Healthcare reform and broad industry and societal shifts are forcing fundamental change on the U.S. healthcare system, but the opportunities for health plan and provider organization leaders to collaborate using information technology are unprecedented: that is the core of the message that Stephen Ondra, M.D., one of the leading BlueCross BlueShield executives in the U.S., delivered in his opening keynote address Oct. 6 to the Health IT Summit in Chicago, sponsored by the Institute for Health Technology Transformation (iHT2—a sister organization to Healthcare Informatics, through their corporate parent, the Vendome Group LLC).
Speaking on the topic “The Road to Health System Reform,” Dr. Ondra, senior vice president and chief medical officer at the Chicago-based Health Care Service Corporation, which encompasses the BlueCross BlueShield plans of Illinois, Montana, New Mexico, Oklahoma, and Texas, struck an optimistic tone in his keynote address Tuesday morning, assuring provider leaders that health insurers and providers are now inevitably becoming positioned as partners in a U.S. healthcare system that is moving rapidly from being volume-based to being value-based.
Casting federal healthcare reform via the Affordable Care Act (ACA), and federal stimulus towards automation via the HITECH (Health Information Technology for Economic and Clinical Health) Act as necessary developments in a far broader and economically and societally necessitated shift, he told his audience that, “With all that change, the entire landscape is changing for providers—and for payers.” Of course, not everything that has happened fits into any kind of uniform narrative, Ondra noted. On the one hand, he said, “Provider consolidation has been a rational response to market changes; and you’ve seen the consolidation on the payer side, too. Provider consolidation is rational,” he conceded, “But then it has in turn been used by providers to drive up prices, and that has led to increased costs.” He argued for a new paradigm, one of continuous collaboration between payers and providers, with healthcare patients/members/consumers as the new center of focus.
Indeed, Ondra told his audience, in the emerging healthcare system, health insurers like the Health Care Service Corporation and its fellow Blues plans and other health plans, are having to shift fundamentally from seeing themselves as “claims processors” to something new. In that regard, he said, he and his colleagues at Health Care Service Corporation now see their organization as a “care management company,” a term he stressed in his remarks.
So where will the common ground of collaboration be? It will be in the form of technology-facilitated partnerships around population health management, care management, and various forms of accountable care, Ondra said. Indeed, he noted, “We’re moving forward strongly to build alternative payment models in all of our markets. But the idea that what works in rural Montana will work in downtown Chicago is naïve. On the other hand,” he offered, “you can’t have all one-offs [with regard to wildly customized risk-sharing contracts], either. So we’re bringing a set of solutions and set of capabilities to all our markets. What’s driving this? Purchasers are seeking this,” he emphasized, noting that he was referring both to large corporations like Boeing, and to masses of individuals who are enrolling in high-deductible health plans.
One important point that Ondra made with regard to stimulating value-based care delivery was around the outcomes quality measures that they’re asking providers to submit. “We’re getting to a uniform set of quality measures,” he noted. “We want to reduce the variability, refine the collection capability, and make it all clinically relevant. So we’re working very quickly to try to get to measures that are more relevant to the consumer, and less process-oriented.”
In that regard, Ondra referenced the fact that he and his colleagues have been developing and refining what he called a “toolbox for alternative payment,” which includes supports for providers partnering with the Health Care Service Corporation in alternative-payment contracts. He added that “We’re thinking about our networks differently. The classic Blue network,” he noted, “is big and broad and everyone gets to buy in. That’s not necessarily the way to go. We want narrow networks, which should be high-value and high-quality—and not necessarily low-cost. So we’re looking at redesigning our networks, and this is happening this year. We’re looking at more tailored networks for markets.”
Ondra asked, “What can we do to facilitate provider success?” His answer? “Provide information, identify and promote technology, develop and use quality measures and cost measures, and focus on the member experience. Right now, we have a healthcare system that’s efficient and convenient for itself. We need to make the system efficient and convenient for consumers.” He reiterated his organization’s commitment to working with providers as true partners going forward, leveraging electronic health records and all other tools available to them, including emerging technologies such as wearables, to refocus the healthcare system with plan members/patients/consumers at its center. And he emphasized that he remains optimistic that the U.S. healthcare system, through intensive work driven by healthcare reform and broader societal trends, can re-vision itself into a system that is of higher quality, better clinical outcomes, more efficient, more cost-effective, and more person-centered, going into the future, and that health plan-provider collaboration will prove to be a core engine helping to drive forward that positive change.