In a Medicare Advantage hearing before the House Ways and Means Health Subcommittee on Friday, America’s Health Insurance Plans (AHIP) President Karen Ignagni confirmed that Obamacare is encouraging health care providers and private insurers to adjust their business models, just as the law was intended to do.
Although Ignagni noted that some of Obamacare’s provisions — such as its modifications to Medicare Advantage’s repayment structure — concern the insurance industry, she nonetheless acknowledged that the law has prompted health care providers, government agencies, and insurance companies to coordinate their care strategies while reexamining payment models:
REP. RON KIND (D-WI): Miss Ignagni, I know you and the plans that you represent in that, have been at the forefront when it comes to a lot of these changes and reforms. I think we need to be doing it on a parallel path between Medicare and the private plans out there. I don’t think doing it in isolation is going to work. Could you give us a quick update on what you’re seeing happening, especially in the private sector right now,with these types of delivery and payment reforms that are happening?
IGNAGNI: [...] There are very significant changes going on all across the country. [...] The story is about collaboration, health plans and clinicians collaborating inpatient-centered medical homes to bring more value to, and case management to, those with chronic illnesses, and taking those strategies into Medicare Advantage, Medicaid plans, SNIPS, and so on and so forth. [...] What is very significant now as a result of these strategies, health plans are showing in peer reviewed journal data that they’re working, with respect to re-admissions, emergency rooms, so we’re not finished by any means…but we have taken a major step and it clearly has to be the future, more coordinated care, more prospective payment, and partnerships between plans and clinicians and hospitals.
Coordinated case management is essential to providing patients with more efficient care. The more that hospitals, insurance providers, and clinicians cooperate and bundle their services and payments, the easier it becomes for American consumers to seek out flat-rate, quality care. As Ignagni mentions, there has been evidence in states such as Massachusetts that coordinated-care facilities treating dedicated patient pools for prospective, bundled fees (pre-determined flat rates) are accruing savings while maintaining high Medicare quality-metrics.