Five things that keep health execs up at night

We asked industry leaders to share what has them counting sheep. You might be surprised what they said.

“I know I’m not the only one challenged by this dilemma, but threading the cost/quality needle has become a real science. The solution needs to emphasize patient engagement and practitioners managing the care must take a wide variety of social, economic and other variables into consideration. Insurers will always play an important role, but an expanded doctor/patient relationship is really the key. Collectively, we must all do whatever we can to promote healthier lifestyles and eliminate overtreatment. If we do, better outcomes-and lower cost-will follow. The question is how do we get from A to Z.”

“I worry most about the things I have the least control over. My biggest concern is that no one is effectively advocating for the healthcare consumer. While Capital District Physicians’ Health Plan, Inc. (CDPHP) is doing what it can to be that advocate, we are up against two major forces-the affordability crisis in healthcare and the inability of government to offer any real solution to the problem. Rising pharmaceutical costs and rising medical costs due to hospital consolidation and physician acquisition are threats to the health of the American consumer. Unfortunately, our government, while well intentioned, doesn’t have a true understanding of how to fix the crisis. The Affordable Care Act (ACA) is an example of the perfect paradox-the government created the program under the guise of making healthcare more affordable; however, the ACA has actually fueled the affordability crisis we are in. Sadly, the consumers are caught in the middle with no one on their side.”

“The world is moving quickly to value and many physicians are unprepared to transition from fee-for-service. Government mandates with Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), The Merit-Based Incentive Payment System (MIPS), accountable care organizations (ACOs) and bundles are confusing many physicians, who need partners to help them prepare for their transitions. If we want to accelerate our move to population health, we must ensure physicians, clinicians and others involved in care delivery possess the necessary accurate, real-time data analytics and clinical support capabilities so they can chart a successful course to value.”

“Healthcare disparities are a pressing issue, particularly in the U.S. which lags behind other industrialized nations in many important health measures. Today, several groups in the U.S. are at a disproportionate risk of experiencing worse health outcomes, including people of color and economically disadvantaged individuals. And in most measures, the disparities gap is growing.

This is an issue that is complex and the solutions must be as well. We must first recognize that these disparities exist and agree that it’s unacceptable for anyone to experience poorer health outcomes based solely on race, ethnicity, geography, or income level. Once we’ve acknowledged the issue, healthcare organizations should focus on eliminating disparities through evidence-based practices, data collection and physician culture to better understand and care for members and patients. And care providers should be recognized and rewarded for closing the biggest care gaps. Because after all, equitable care is just part of good medical care.”

“I believe that the top three imperatives of our time are securing world peace, solving world hunger and improving the healthcare system in the United States. To improve the healthcare system we need to focus on the basics-simplify wherever we can and optimize the connections between members, providers, customers and partners. 

Our recent partnership with Quartet Health, a technology company backed by Google Ventures, is just one example of how Highmark is making an impact on both fronts.  Their platform simplifies the process of identifying patients with undiagnosed mental health issues, improves the connections between primary care physicians and behavioral health specialists and, when needed, speeds up referrals to behavioral health specialists eliminating what can be wait times of up to several months for that first appointment.  That’s good progress.

 The burning question for me is: Are we working in alignment-pulling all possible levers-to improve the healthcare system and make it easier for our members to get the care they need?