Left to right: Chitra Nawbatt, Director of Global Assurance at General Catalyst, moderates a panel discussion with Kari Hedges, Senior Vice President, Marketing Solutions, Blue Cross Blue Shield Association, and Michelle Zettergren, President of Labor and Chief Sales and Marketing Officer, Brighton Health, on Planning Solutions
We are all consumers of healthcare, but the products and services we get are not like anything else we consume. Michelle Zettergren, chief sales and marketing officer at Brighton Health Plan Solutions, explained that many people have personal stories of dissatisfaction with their care or expenses. These emotions lead people to consume less healthcare, leading to worse health outcomes.
The reality, Zettergren said, is that healthcare is broken. But payers are coming into play to try and fix that. Insurers are coming up with new strategies emphasizing better patient outcomes as the primary goal, rather than offering more services.
Zeit Glenn on Monday MedCity INVEST Conference Chicago In a panel discussion on payers and value-based care. She was joined by Kari Hedges, Senior Vice President of Marketing Solutions for the Blue Cross Blue Shield Association, which represents 34 Blue Cross Blue Shield companies from across the country. The session was moderated by Chitra Nawbatt, Director of Global Health Care and Innovation at General Catalyst.
Brighton works with health systems that want to have a direct relationship with self-financing employers. For these relationships to have a successful value-based design, health systems need to provide comprehensive services to specific patients, Zettergren said. These systems can then incentivize employers to create benefit designs that direct members or employees to that health system. With this relationship, employers and health systems work together to reduce costs over time.
The healthcare industry has experience with models designed to control risk and cost. Hedges said she experienced the rise of health maintenance organizations in the 1980s and 1990s. The difference between the HMOs of the day and the value-based reimbursement model of today, she said, was the alignment of incentives. The alignment is between the patient and the primary care physician. In a patient-centered relationship, primary care physicians are like quarterbacks, calling the drama that leads to high-quality health care outcomes the end goal, Zettergren said.
Another difference between HMO and value-based care is the availability of data. Electronic medical records are a key tool for providers, Hedges said. Knowing the patient’s previous medical history can help provide care when a patient presents to the emergency room. But one obstacle to this tool is the lack of interoperability between different systems. Data alone is not enough. Analysis is key to inform treatment decisions that lead to better outcomes.
“It’s beyond the data,” Hedges said. “You can’t measure what you don’t know. Beyond that, you need analysis.”
Photo by Walter Lim of MedCity News
