Summit: Insurers, doctors, hospitals and patients need to change patterns to control medical costs

KIM A. Keck, president and CEO of Blue Cross & Blue Shield of Rhode Island, said BCBS is using various tools to impose more accountability on plan members. Keck spoke at the Providence Business News Health Care Reform Summit on Thursday. / PBN FILE PHOTO/MICHAEL SALERNO
KIM A. Keck, president and CEO of Blue Cross & Blue Shield of Rhode Island, said BCBS is using various tools to impose more accountability on plan members. Keck spoke at the Providence Business News Health Care Reform Summit on Thursday. / PBN FILE PHOTO/MICHAEL SALERNO

(Updated 1:19 and 2:16 p.m.)
WARWICK – Controlling health care costs is largely a matter of supply and demand, but Rhode Island tradition throws some extra wrenches into the works. Two of them, for instance, are the state’s oversupply of hospitals and the assumption by consumers that they’re entitled to any care they choose.
Those were two major themes of the Providence Business News Health Care Reform Summit, held Thursday at the Crowne Plaza Providence Warwick, where insurers, a doctor and employers talked about the thorny problems of medical care and cost.
Panelist Dr. Peter Hollman, chief medical officer of University Medicine Foundation, opened with a four-point diagnosis that most of the panel later reiterated. He said:

  • The state’s improving economy is driving more people to use medical services, including medical care that some people might have been postponing;
  • Labor costs are up;
  • The state population is aging;
  • Conditions that at one time were not considered medical problems – an example is menopause – are now being treated as illness.

A major theme of the panel was that Rhode Islanders historically feel entitled to as much medical care – including the use of specialists – as they want, when they want it.
Wendy Kagan, a senior vice president at BankNewport, noted that health insurance is a major element in contract discussions with prospective employees.
“Employees expect rich, one-stop insurance; it is a major part of their total compensation,” Kagan said.
Sandra Coletta, chief operating officer of Care New England, added a dash of humor when noting another oft-cited condition. She said when you drive through Rhode Island you see many “giant piles of brick and mortar” – that is, hospitals – some of which have beds that are half or one-third empty. Nods by other panelists indicate that oversupply of hospital beds is a problem still needing a solution.
Several panelists said Rhode Islanders need to be de-conditioned from the assumption that there should be no limits on their choices and use of medical service.
Kim Keck, the president and CEO of Blue Cross & Blue Shield of Rhode Island, said she was impressed, when starting the job earlier this year, to see the extensive health insurance plans Ocean State workers expect. She said Blue Cross Blue Shield is using various tools to impose more accountability on plan members, like making premiums more affordable, but then setting co-pays and deductibles at levels that encourage members to seek cheaper medical service.
Coletta said CNE employees last year were offered plans at a lower cost that also required them to use providers within Care New England, where possible. She said the company experienced some strong push-back from employees who wanted to use any provider of their choice.
“The concept of restraint feels challenging,” Coletta said, adding that the solution is to continue educating employers to start changing their assumptions.
During a question-and-answer session, a man in the audience said he was utterly 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. “I cannot price shop” for medical care, he insisted.

Some panelists quickly acknowledged that insurers and practitioners also are responsible for bringing greater transparency to 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 Rhode Island.
Keck said Blue Cross Blue Shield has a “major goal to make cost of health services accessible.”

Another theme of the summit was educating health plan members to make better decisions about their health and getting them to take more ownership of their health.

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Lisa Ranglin, a former vice president of Bank of America and currently serving as volunteer president of the R.I. Black Business Association, said she was interested by that discussion and how employers need to engage with their employees to help them make better choices.

“That knowledge is critical, but we need to make sure it’s used in a meaningful way,” she said, such as selecting the right provider and knowing where to go to get the proper care.
One part of the health care picture that came in for praise by the panelists was the primary care providers in the state who are moving toward consolidating services – including specialists – that work cohesively in a group with the patient at the center of coordinated services. One of these models is called patient-centered medical homes, and these are credited with delivering better care and saving money.
Staff writer Matt Bower contributed to this report.

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