The federal healthcare reform law contains a number of positive steps that Humana supports, but it falls short in other areas.
The law widens access to coverage, putting health insurance in reach of millions of Americans who otherwise were shut out. It also removes pre-existing conditions as a barrier to coverage, rightly ensures that premiums are no longer based on health status or gender, and provides financial assistance for those who need it, so that no one falls through the cracks.
However, the law falls short in addressing the underlying cause of our healthcare crisis – rising costs. Americans need secure, affordable coverage choices, and cost control is critical to achieving that goal. We are concerned that the healthcare reform law does not address some of the root causes of medical cost inflation, which means the cost curve is likely to continue bending in the wrong direction. The law also includes a premium tax, scheduled to take effect in 2014, that will unfairly drive up costs for small businesses and many seniors.
Improving the System
To truly make coverage more affordable, all parts of our healthcare system must do more to create value, eliminate waste, encourage effective care and promote health. We must:
- Align incentives to reward value. Instead of paying providers based on the volume of healthcare services delivered, we must pay for performance and create incentives to achieve high-quality outcomes at low cost.
- Root out waste, fraud and abuse in our system. Unnecessary procedures, prescription drug abuse and fraud drive up healthcare costs by billions of dollars each year.
- Eliminate needless and costly variation in care delivery. To get the most for our healthcare dollar, we must ensure widespread adoption of medical best practices.
- Attack costly underlying public health problems like obesity, inactivity and smoking, which contribute to an epidemic of preventable chronic conditions.
- Apply technology to improve care – connect the system, reduce errors and eliminate redundancy.
Looking Ahead
The most significant healthcare reforms are set to take effect in 2014, including guaranteed coverage, rating restrictions and health insurance exchanges. These dramatic changes will considerably alter our healthcare system, and our goal must be a smooth and stable transition that does nothing to disrupt the coverage that Americans count on today.
For example, we must find ways to ease the transition to new rating requirements, which state experience shows us will abruptly raise costs for the young, unless we build-in a gradual transition period. We must also preserve a wide range of options, so people can choose a plan that's right for them.
Modernizing Medicare
Medicare is another critical piece of our nation's healthcare system. We must find ways to modernize Medicare and help it overcome its cost challenge. Humana agrees with the President and leaders of both parties that the Medicare program needs to be improved to cope with upcoming challenges. The Congressional Budget Office forecasts that Medicare cost will nearly double in 10 years , to more than $1 trillion, and roughly three of four adults age 65 or older have two or more chronic conditions.
We must ensure that people with Medicare will have the affordable, quality coverage they need – not just today, but into the future. Reform proposals vary, but many share important similarities like choice and an emphasis on care coordination. They all succeed in creating dialogue that gets us closer to solutions.
Medicare can best be improved by combining the best of the public and private sectors. The public sector provides an important safety net, while the private sector – through Medicare Advantage – has helped improve quality, create value-based networks and systems that coordinate care, and control cost. Medicare Advantage and its coordinated approach to care – encompassing clinical, wellness and prevention programs – is a model that can help stabilize the Medicare system.
Leading the Way
Humana is committed to helping build a sustainable future for American healthcare. And, we're not waiting. We're advancing ideas and collaborating with doctors, hospitals and other healthcare providers to advance quality and enhance health outcomes, promote prevention and wellness, help patients and physicians fight chronic conditions and reduce unnecessary costs and services. In short, Humana is delivering innovative approaches that are both good for people and good for our healthcare system:
- Individualized care services, such as care coordination programs and transition planning, which keep people healthier and reduce the need for costly urgent care. Special programs such as post-discharge telephone outreach and meal delivery to those in need have reduced 30-day re-hospitalizations by more than 2 percent and 8 percentage points, respectively.
- Patient safety initiatives, like programs that can prevent harmful drug interactions, which greatly reduce dangerous and costly mistakes. In 2011, Humana's comprehensive efforts to improve medication safety successfully prevented more than 500,000 potentially harmful drug interactions.
- Programs like Humana Vitality that motivate people to live healthier as they pursue lifelong well-being – because the health benefits you choose not only should cover you when you're sick, they should help you stay well. According to a study published in the American Journal of Health Promotion, people engaged in the Vitality incentive-based wellness program had lower medical costs, shorter hospital stays and fewer hospital admissions in general. (Source: Am J Health Promot 2010;24[3]:199–204)
- Ways to identify and stop waste, fraud and abuse. We're working with doctors, hospitals and law enforcement agencies to prevent fraud and abuse before they happen, which helps hold down the cost of healthcare, keeps healthcare safe and keeps resources focused on helping people stay healthy and get the care they need.
- New technologies, like Anvita Health, that allows us to send real-time health alerts to providers and members, and the Availity health information network, that makes health information more accessible to providers, reduces medical errors and improves communication between doctors, hospitals, and pharmacies.
- New models of care, such as medical homes and Accountable Care Organizations (ACOs). A high-profile ACO project with Norton Healthcare in Louisville that's sponsored by The Brookings Institution and The Dartmouth Institute for Health Policy and Clinical Practice has decreased unnecessary emergency room visits by close to 50 percent, lowering expenses of more than 12 percent. (Source: Norton Healthcare: A Strong Payer–Provider Partnership for the Journey to Accountable Care, The Commonwealth Fund, Case Study Series, January 2012.)
Despite deep divisions, our nation needs to find ways to move healthcare solutions forward in a constructive way. Humana will continue to work with policymakers on both sides of the aisle to promote healthcare affordability, provide security and preserve choices for all Americans.
