Health insurance chiefs tout value-based care, transparency, technology


Vince Calio, 2/26/18

More health care groups need to share risk in order to make value-based care work.

That’s the word from top executives of some of the top health insurance companies in N.J.

Also, health care systems need more transparency in pricing, and pharmaceutical companies must figure out how to lower the cost of specialty drugs, execs said.

The comments were made during the Commerce and Industry Association of New Jersey’s panel discussion on the future of health care in the state on Feb. 22 at the Hilton Meadowlands.

Michael Munoz, president of AmeriHealth New Jersey, said more health providers should create a payment system in which they take on payment risk, while providing cost-efficient, high quality health care. And if the provider can provide quality care at a lower cost, then they would share in the savings that they’ve provided, he added.

“Consumers started coming into the [health insurance] marketplace in 2014, after the implementation of the Affordable Care Act,” Munoz said. “We talked about the need to educate them and help make them understand how to purchase health insurance and how it works. I will tell you that today they are just as frustrated as they were prior to 2014. We have a cost problem and we have outcomes problems.”

Health care groups should focus more on outcomes data and delivering value-based care over fee-for-service, and they need to band together to create industry standards to do so, he said.

“Due to the regulations in New Jersey, providers can’t really have skin in the game unless they organize themselves and go through the whole process of getting licensed to do that,” Munoz said. “We have one organization that I know of that has done that – Summit Medical Group. There are others that are planning to do it.”

Allen Karp, senior vice president of Horizon Blue Cross Blue Shield of New Jersey, said insurers need to work with the biopharmaceutical industry to lower the cost of specialty drugs.

“The explosion in pharmacy costs is what’s really driving the trend [of rising health care costs],” said Karp. “The pipeline is filled with specialty drugs, but the problem is that there are no generic substitutions for them yet. So you don’t get an opportunity to move members towards lower costing alternatives that have the same quality.”

Paul Marden, CEO of the health care plan of New Jersey for UnitedHealthcare, stressed that information technology advances and transparency of costs needs to be more significant in the state.

“We are trying to provide people with access to information that will tell them what their health care will cost them,” Marden said. “And we are trying to use as much of our research and development dollars to simplify that experience for users.

“We also have to flex to the way people like to get information everybody,” he said. “Everyone is glued to their smart phones, and we’ve brought that to health care. Right now, our customers can cross compare the providers in our network and understand what their prices are for specific services and compare those to other providers. We need to make sure that people have access to health care information.”