posted by Alicia Caramenico
on March 11, 2016
As health plans look towards the future, AHIP President and CEO Marilyn Tavenner outlined how the private sector must lead the way in delivering better value for the health care system and consumers during this week’s National Health Policy Conference. “Health plans are stepping up and taking a larger and larger leadership role in alternative payment models,” she said.
These models include accountable care organizations, bundled payment programs, patient-centered medical homes, and Medicare Advantage. And these new payment arrangements are proving increasingly successful, Tavenner said. Medicare Advantage plans have up to 14 percent fewer inpatient hospitalizations and 13 percent to 20 percent lower hospital readmission rates compared to fee-for-service Medicare, she noted. Medicare Advantage plans also are outperforming traditional fee-for-service on nearly all quality measures.
Tavenner also highlighted the need to change the way we pay for care. “Disruptive innovators in health care won’t matter if we don’t get payment or delivery correct.” To get it right, Tavenner said the health insurance industry must get its arms around data analytics, provide actionable clinical data to providers about their performance in comparison to peers, and offer case management tools such as clinical support and telehealth.
“There are a thousand things going on in health care, but we can’t change a thousand things,” she told the audience. That’s why health plans are focusing on supporting Medicare Advantage innovation and care coordination, enhancing Medicaid managed care to improve value, and investing in more sophisticated data management and transparency.
The Policy Conference also featured a session on “Emerging Trends and Enduring Challenges in U.S. Health Care Spending,” which pointed to prices as the main driver of health care spending growth. Attendees also learned the evidence doesn’t support claims that provider consolidation leads to lower costs, higher quality, or more coordinated care.
During a session on “Transforming the Prescription Drug Cost Paradigm,” panelists noted that pharmaceutical costs are rising faster than any other health care service, making drug pricing transparency more important than ever. Other sessions focused on Medicare Advantage and Medicaid managed care making a big difference in the lives of patients and consumers calling for health care that is value-based, predictable, and personalized.