Several of the country’s largest health plans have recently issued reports or statements relating to health care reform. While the source needs to be considered in reading any discussion of health reform, these plans do have a significant body of experience regarding coverage, cost and quality issues and they retain formidable lobbying weight. So their perspective will likely have some influence.
United HealthGroup’s Center for Health Reform and Modernization issued a report entitled Federal Health Care Cost Containment-How in Practice Can it be Done? (UHG Report) The report examines 15 options for controlling health care costs and estimates savings of $540 billion over ten years if those options were fully implemented across the entire population. The options fall into four categories: Incentivizing patient use of quality providers; reducing inappropriate care; incentivizing providers to practice quality care and using evidence-based standards in making reimbursement decisions. The savings estimates are said to be based on UHG’s own experience in utilizing these techniques. In issuing the report, UHG has obviously chosen to zero in on the most difficult aspect of health reform–how to reduce costs to more palatable levels, but has largely described options previously identified as methods to obtain better cost controls. The report is similar to the Congressional Budget Office’s December 2008 work analyzing a number of techniques to limit costs.
WellPoint’s Institute of Health Care Knowledge has put out several pieces relating to health reform. A recent one, What’s Really Driving the Increase in Health Care Premiums, appears designed to rebut public perceptions that insurers’ profits are responsible for rapid health cost rises. (Wellpoint Report) The report, drawing on other researchers’ work, identifies medical technology, excess price inflation, cost-shifting, regulatory compliance and patient lifestyles as the major contributors to increasing health costs. The Company has also released a piece called “Building a Sustainable Health Care System” that identifies key solutions the company believes should be part of any health care reform. These solutions include promotion of evidence-based medicine, greater ability to disseminate and share information to improve quality, focus on prevention and chronic illness, better use of drug therapies, reduce medical errors, eliminate fraud and reducing malpractice costs. Nothing earth-shattering.
Finally, Aetna has put out some statements on reform. “Our Plan for Reform” again identifies certain factors-excess unit price increases, more utilization, medical technology-as the cause of health cost rises. (Aetna Proposal) Aetna’s proposal regarding key reform principals includes: an individual mandate to have health insurance; government subsidies and plans for low-income citizens; support of the private, employment-based insurance system; equalizing of tax treatment for employment-based and individually purchased insurance; portability; promotion of preventive care and wellness; improving quality and safety by best practice research and pay-for-performance programs; and greater use of health information. Again, nothing particularly innovative.
What is noticeable is that the large health plan companies, and their trade association, America’s Health Insurance Plans, understand the significance of the health reform discussion for their businesses, want to portray themselves as being helpful contributors to the discussion and want to picture factors and actors other than themselves as responsible for the cost problem.