posted by AHIP
on March 12, 2018
WellCare’s CEO Ken Burdick (pictured) presented on a panel at AHIP’s National Health Policy Conference 2018 in Washington, D.C. The session focused on “Navigating What’s Next for Health Care,” which highlighted key opportunities and challenges for the health care industry, examples of innovation, and perspectives regarding how health insurance providers can demonstrate value. Burdick shared his insights with AHIP following the event.
Ken Burdick: There are dozens of challenges ahead of us. From WellCare’s perspective, though, some of our greatest challenges are affordability, access to care, fragmentation of care, variation of practice and process, misplaced incentives, and the issue of consumer engagement.
Burdick: Our opportunity lies in our ability to stay focused. We must center our attention on a few things that will really move the industry forward. Advances in technology as well as data and analytics will enable health care to run more effectively, which is a move toward integrating and coordinating care. However, we must also adapt administrative simplicity while balancing technological advances, which could make a complicated system even more complicated.
Burdick: One way WellCare is innovating is through the use of machine learning to improve interactions between our customer service representatives and members. This past year, WellCare provided a tool to our front-line representatives that aggregates medical terminology to provide associates with more accurate information for our members. Another WellCare innovation is a complete process overhaul of our prior authorization process for outpatient and elective procedures. This new process will take 80 percent – 90 percent of prior authorizations out of the system, which decreases complexity and creates a better member experience.
Also, in the area of social innovation, WellCare launched CommUnity Impact six years ago, which addresses unmet social needs and barriers to care. In 2017, we connected 33,000 members with 106,000 community and agency services.
Burdick: There are so many ways we can provide value, but I do believe there are three primary areas we must address. The first is providing integrated, holistic, coordinated care. Our health system is fragmented and doesn’t serve the population well. We cannot continue to treat behavioral health, physical health and substance abuse separately. That’s not the way we are constructed as human beings. Second, we must accelerate the transition from volume to value. Only a small fraction of our system is truly value-based. We still operate in a fee-for-service, volume-based system, and we need to move as quickly as possible to make real change. Lastly, we must make sure that high-tech doesn’t put us in the position of losing high-touch. Our biggest opportunity exists in the relationship and the human connection we make with our members.
Burdick: WellCare believes that cultivating long-term trusting relationships with our members is the key to helping change their behavior. While it’s not a simple goal, it is the central way to truly developing a high-performing health care system.