As the CEO of a health insurance company, I wake up every morning trying to find a way to put myself out of a job.
I want to get rid of the need for health care insurance in this country. I guess that’s a startling admission from someone in my position. But I know firsthand that the U.S. insurance system is getting increasingly expensive and complicated. The frustration it causes for Americans can’t be good for anyone’s health.
Health insurers are actually just intermediaries within a vital health care relationship: the one between patient and provider. As intermediaries, unfortunately, insurers can hamper physicians’ treatment of their patients.
Too often patients don’t get the treatment they need because of the way the payment system is set up. For example, a commonly recommended treatment for a patient who’s suffered a fracture due to osteoporosis is an IV bisphosphonate infusion. It strengthens bones and prevents future fractures.
But, because a hospital won’t receive additional reimbursement other than what they get for treating the fracture, providers recommend a patient receive the infusion after discharge. This requires additional paperwork, scheduling and the inconvenience of another visit to a hospital to receive the infusion. Due to the roadblocks incurred by our payment system, many patients never receive the infusion they need. This ultimately harms people and increases the cost of care.
No one wants the insurance industry making medical decisions. But it has an influence on an enormous number of decisions, particularly beyond the consequential determination of when and where drug treatment begins after a hospital stay. We need an incentive for doctors to keep patients healthy once they leave the hospital. This is clearly better for physicians, and for patients, and a long-term saving for the entire system.
The payment of appropriate health care has been the responsibility of the health insurance companies; the delivery of care is for physicians to decide. That’s how it’s supposed to work. Both sides infringe a bit on the other’s territory. It’s a bit of a tug of war. The insurance companies apply brakes to unnecessary health care spending and the physicians focus on getting the patient better, regardless of cost. This has led to a kind of rugby scrum — one side pushing to reduce “unnecessary” costs, the other to order “appropriate” services.
We should develop a system where physicians can balance the appropriateness of the care with the cost of the care. For example, a spine fusion costs approximately $50,000. For some people, physical therapy service, including medication, is just as effective and only costs a few hundred dollars. Currently, the physician has an incentive to do more expensive procedures.
But what if insurance companies paid physicians simply for getting patients healthy? That way a doctor would be paid the same amount for getting a patient back to normal function, whether it’s accomplished by surgery or physical therapy treatment.
Reducing the role of insurance in medical treatment will mean more direct engagement between doctors and patients. It would encourage patients to realize the essential role they play in sustaining and improving their own health. With guidance from health care providers, patients could better educate themselves about lifestyle habits to ward off risks to their wellness. Physicians would be paid for health care, not just sick care.
We need doctors facing fewer insurance regulations and receiving reimbursement for quality patient outcomes. We also need patients striving to shape and improve their own health. Together physicians and patients could substantially reduce health care costs in the United States which currently consumes 18 percent of our gross domestic product.
While I like to imagine the day when a job like mine no longer has a place in American life, that dream is not yet on the horizon. But from where I sit, I can promote better alignment of costs and outcomes. In our sights is a strong direct relationship between doctors and patients that benefits both groups. Greater engagement would reduce the role of the aggravating obstacle in the middle: insurance companies. This is a relationship that I, as a health plan CEO and health care consumer, am committed to nurturing.
Chad Westover, MPA, is CEO of University of Utah Health Plans.