Cooperation, not confrontation
There was a time when health care providers, insurers and employers had little in common.
"The best way to describe the historical relationship between health care providers and employers was that there was no relationship," Asante CEO Roy Vinyard told a Medford audience Monday. "There really wasn't any form of communication or work between the employer and provider, other than delivery of care. Between the provider and the insurer, I'll have to say it was somewhat confrontational."
Vinyard shared the stage at the Chamber of Medford/Jackson County Forum at the Rogue Valley Country Club along with Angela Dowling, president of Regence BlueCross BlueShield of Oregon, and Southern Oregon Cardiology CEO and Executive Director Rich Bodager.
When insurance companies and health care organizations sat down to bargain, Vinyard said, both had the goal of coming away with the best deal for their organization.
"This sounds a little harsh," he said. "It wasn't so much about care delivery as it was about finances of health care delivery."
Dowling said all three parties operated individually. As the organization in the middle between the employers and health care providers, insurance companies negotiated with both parties.
"It's a challenging place to be," Dowling said. "But long-term we have to work collaboratively if we want to solve the health care cost equation."
Wasted health care dollars can be found a lot of places, she said, but the easiest to find might be in the home medicine cabinet. Dowling said three in 10 prescriptions go unfilled or are filled and not taken. As a result, patients aren't getting better or their long-term status suffers. She said her organization's goal is reduce such waste to 10 percent.
"You clearly have a reason to take the medication," Dowling said. "It's wasteful, sitting in the medicine cabinet. As a society we need to understand you do need to take all of that antibiotic so you don't relapse."
Vinyard said fragmentation of health care delivery and lack of coordination contribute to waste of medical dollars.
"You have a lot of redundancy of procedures and tests," he said. "It's also an inconvenience to patients who have to get the same tests two or three times."
Vinyard said overutilization of brand-name drugs versus generic alternatives also runs up costs, while the overuse of emergency departments is an inefficient drain on resources.
"Many, many communities have physician shortages and/or many people not covered by health care," he said. "Their first alternative, even for primary care delivery, is the emergency department — the most expensive form of delivery you could possibly get."
Vinyard said there has been a big shift in the relationship among the involved parties from confrontational to collaborative.
"It's an inclusive partnership between the provider, insurer and employer and getting all three at the table," he said. "We can encourage preventative health and encourage wellness, and take away barriers from access to primary care. For providers, it's utilizing information systems that can help them better coordinate the care for a patient."
Dowling said the conversation with providers has changed in just the past year.
"Frankly, it's more around how we can work together collaboratively," she said. "Let's take care of the fee schedule, but more importantly, how do we engage providers with employers, with our customers, so that we can deliver more effective, efficient medicine and take that waste out. So there can be lower premiums, so that it costs you less as consumers."
Reach reporter Greg Stiles at 541-776-4463 or firstname.lastname@example.org. Follow him on Twitter at www.twitter.com/GregMTBusiness, on Facebook at https://www.facebook.com/greg.stiles.31, and read his blog at www.mailtribune.com/Economic Edge.