Reform, in some way or another, is here to stay


Dina Overland

The message is loud and clear here in Salt Lake City: Healthcare reform won't stop, even if the U.S. Supreme Court nixes the entire reform law. The Supreme Court is expected to rule this week.

Everyone I interviewed, each session I attended and each person sitting next to me that I casually chatted up during AHIP Institute 2012 last week said the same thing. The health insurance industry has started down a path that can't be stopped, and it doesn't matter what the Supreme Court says.

"The tension of this moment is really just a concentrated version of the uncertainty that will go on forever because we do know that no matter what the Supreme Court decides, reform is inevitable," Group Health CEO Scott Armstrong said during a general conference session. "It's necessary because the cost of care is too high, and outcomes aren't good enough."

And while a few of the big insurers already have pledged to keep some reform provisions in place regardless of the Supreme Court ruling, I would love to see health plans come out in favor of initiatives that will drive more impactful, lasting changes in the industry by improving quality while lowering costs. That's where real reform--and I'm not talking about the Affordable Care Act anymore--is needed.

If the predictions of Kaveh Safavi, Accenture's North American health lead, play out, I just may get my wish.


"Broad trends and discussions pre-date the reform law and will continue post-Supreme Court ruling."

--Kaveh Safavi, Accenture's North American health lead

"The three years that have led up to reform implementation makes it likely that some of those reform changes will stay on a voluntary basis," Safavi told FierceHealthPayer. "Broad trends and discussions pre-date the reform law and will continue post-Supreme Court ruling."

And in fact, insurers are starting to make "explicit commitments toward consumer orientations," with their marketing strategies already beginning to communicate that consumer focus, he said.

The folks at McKesson agree that reform is vital for the industry and rest their collective hopes on value-based payment reform as a "very promising" method of change.

"Value-based reimbursement can lead to medical savings, quality improvement and fewer duplicated services," Melanie Marcus, vice president of strategic marketing at McKesson, told FierceHealthPayer.

So what does the future hold? As Health Net CEO Jay Gellert said, insurers must do "something profound in the next three to five years," such as containing unit costs and providing better care for special populations. Otherwise, price setting, which "will retard this country, is inevitable," he added.

Others stress the importance of changing benefit designs to help address such high-cost chronic problems, as obesity and diabetes, or enhancing payer-provider collaborations, or leveraging information technology, or changing the structure of the primary care system. The list of problems needing fixes is endless.

My biggest hope right now is that insurers keep those challenges (and possible solutions) top of mind, even in the face of the inevitable media firestorm that is sure to ensue the second after the Supreme Court announces its ruling. I surely don't want Gellert's predictions to be realized. If the justices can keep their eyes on the prize--lower costs and better quality care--I hope the industry will take us into the next era of improved healthcare. --Dina (@HealthPayer)