Delivering a patient-focused health insurance model
Despite continued efforts from stakeholders across the healthcare spectrum, healthcare providers, industry, payers and insurance companies often struggle to deliver a truly patient-focused care experience.
During a session entitled “Patient delivery models: making health insurance work for patients,” experts from all areas of healthcare debated this issue and addressed questions from the audience. The panel included:
- Mary Grealy, President of the Healthcare Leadership Council (moderator)
- Andy Baskin, National Medical Director of Quality and Clinical Policy at Aetna
- Glenn Monteith, Vice President of Innovation and Health Sustainability at Innovative Medicines Canada
- Kenton Stewart, Senior Vice President of the Health Systems Business Unit at Astellas
- Pam Traxel, Senior Vice President of Alliance Development and Philanthropy at the American Cancer Society Cancer Action Network.
“Our healthcare system really works better when the insurers, the providers and the manufacturers aren’t operating in their own individual silos but rather they’re working together and acting in concert to try to achieve greater value and attain improved patient outcomes and sustained health,” said Grealy, opening the panel session.
The comment hit on one of the biggest issues for the industry: interoperability. On a broad scale, the health system is thought of as just that – a system – agreed Baskin, when it is really a collective group of separate entities.
“There’s an expectation that the health system works together to create the best quality of care and that’s what we should be delivering. The system has made it difficult because it doesn’t communicate with itself. We’re making progress but too slowly,” said Barry.
Glenn Monteith also agreed with Grealy’s opening statement, describing Canada’s difference in approach toward drug development: “Canada has two agencies for drug development – one that looks at the effectiveness of a drug and another that negotiates its price before going on sale.”
As a result, the process is streamlined, leading to more effective interoperability at all stages, according to Monteith.
Educating the patient
“We’ve all been to the doctors and had that experience where you’re not sure what they’re saying and not sure whether you’re OK,” said Traxel, addressing the next subject of the session: patient education.
According to Traxel, more effort needs to be put into ensuring patients fully understand the process between diagnosis and treatment as well as the role that their insurance company plays in the entire process.
“Most patients don’t know what’s going to happen because they don’t know what’s next,” said Traxel. “We’ve got a lot of work to do to help patients understand what they are buying and why it is important.”
This confusion adds to an already complicated process for patients with more complex diseases, explained Traxel, particularly around what their insurance cover provides.
“Ultimately, tools are only as good as those that use them. We need to teach patients to use their voices and not just talk to their providers about what they want.”
“The patient’s best interest is the best advertisement I have,” said Baskin, commenting on a final question about the gradual incorporation of patient voice into care.
The patient voice, as well as the payer and provider’s, is being incorporated more into drug development, added Stewart – a feature that gives pharma the opportunity to step back and look at the value of drugs being brought to market.
“It lets us see the long-term impact of products in society and gives us the chance to look at the voice of the customer and improve trial endpoints.”
Traxel agreed with the sentiment; however, she added that more needs to be done to help define patient-centered care: “We still need to answer the question of what patient-centricity is and how we address it.”
Once it is defined, care at all stages can begin to be refined into a more effective model, said Traxel, one that delivers exactly what matters to the patient.