Health Insurance Plans (AHIP), a trade association representing more than 1,300 health insurance providers, has offered a proposal it says could help the United States reduce total spending on health care by more than $145 billion in the next decade while improving quality.
Experts acknowledge the association’s insight into the cost-drivers of health insurance in America but are criticizing AHIP’s willingness to make concessions to government instead of advocating for a market-driven overhaul of the insurance system.
Rising Cost of Services
“The rising cost of medical services has a clear impact on patients, employees, and employers of every size competing in an increasingly global marketplace, and on taxpayers who fund public health care programs,” said AHIP spokesman Robert Zirkelbach.
Zirkelbach said AHIP’s board of directors has developed a strategy that “teams innovative health plan cost containment tools with sensible public policy initiatives to make health care more affordable” and thereby can help control unsustainable growth in the cost of health insurance.
“The nation faces complex health care challenges, and only an integrated strategy that addresses costs, quality, and access will bend the cost curve and allow the country to ensure that all Americans have access to affordable health care,” said Karen Ignagni, president and CEO of AHIP.
“AHIP clearly understands where the cost-drivers of health care are, and its members have good insight and experience at managing costs effectively,” said John R. Graham, director of health care studies at the Pacific Research Institute.
Appeasement of Government
“Private health plans are absolutely necessary to improving American health care,” Graham continued. “However, AHIP’s latest proposal continues its policy of appeasement of those who want more government control of health care.”
The initiative, unveiled in June, “is part of an 18-month effort to present a roadmap that offers comprehensive solutions to address the nation’s health care crisis,” said Zirkelbach. “These solutions have been designed to be workable, affordable, and achievable now–through a uniquely American public-private effort.”
The AHIP proposal includes giving “providers, patients, and purchasers access to a trusted source where they can find up-to-date and objective information on which health care services are most effective and provide the best value,” as noted in the proposal, titled “A Shared Responsibility: Advancing Toward a More Accessible, Safe, and Affordable Health Care System for America.”
That goal is to be accomplished by encouraging adoption of health IT tools and techniques, such as e-prescribing and electronic health records; by replacing the current medical liability system “with a dispute resolution process consisting of an objective, independent administrative process to provide quick and fair resolution to disputes while promoting evidence-based medicine”; and by “working for the broader adoption of value-based reimbursement mechanisms and provide consumers with more actionable information about health care value,” the proposal states.
‘Blunt Tool’ of Government
Under the proposal, a Comparative Effectiveness Board (CEB) would be established to compare the effectiveness of drugs and procedures, assess alternative treatment plans, and distribute information to patients.
The proposal does not specify who would serve on the CEB, how members would be selected, or who would be responsible for conducting oversight of the board–a matter of concern for Graham.
“I am especially concerned that AHIP’s proposed Comparative Effectiveness Board would become a blunt tool, fashioned by government, that would facilitate health plans’ collusion with the state to control costs at the expense of innovation and patient-centric therapies,” Graham said.
Graham continued, “AHIP needs to focus on the barriers the government erects to good patient care, not collaborating more with the state.”
Regulatory Barriers Unaffected
“For example, AHIP’s proposal notes the high cost of obesity-related illness,” said Graham. “However, according to federal Health Insurance Portability and Accountability Act nondiscrimination rules, charging higher premiums to obese people who do not adhere to weight-loss programs is illegal.
“AHIP should be lobbying the government to roll back these and many other regulations so that its members can find the places where consumer-directed care and value-based care meet–which is a dynamic and ever-changing frontier, a suitable place for risk-taking enterprises to place themselves,” Graham concluded.
Dr. Sanjit Bagchi ([email protected]) writes from India.