Health plans face a myriad of challenges this year, like waning market stability in ACA health exchanges, looming repeal and replacement of the health law and a surge toward care efficiency.
Ceci Connolly is CEO of Washington, D.C.-based Alliance of Community Health Plans, a national organization of 20 health organizations. She told Becker's Hospital Review ACHP members approach regulatory and market uncertainty with an eye toward providing affordable, quality-based coverage and care.
ACHP members include Danville, Pa.-based Geisinger Health Plan, Oakland, Calif.-based Kaiser Permanente, Temple, Texas-based Scott & White Health Plan and Pittsburgh-based UPMC Health Plan, among others.
Here, Ms. Connolly responded to Becker's Hospital Review's five questions about health insurance industry trends, as well as strategies for coordinating care and creating efficiency in an evolving healthcare ecosystem.
Question: What is a top trend to watch this year in the health insurance industry?
Ceci Connolly: Navigating uncertainty is obviously the biggest because of the election results and now the debate in Washington — which I'm referring to as health reform 2.0. In many respects, we're heading back to square one and there are still so many unknowns dominating the entire health sector, not just plans.
Q: How are some health plans navigating this uncertainty?
CC: There is something that's often referred to as a 'no-regrets move,' something that will be beneficial no matter what happens in the political or regulatory environment. For instance, continuing to be super efficient. That's an enormous challenge for the entire healthcare sector.
For ACHP [members], all of them are nonprofit and community-based. They're focused on social determinants of health. Nutrition, food deserts, transportation, adequate housing, health literacy, mental health — these are all things our plans continue to invest in because we think it's the right thing to do for patients and communities — but we also think it's a smart long-term investment.
Q: Some of the largest insurers — Aetna, Anthem, UnitedHealth Group — are spending nearly 50 percent on value-based care models. Is this trend here to stay in the health insurance industry?
CC: It's a good question and something of a concern in our world. I would be a little cautious about that 50 percent figure. We [ACHP] have a much more specific view of value and value payment in healthcare, and it involves financial risk.
To say to a doctor or a hospital, 'We're going to pay you extra if you've done the right thing and delivered quality' — well, that's a bonus. That's not the value-based model we're advocating and pursuing in our members. To get to true value, there has to be financial risk for all of the players, and that includes the providers. It means maybe getting paid less if you're not a high-value clinician or health system.
When you hear these 50 percent numbers, a lot of the time they're counting the ones where you pay somebody a bonus — that's not a very risky proposition. It's like getting your cherry on top of your ice cream sundae.
Q: Some health plans are creating jointly owned plans with providers — like Allina in Minnesota and Aetna. What are your thoughts on this?
CC: Almost all of our members — like Select Health (Salt Lake City) and Geisinger Health Plan — have deep provider relationships. We believe that is the best model of care. It's the best thing for patients. When you get coordination and close alignment going, you don't have as many gaps in care. You start to align the financial incentive, so instead of competing over the healthcare dollar, you're working together to spend it wisely.
Q: How does joint venture activity currently stack up in comparison to M&A in the insurance industry?
CC: I don't think there's one perfect approach. There are a lot of variables from market to market and company to company. When many health systems got insurance licenses and opened plans, they discovered running a health plan is very difficult. Being able to forecast and manage risk is quite complicated. Our members have learned that through years and decades of experience, sometimes partnering with an established plan can be beneficial.
This article was updated Feb. 9 at 10:12 a.m. CT to reflect ACHP has 20 members, not 21. We regret this error.