New Perspectives on the Health Care Crisis

Some of the Capital Region’s renowned employers recently joined CDPHP^® for a candid conversation on the health care crisis—as well as new perspectives on solutions. As a product innovator, I was naturally nervous about having this discussion without offering that one product or service to solve all the problems. What I quickly realized is that it’s not about that one product. It’s about taking a new approach to a bunch of old problems and aligning a team to do it.

So, what’s the crisis? Affordability for the average American. There still remains a large uninsured population. And many of those who do have coverage can’t afford their deductibles. When it comes to paying rent or insurance, they’ll naturally choose rent. But the squeeze on the system is not the insurers. I should know—I am one. 

A Team Challenge

Everyone has a piece of the pie. Not one player can solve the health care crisis alone. We have to do it together—consumers, employers, insurers, doctors, and, yes, even regulators. Consumers need to ask about costs. We spend more time shopping for a deal on our cell phones than on our health services. Doctors have to push for quality and efficiency. Employers can’t just pay premiums—they need to help lead the conversations about affordability for their employees. Engaging in a culture of wellness and accountability is critical, but it can only take the affordability issue so far.

While well-intentioned, reforming health care has become something of a tactical checklist:

• Value-based payment and care models
• Hospital and provider consolidations
• Provider/insurer partnerships
• Employer cost-shifting
• Public and private exchanges
• Retail and alternative care sites
• Drug cost transparency
• Population health and wellness

As a self-proclaimed health care geek, none of these concepts are new to me. We are researching and developing in this space every day. In fact, CDPHP is a leading innovator and influencer in many of these categories. For example, our nationally recognized Enhanced Primary Care (EPC) program has not only helped save more than $20 million dollars, it’s enabled doctors to focus on quality of care instead of how many patients they see in a day. The key, however, is more about how the goals are accomplished: with an approach like social work. It’s about marrying tools together to effect change on a personal level.

The Human Face of Reform

Our discussion leader, Ian Morrison, is an internationally known author, consultant, and speaker who specializes in long-term health care forecasting and planning, as well as the changing business environment. He is also a founding partner of Strategic Health Perspectives (SHP), a Nielsen company. SHP provides insight for a mix of health care players, including suppliers, providers, and payers, including employers.

It was refreshing to listen to Ian describe how SHP takes very complicated systems and data-driven concepts and boils them down to one very human concept: listen to people. For example, he told the story of a woman who was constantly returning to the hospital because she wasn’t taking her medications. Not only were her frequent hospital visits detrimental to her health and costly for her, but they were also a squeeze on the financial health of the system. No one could figure out why this kept happening until one person just asked her why she wasn’t taking the medicine. Her answer? She didn’t have a refrigerator to store her specialty medications. How did the hospital solve that complex health care problem? They bought the woman a refrigerator and her repeated emergency room visits stopped.

Our Philosophy at CDPHP

That mentality is at the heart of CDPHP—and it has been for more than 30 years. As a physician-founded and -led plan, we work, live, and breathe collaboration. Our very foundation supports working with our providers to figure out how to make care more affordable. Our passionate service representatives, care coordinators, and case managers reach out to hundreds of members on a personal level each and every day. Those who aren’t working directly with members on the phones or at one of our CDPHP^® Customer Connect℠ locations are advocating on their behalf from behind-the-scenes. It doesn’t stop there, as we support and lead efforts for better access to care and health improvement in our communities.

CDPHP also works with employers in many ways, so that they can continue to offer competitive benefits packages and attract loyal workforces. CDPHP Shared Health provides large employers unprecedented cost transparency, which gives them the power to reduce costs and control premiums. Our clinical account teams tailor worksite programs to the health needs of employees, influencing health behaviors at all levels.

So, let’s keep the momentum going and do this together. The problems in health care today are the same problems we’ve been experiencing for decades. The power to change them lies in how we approach the solutions—as a team focused on curbing trends with a fresh perspective on our purpose: the patients.