With Access Rising, Health Plans Focus on Delivering Affordability, Quality

Judging from prevailing media coverage, progress toward the implementation of the Affordable Care Act (ACA) has been measured largely by the number of Americans who gained health care coverage since Medicaid expansion, health insurance exchanges and related subsidies began to take hold. By this measuring stick, the nation is making steady progress, with Gallup reporting in June that the percentage of Americans who remain uninsured has fallen from 17.1 percent at the end of 2013 percent to 13.4 percent today.

To gauge success on this measure alone, however, is shortsighted. Ensuring that the ACA ultimately leads to affordable, high-quality care is arguably a greater, longer-term challenge, and one that health plans, employers, providers, and patients must tackle together.

At the Alliance of Community Health Plans, 23 member organizations are working to manage and deliver the intertwined priorities of quality and affordability for their 18 million beneficiaries. With different markets and customer bases, each plan has approached this challenge from a unique perspective.

Leaders at Geisinger Health Plan in Pennsylvania have long worked to sync clinical and health plan operations to meet the Triple Aim of better patient experience, improved health and lower overall costs. Geisinger’s ProvenHealth Navigator medical home program offers a textbook case study to this approach, employing care managers to work closely with patients with diabetes to reduce their risk of heart attack, stroke and vision loss. Between 2007-2012, the ProvenHealth approach led to a 27.5 percent reduction in acute care admissions, a 34 percent drop in 30-day readmissions and a 7 percent overall reduction in the cost of care for medical home enrollees—which translated into real savings for both the plan and its members. And Geisinger has been able to transfer this program to other systems in other states successfully, proving that their approach is replicable.

Meanwhile, leaders at Seattle-based Group Health Cooperative have relentlessly focused on providing excellent care and service in an era of increasingly tighter margins. It wasn’t easy, but starting in 2012, the board and executive leadership devised a plan focused on achieving health care’s triple aim – high-quality patient care, a positive patient experience and more affordable costs. Thanks in part to a disciplined approach to cost cutting, as well as intense, ongoing efforts to pursue the organization’s most important clinical goals, Group Health progressed on both priorities. Today, Group Health is one of only a handful of health plans in the nation to receive – and maintain for the past three years – a 5-star Medicare Advantage rating. It outpaces its local competitors, and much of the country, on quality performance.

Seamless integration across health plan and care delivery was the biggest challenge facing HealthPartners in Minnesota. To reach that vision, leaders set ambitious goals, including achieving a cost of care 10 percent lower than regional averages, and reducing the total cost of care by 1 percent in 2014. Today, numerous initiatives are in place to help reach those goals – including proactively identifying and better serving high-cost and high-risk patients, new online and mobile services to diagnose and treat common conditions, and rethinking the operations of pharmacy, benefit and plan administration.

While these three plans have taken different paths to reducing costs, what they have in common is a strong commitment to reducing costs and improving quality and the courageous leadership to make it happen. Now that millions of Americans have health insurance for the first time, or are changing plans in an era of greater options, it is important that health plans, providers and other stakeholders not lose sight of why people need health insurance in the first place: so they can have access to the best care possible in the moments they need it most, at a cost they can afford. Community health plans are committed to realizing that goal in a turbulent marketplace.

Patricia Smith is the President and CEO of the Alliance of Community Health Plans.

Morning Consult