State of the Industry 2009: Reform

October 1, 2008

While it appears as if healthcare has taken a back seat to current economic and global issues, 25.9% of nearly 500 MHE readers surveyed see health plans as being the agents of change in reform.

While it appears as if healthcare has taken a back seat to current economic and global issues, 25.9% of nearly 500 MHE readers surveyed see health plans as being the agents of change in its reform.

"This indicates a confidence in their own ability to change, as well as skepticism about government's ability to drive reforms effectively in a contentious environment. If there is a surprise, it is that [25.9%] is not higher," says Jeff Munn, design and development group leader in the health management consulting practice of Hewitt Associates.

"Momentum issues get attention, and, assuming that there are solutions that the executives feel strongly about, gaining grassroots awareness and support for those issues will be critical no matter who wins the White House," Munn continues.

The outcome of the upcoming election could play a role in why almost 23% of managed care executives surveyed by MHE say that they aren't certain which stakeholder will make the most progress on health reform.

Foote goes on to say that while most health plans support expansion of coverage to more individuals, few have faced the reality of cost constraints that accompany that expansion, including efforts to pay for quality and not volume.

Expanding coverage is certainly something that Commonwealth Health Insurance Connector Authority in Massachusetts knows about. "With critical support from the federal government, we're showing it can be done," says Jon Kingsdale, executive director of the Connector. "Lessons learned are priceless. Look closely at the data, not just the headlines. Look locally, look nationally and look internationally. There is much out there to be both emulated and avoided."

According to Kingsdale, there are nearly 440,000 newly enrolled beneficiaries since reform was implemented in July 2006. A recent annual survey by the U.S. Census Bureau reports that Massachusetts had the lowest rate of uninsured in the country at 7.9% for the two-year period between 2006 and 2007.

But, whatever path managed care executives decide to take, Peter Kongstvedt, an independent advisor based in McLean, Va., suggests being as proactive as possible, preferably in concert with other forward-thinking organizations.

"Being reactive always means that somebody else is setting the agenda, proposing the rules, setting the goals," Kongstvedt says. "Being proactive doesn't guarantee success, but it at least means that your own goals and objectives will be in the mix early on.

"Having said that, proactive absolutely must not look like an exercise in selfish protectionism-which means understanding the legitimate needs and goals of others, and translating your own goals and objectives into terms meaningful to others," he concludes.