Cost, quality, access remain concerns

Michelle Swafford

Friday, June 10, 2005 | 10:47 a.m.

Cost, quality and accessibility are the three major challenges facing health care companies and consumers.

The proposed solutions are as varied as the medical conditions contributing to the massive health care economy that now equates to about $1.6 trillion, or 16 percent of the United States' gross domestic product.

More than 3,000 health care leaders met this week in Las Vegas to discuss solutions during the annual meeting of America's Health Insurance Plans -- a Washington, D.C., trade group for health plans.

"They have been the same three issues for the last two decades," AHIP President and Chief Executive Karen Ignagni said. "Some progress has been made, but there's certainly more to do."

Dr. Peter Kongstvedt, vice president of health and managed care consulting services of Capgemini, said revenue pressures on hospitals, pharmaceuticals, increased regulations and benefit mandates, aging Baby Boomers with increasing health care utilization and medical malpractice are ongoing contributors to health care's high costs.

Technology and genomics are new contributors to health care costs, he said.

Managed-care plans were a solution to health care costs and accessibility in the 1990s because they provided an affordable option for employers and increased employee coverage, Ignagni said.

Those plans became less affordable when politicians said consumers deserved broader provider networks and more choices in their health plans, which resulted in higher premiums and reduced the number of people with health insurance, she said.

Managed-care plans are still the least expensive health plan and offer the "richest benefits" excluding consumer-directed plans such as health savings accounts, Kongstvedt said.

Health plans are tackling rising costs by pushing the use of generic drugs -- a less expensive equivalent to brand-name drugs, -- disease management programs to make sure patients take their medications and care for themselves and health savings accounts, Ignagni said.

Health savings accounts shift more of the health care costs to consumers, which can put tax-free money aside for their medical, vision and dental services. Employers and employees can contribute to the accounts and any unused money rolls over annually. The accounts accompany high-deductible insurance plans to cover major medical expenses.

Ignagni said savings accounts can provide affordable coverage for uninsured people and about 40 percent of the current account users were previously uninsured.

There are drawbacks to health savings accounts such as increased premiums for the sickest patients on traditional health plans when healthy people leave the risk pool and reduced quality of care and patient outcomes when consumers are left to make all of their health care decisions, Krongstevdt said.

Quality health care is the other major focus for health plans and providers, especially as more information is made available to consumers.

"Fifty-five percent of what's done in health care is best practices," Ignagni said, adding that if a manufacturing firm had that type of record "people would be appalled."

As health care becomes more transparent, patients can select providers that meet industry standards and hospitals and doctors will improve their care to rise to their competitors, she said.

Transparency isn't the only major change that will improve quality.

The next 30 years is likely to bring about major information technology transitions and personalized medicine, said Andrew Zolli, a futurist-in-residence with Popular Science and American Demographics magazines and cofounder of Z + Partners think tank.

For example, radio frequency identifications will be placed on medications to make sure they are not redirected during the delivery from manufacturers to patients, he said.

Other transformations include an implantable glucose monitor that is smaller than a quarter, neuroimplants that return vision to blind people and genomic mapping to determine if a prescription is suitable for a patient, Zolli said.

There are already companies that will conduct genomics exams for consumers to help them know what medical conditions they are at risk for based on their medical history and a DNA sample from their cheeks, Zolli said.