How we aim to control premium costs

We propose a three-way partnership among providers, patients and insurers.

By Gus Manocchia, M.D., BCBSRI Chief Medical Officer

Earlier this year, the headlines started popping up in newspapers across the country: healthcare premiums to rise. Rhode Island is not immune to this trend or the underlying reason for premium increases – escalating healthcare costs.

When we look at what is driving these increases the answer is fairly straightforward: how much care we use, and how much that care actually costs. In Rhode Island, we know healthcare costs are high. In fact, our state ranks in the top 10 in the country for healthcare costs. And, with an aging population, we tend to use more care and services.

But, we also know that encouraging more collaboration among primary care providers, specialists and hospitals – in what we call a system of care (SOC) – can make a difference with fewer emergency room and inpatient hospital visits.

To continue our forward progress, we propose a three-way partnership among providers, patients and insurers. Working together, we can provide the incentives, tools, and information needed to improve quality and outcomes and slow the rise of costs.

Step one in the partnership builds on the work we’ve already done with providers and hospitals in the SOC model. The SOC model creates a more coordinated healthcare system, focused on prevention and wellness, better management of chronic conditions and diseases, and more effective communication among providers across various care settings.

Unfortunately, more than half of all Rhode Island primary care providers (PCPs) and nearly 90 percent of all specialists are not yet practicing in a SOC. This has a considerable impact on cost and quality. Working together with the medical community, we hope to better educate providers – PCPs and specialists – on the benefits of the SOC model and how it improves quality of care. Encouraging specialists to participate in SOCs is particularly critical given that specialists direct about 70 percent of all healthcare spending – through direct care they provide, ordering of lab and radiology examinations, prescribing of medications, or use of hospital services.

Step two is accelerating the shift from paying providers for the number of services they provide to a model that offers financial incentives for quality, efficiency, and improved patient outcomes. Effectively managing patient care – whether through coordinated care management for a chronic disease or by providing a single, or bundled, payment for a “standard” procedure like a knee replacement – makes much more sense, especially within a patient-centered system of care.

The third step is enabling better decision making by giving providers, employers, and consumers actionable data on the quality and cost of specific healthcare services. Today, only 2% of BCBSRI’s provider network uses our patient cost estimator tool and, in the past six months, fewer than 1% of all members have accessed cost information on our member website.

Patients and providers need easy-to-use tools to make educated choices. With access to the right information, patients can save hundreds of dollars, if not more, in co-pays and deductibles, and providers can recommend the right care at the right time and in the right setting more often.

Together, these actions better position us to introduce innovative plans to our consumers – both businesses and individuals. Consumer-driven health plans can offer premium and tax savings for employers and employees along with opportunities to earn incentives for healthy activities. Despite the many benefits of these new plans, Rhode Islanders have been slower than the rest of the country to embrace them, with 88% of our commercial members still in traditional plans with higher premiums. BCBSRI is committed to offering an array of products that feature lower costs, robust networks, and compelling financial rewards for responsible choices.

These efforts require trust, focus, and commitment to change. We pledge to work with our members, providers, hospitals, employers, and the larger Rhode Island community to move forward more quickly so that simple, affordable healthcare becomes a reality.

This piece originally ran in the Providence Journal on July 11, 2017.