experience their care in the most positive of ways. They include in an integrated care setting, like a patient centered medical home, where all a patient's doctors are working together on their whole health. In how we manage their pain, giving patients options and alternative treatments that allow them to avoid opioids when they can, and the perils of addiction that can come with those drugs. In caring for their minds as well as their bodies, identifying mental health concerns before they become too severe, and getting patients into appropriate treatment to improve their well-being.

Beyond such formal, value-based arrangements, health plans work alongside providers to address many of the critical health issues that threaten our communities. Such as stakeholder roundtables, to get to the root of a health issue that's affecting our communities, like immunizations, asthma or tobacco use. The ways in which we collaborate are as varied as the health challenges we face – and the innovative solutions we must develop. It is that variety that makes our collaborations work so well. This will increase as more private and public sector organizations work to address the various social determinants of health for better and more sustainable well-being.

When we come together across disciplines, across businesses, to focus on the people we serve, we make a real difference.

Q. What innovations are you seeing?

Health plans are pursuing the promise of clinical innovation, especially in controlling and mitigating the debilitating effects of chronic conditions – like arthritis, asthma, and diabetes.

Chronic diseases are complex and multi-faceted, and don't just create a strain on the health care economy. They also create tremendous strain on the individual and their families and they struggle in managing them day to day. For several years, health plans have been studying how people with chronic conditions travel through the health care system, and what specifically we can do to help them keep their conditions under control.

Q. Do you see insurers going beyond the business of being a traditional health insurer?

Health plans enjoy a unique perspective in health care. In their role, they have a 360-degree view of how health care functions and how to make it better. We know the impact that changes and new programs can have on our industry, providers, hospitals, businesses, and the people we serve. We understand the consumer and patient experience – how they use their coverage and care, how we can improve their whole health and well-being. And we know how consumers want us to do better.

Much of that insight, is brought to light through the gathering, mining, and analyzing of data.

Q. Are insurers thinking about data differently as a result?

New techniques in data analytics are helping us to understand the member at a deeper level than ever before. We can spot health concerns, and address them proactively. We can help coordinate care, and ensure treatment for one illness does not inadvertently aggravate another condition.

Take an issue such as medication adherence. Medication nonadherence costs the U.S. health care system between $100 billion and $300 billion in avoidable health care costs annually.

At the community level, data and technology can help spot health trends, like medication adherence, and more rapidly respond to them before they become an epidemic. And we can identify illnesses that are rampant in a community, and ensure they have the additional resources they need.

Just as these technologies are improving healthcare operations, consumer-focused technology is being introduced to improve the health care experience.

Telemedicine is helping to provide more convenient access for those in rural areas or individuals and families may not have immediate access to a hospital or doctor. Leveraging the devices we all have at our fingertips daily, telemedicine offers immediate access to care and improved patient experience all while lowering costs through reduced ER or urgent care visits and increased productivity.

In-home technologies are monitoring and reporting on a person's vital signs and other biometric data, a tremendous advance for those with chronic conditions.

Social media is being used more frequently to connect patients to peer groups and online communities for support and encouragement in improving their health. Apps and online resources are offered to consumers to help them stay educated on their conditions, and to help them understand how to be more compliant with their program to keep their conditions under control. Some even offer Touch ID technology through their apps to easily log in and out of member accounts.

Twitter: @SusanJMorse

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