Many factors push against medical-cost restraint

TOUGH TALK: From left, Kim Keck, president and CEO, Blue Cross & Blue Shield of R.I.; Peter Marino, president and CEO, Neighborhood Health Plan of R.I.; Sandra Coletta, Care New England, chief operating officer; Dr. Peter Hollmann, chief medical officer, University Medicine; Wendy Kagan, senior vice president, BankNewport; and Alok Gupta, R.I. Quality Institute COO, discuss medical costs at the PBN Health Care Reform Summit. / PBN PHOTO/RUPERT WHITELEY
TOUGH TALK: From left, Kim Keck, president and CEO, Blue Cross & Blue Shield of R.I.; Peter Marino, president and CEO, Neighborhood Health Plan of R.I.; Sandra Coletta, Care New England, chief operating officer; Dr. Peter Hollmann, chief medical officer, University Medicine; Wendy Kagan, senior vice president, BankNewport; and Alok Gupta, R.I. Quality Institute COO, discuss medical costs at the PBN Health Care Reform Summit. / PBN PHOTO/RUPERT WHITELEY

Insurers, doctors and hospitals are ratcheting down the cost of health care with slow and difficult methods, like redesigning doctors’ practices and persuading patients to settle for less.

Opposing them, jacking costs up, are tough opponents. These include the high cost of drugs and technology, patients’ insistence on using specialists and the medical treatment of problems that used to be seen as just part of life: menopause, obesity, depression.

Some upward pressure on cost is from good things: longer lives, better-paid workers, a stronger economy and lavish health insurance plans.

How to control prices in a state where people want better, more and longer care was one subject discussed by a panel of insurers, business leaders and a doctor at the Providence Business News Health Care Reform Summit at the Crowne Plaza Providence Warwick on Oct. 20.

- Advertisement -

Rising health care costs was a big topic, but not the only one. Also discussed was the impact of urgent-care clinics, the benefits and risks of electronic health records, the value of preventive care and how employers can wheedle employees into accepting limits on their care choices.

One set of Rhode Island citizens targeted for much implied criticism was people who expect very extensive health insurance from their employers, and who use medical care and specialists, in particular, without regard to cost.

Kim Keck, president and CEO of Blue Cross & Blue Shield of R.I., said, “The price for [medical] services in dollars had been moderate, but the amount of services consumed is rising, especially for specialists.”

Keck came to Blue Cross last spring, after working in the industry in other states. She said she was surprised how Rhode Island employers believe they must offer “rich benefits with lower deductibles and every doctor and facility covered.” She said in other states, employees will live with networks “40 percent smaller” than in Rhode Island.

Keck said Blue Cross is attempting to make premiums more affordable by adjusting the cost of copays and deductibles to create better “cost accountability.”

Wendy Kagan, a senior vice president at BankNewport, noted that health insurance is a major element in contract discussions with prospective employees. “People think more about where they can get the cheapest gas than about the cost of their health care,” she said.

Sandra Coletta, CEO of Care New England, said CNE employees were offered plans last year at a lower cost that also required them to use providers within Care New England, where possible. She said the company got some strong resistance from employees who wanted to use any provider they liked.

“The concept of restraint feels challenging,” Coletta said, adding that the solution is to continue educating employees to change their expectations.

Later, during a Q&A session, an unidentified man in the audience said he was mystified by Medicare charges levied on his mother some years ago, and he was never able to determine the reasoning or origin of the charges. “We are blind consumers; we don’t know what things cost,” the man said.

The panel acknowledged the industry needed to give consumers more information on medical costs.

“There is a need for more-transparent and easier-to-use cost of care,” said Peter Marino, president and CEO of Neighborhood Health Plan of R.I.

The panel emphasized the importance of primary care practices as places where cost-saving care is being done in fresh ways. Some primary care doctors are moving into new types of self-organization – sometimes called systems of care or patient-centered medical homes – where the patient is at the center of a constellation of doctors and providers who come together in one place to consult about treatment.

“To reduce costs, we have to transform the delivery system,” said Dr. Peter Hollmann, chief medical officer for University Medicine. “Primary care practitioners have dramatically transformed their care … they are doing better care coordination. They are willing to move forward to a different payment system and being responsible for cost of care.”

Marino said Neighborhood Health Plan took on patient-centered care along with the thorny problem of chronically ill people who are driving the largest share of cost increases by going back to the old days of home visits. He said Neighborhood’s Health@Home initiative sends health care workers into patients’ homes to help keep them connected with doctors.

Panelists said the need for patient-centered treatment is being highlighted by use of urgent care, walk-in clinics.

Keck called the public’s use of urgent-care clinics a “disruption” of existing medical systems because it is forcing practitioners to recognize they must be more patient-centered, with methods like evening office hours or the ability to consult a doctor or nurse by phone or email.

Hollmann said urgent-care clinics meet a consumer need “but do not solve long-term health problems.”

Companies have a role in improving health and lowering costs by running effective in-house wellness programs. Kagan said a company’s wellness program must have buy-in from executives, but if it is effective it can change behavior and save money.

Another topic – also much discussed in recent years – was the large number of unoccupied hospital beds in the state.

Coletta noted with a bit of whimsy that people driving through Rhode Island see many “giant piles of brick” – hospitals – some of which have beds that are half- or one-third empty. The observation was part of the panel’s listing of entrenched problems, but no specific solutions were offered.

Hollmann said, “We have always had a high number of doctors and beds. Demand fuels its own use. If we organize ourselves more effectively, we will be more efficient.”

Fragmentation of health records among a patient’s many providers is considered a costly and intractable problem. Panelist Alok Gupta is chief operating officer of Rhode Island Quality Institute, which operates CurrentCare. This is a secure and voluntary electronic network that gives medical professionals access to their patients’ up-to-date, protected health information from multiple sources.

“There is no reason information should be missing,” Gupta said. “There is improved care … when [doctors] have all the intelligence to connect the dots to see how a patient is doing.”

Panelists differed about whether patients trust the security of the system enough to opt into it.

“Patients are recognizing that CurrentCare is good for them and helpful,” said Hollmann.

Marino countered, “People are going to be sensitive about revealing this information. I see a reluctance to share information.” •

No posts to display