Modern Healthcare recently held the second installment in its issue briefing breakfast series in Indianapolis. The breakfast featured a panel discussion with some of the major players in the local market: Rob Hillman, president, Anthem Blue Cross and Blue Shield Indiana; Dennis Murphy, president and CEO, Indiana University Health; and Jonathan Nalli, CEO, St. Vincent. Modern Healthcare Editor Merrill Goozner moderated the event.
The following is an edited transcript of a portion of the audience discussion with the panelists.
Audience member: I'm interested in population health management. It's such a big thing to get your hands around and I think it's further complicated in Indiana. From a health system's standpoint, as well as an insurance standpoint, what can be done to help people just live healthy lives?
Dennis Murphy: I think the value-based discussion is actually helping us in that we know now that we've got to actually manage lives rather than manage encounters with patients and so there's now a different incentive.
We talked about pre-conditioning for joint replacement patients. We're actually talking about what's your BMI before you go in. And so, I think the incentives are going to start to swing that way because all of the incentives, and I've worked in a couple of other states, I would say that Indiana has been structured to take optimal advantage of the fee-for-service environment. And it's partially because there's not a certificate of need here, so things were built and optimized to take full advantage of that and that happened over a series of decades. That was not a short-term activity. And so now you're trying to move the Titanic, an entire industry, to change and I think it will take time, but I see that happening.
Jonathan Nalli: We're never going to stop the smoking issue, obesity issue, unless we look at how are we dealing with providing communities who have zero resources to actually understand what those are.
We've got to partner, and really partner for a period of 18 to 20 years to truly affect the change that we're going to see in health outcomes about how are we educating our kids in what is usually in single-parent homes, broken families, to reduce that cycle of poverty and the absence of education to be able to have an impact on what we're doing with food insecurity and smoking and obesity, the premature death rate and infant mortality, those can all be stopped, but it's the mass resources that we're putting in together so that we can affect population change. Because we shouldn't have issues related to COPD like we have today in 20 years. That needs to go away.
Merrill Goozner: I'll do the followup for Rob [Hillman of Anthem]. There certainly is no CPT codes for public health. So, what can you do with an insurance contract to promote this?
Rob Hillman: Well, we've tried everything. Here, I'll sort of echo what the other two have already said, but I think what happens in this space is that the way that we've always attacked this in the past, it's generational and this is the United States, and we don't have a lot of patience, but this is something you have to stick with and you have to stay at for a very long period of time.
So, the thing that I have become more intrigued with than anything is this concept of blue zones. And I'm not going to into a real deep dissertation on what blue zones are … but it's this concept that the quickest way to change that problem is to change the environment that surrounds the people, as opposed to trying to change the behavior of the people themselves, because if you change the environment then it will change the behavior. You can try all day long to change the behavior, but if you don't change the environment it will never change.
Audience member: Is there a way we can get the patients to really own some of the responsibility for their health outcomes? I realize it's a difficult area because it's behavioral, but I do think that we need to really invest innovation, resources, to try to get patients more incentivized to eat better, exercise, things like quit smoking.
Murphy: The million dollar issue, maybe billion dollar issue. I think lots of people have tried. So, there have been examples, IU Health was one where we were going to tier your insurance payment based on you behavior, and there was this massive backlash that occurred. And so, what we probably learned is incentives are better than penalties because at least people don't want to be penalized for their behaviors.
So, if you ask me what's the solution, I don't think there's a policy solution, I think it's individualized care plans and engagement that require a lot of time and effort … I'm a big believer that if you align incentives right, you can get changes in behavior. Most people who aren't healthy don't want to stay that way.
Hillman: I believe the answer is yes, in that you're going to need a myriad of tools in the arsenal to effect the change. I would say there is no bad incentive you can offer or try.
What we have found in the work that we're doing with the shift to value is that as much as I would love to focus on the population that can drive the greatest change … what our clinicians have shown us is the population that we can move faster is that middle population. Because they have a better understanding of it, you can have a quicker conversation and that they'll grasp onto and you can use that as the catalyst to begin to generate that momentum that allows you to effect change ultimately with your kind of your largest, most catastrophic group of individuals with it. And that, to us, has been kind of the ingredients in the playbook that we're using to effect the change, with not just our employees but the population we serve.
The event was sponsored by Anthem, Indiana University Health and St. Vincent.