World Health Care Congress – Monday

WASHINGTON, DC – At the World Health Care Congress event being held at the Gaylord Convention Center. Here are some notes, quotes and observations from the Day One proceedings:
Ron Williams(CEO, Aetna) and Denis Cortese, MD(CEO, Mayo Clinic) discuss ‘Rebuilding Health Care.”
Cortese suggested taking the top 3-5 diseases and top 3-5 procedures, which make up 70% of Medicare costs, and don’t cut the reimbursement rates for those that perform the best. He proposes that you’ll see the system self-organize in response, and it will trickle over into commercial plans.
Williams believes health plans can help provide transparency, with the following example: Consumers should be able to see procedure pricing at Hosptal A, Hospital B, an ambulatory surgery center, etc. before the service is provided, along with outcome and quality data. A BIG change, but that day is coming. Also stated that health plans have entered a new period that will require big changes is strategy in order to be successful in the next decade.
Clayton Christensen(Harvard, author of The Innovator’s Prescription) covered the general theme of his book. I’ll cover this more in a separate post. Suffice it to say, his book is a must-read for those in the health care industry.

Juan Davila(SVP of Provider Networks, BS of CA) presented on a MedeAnalytics application they’ve deployed to work more collaboratively with hospitals. Particularly noteworthy was a Venn diagram mapping out the shared goals between payer and hospital as a way to get cooperation. These were: Higher auto-adjudication rates; Improve claim turnaround time; Quick dispute resolution; Reduced re-work; Cleaner contracts. The goal for BSCA was to be able to pay hospitals fully, quickly, and according to the contract.

Richard Chung(SVP, Hawaii Medical Services Association) reviewed the health care coverage in Hawaii: 1.3M members, universal coverage since 1974, employer pays 98.5% of coverage, 70% commercial market share. Have had good past performance but costs are continuing to climb, so HMSA is turning their PPO into a virtual IDN. (Christensen pointed out earlier in the day that IDNs typically deliver 15-40% lower cost with better outcomes.)
Chester Burrell(CEO, CareFirst) – Notable comments:
CareFirst has had 14% average premium increases the last three years, and will post a similar increase this year.
Employers are whacking healthcare costs by increasing deductibles, decreasing coverage.
57% of employers this year offer a high-deductible health plan this year, up from 3% just a few years ago. He hasn’t seen that rate of growth for any other product before.

Michael Quilty, Matrix Health Network) – Notable comments:
There will be a physician shortage of 125K by 2025(this estimate is pre-HCR bill)
Nurses will play a big role as ‘physician-extenders.’
Concierge medicine will get big. MDVIP was just purchased in full by Procter & Gamble…
Who know whether Medicare will get small or grow, but Medicaid will become huge and that is ”where the there is.”
George Halvorson(CEO, Kaiser) and Alfred Spector(VP, Google) spoke. I’ll have more notes on that session later.