If You’re Going to San Francisco

Les Masterson, for Health Plan Insider, June 11, 2008

Like many of the readers of this column, I am preparing for next week's America's Health Insurance Plans (AHIP) conference in the land of cable cars, fog, and Barry Bonds supporters—San Francisco.

The flight has been booked, the hotel room reserved, the Giants tickets purchased, and the trips to Alcatraz and the Charles M. Schulz Museum planned.

All that's left is to think about the conference—which I'll have plenty of time to do during my six-plus-hour flight from Boston. Before attending a conference, I take a step back and think about the industry and trends. There is no better place to come bearing questions than a national conference with hundreds of industry leaders. (Check back next week to the health plans page and find out what I'm learning. I will be blogging from the conference.)

Here are some of the questions I plan to ask during my time in the city by the bay:

  • Are health plans situated in a way that they will always be the bad guys or is there a way for health plans to gain the support of providers and members? As I have written before, health plans have become a convenient whipping boy for politicians. I wonder if there is any way to change that. Step one would be improving reimbursements and creating greater transparency with physicians, but what else is needed? I hope health plan leaders have some ideas.
  • How will the Microsoft and Google personal health records impact the future of healthcare? Is a personal health record really going to spark a patient to become more engaged in his or her health? Colleague Molly Rowe recently offered a list of questions for Google. In addition to Molly's questions, I wonder if personal health records are just the latest in a line of ways that health leaders think will engage patients, but simply don't create the desired spark. The problem is: How do you get a person to do something when he doesn't see the benefit? I'm sure attendees will get an earful on that topic.
  • Given the growth of the individual health insurance market, how can health plans create a system that reduces costs while providing coverage to everyone who is eligible? Are rescission policies the only way to perform that balancing act? California has been ground zero in the rescission fight. The California situation shows that health plans need to get out in front of controversies like rescissions. The health insurance industry must become more forward-thinking and review its programs. If there are more effective ways to offer services, improve outcomes, and reduce costs, health plans need to get ahead of the curve—before the states create laws that don't benefit the industry.
  • Is health management cost effective or just the flavor of the month? Leaders in the disease management realm are pointing to health management (the combination of disease management and wellness) as a way to save money. Studies have shown ROIs of 3:1 and 5:1. But for every health management supporter there are those who say there simply isn't an adequate gauge of ROI for health management. I'm curious to see what industry leaders think of health management and whether there are ways to accurately find an ROI.
  • Will not paying for "never events" improve quality and impact health plans' bottom line? Health plans have followed Centers for Medicare & Medicaid's lead on not reimbursing for "never events," such as operating on the wrong side. Cynics see health plans' move as a way to merely cut costs and has nothing to do with improving quality. One way to change naysayers' opinions is for health plans to take that money they saved from "never events" policies and put it into research to find ways for hospitals and doctors to avoid those situations.
  • Is Massachusetts healthcare reform, with its collaboration with private health insurers, the best way to offer coverage to the uninsured? Other states are looking to move slower than Massachusetts. Instead of mandating coverage, they have implemented cost-saving measures and quality improvements. The belief is that lowering costs will allow uninsured people to get health insurance. There are other states, most recently Florida, that have legislated mandate-lite health insurance policies, which allow individuals to buy lower cost insurance that doesn't include state-mandated programs, such as maternity, geriatrics, and gynecology. But the controversial nature of mandate-lite policies is also evident in the Sunshine State. A week after approving the mandate-lite legislation the state added autism to its mandated coverage list. In one sense, the state looked at mandate-lite policies as a way to decrease costs, but on the other hand an added mandate puts more costs on health plans. As this dilemma shows, healthcare reform is not easy.

Next week's sessions should prove insightful and will hopefully answer some of my questions—though I'm sure the conference will raise a few dozen others.

I look forward to meeting with industry leaders at next week's conference. Make sure you say hello if you see me.

How will you know me? I'll be the one asking a lot of questions.

Les Masterson is senior editor for Health Plan Insider. He may be reached at lmasterson@healthleadersmedia.com.

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