Thursday, March 4, 2010

The Real Debate in D.C. (Part 2)

Last week, we discussed the difference between the Bipartisan Summit and other, less publicized but more comprehensive events, such as the Managed Healthcare Business Forum.

As a follow-up, let's talk about some of the outcomes. There has been a great deal of coverage on the event with elected officials, but none on the other. So, here is first-hand account on some of the key topics discussed:

Health Reform: The discussions were much like what was happening across town. What are the next steps? Where do we go from here? What should we expect from our regulatory bodies and the current administration? The truth is that much is known and yet unknown at this point. It is expected by most that some type of health reform will be developed this year. However, the size, scale and price tag remain a mystery.

Streamlining Cost and Quality of Care: Cost reductions and the management of costs are at the forefront of all discussions. Being creative is essential, thus newer ways to incent (i.e. work with) providers are emerging, such as payment programs and quality metrics to determine performance within their patient base and to their peers. Most would see this as the old standard capitation methodology with a twist. However, when you delve deeper, you can see the potential cost savings and the new horizon for quality metrics reporting, monitoring and performance.

Health and Wellness of the Membership Base / Moving Health and Wellness to the Next Level: Health and wellness of our membership continues to be a key to any solution worth implementing, and therefore new ways to carve out components of our membership and incent them to actively participate in wellness campaigns is on the horizon more so now than ever before. There are two basic reasons:

  1. To enhance/improve a members overall quality of life.
  2. To streamline/enhance cost savings.
Examples of ways to accomplish this were discussed, including how to develop customized, well-rounded plans that would allow individuals to potentially lower their premium costs if utilized. So, if a member had diabetes, they would be in a plan specifically designed for them with tailored programs to facilitate education, wellness, and healthy lifestyle habits that would not only benefit them, but in a small way, help the industry become more efficient.

Service: This concept continues to be a major separator in the playing field. While price and benefits continue to be the top components, service is a close second. With a competitive price in the market place, service will be the key component that separates plans. Members are looking for "first call resolution" (as opposed to be being transferred multiple times) and a one-stop shop for answers. Those that can perfect (or come closest to) a model in which a single phone number can result in a live body that can handle all their needs will have a leg-up on competitors.

The event provided all that attended with an abundance of information, with the added benefit of zero television cameras, so ideas could be shared without 'post-event wrap-up commentary.' The next step is the hardest, though. We need to take these ideas and philosophies back to our respective corners of the world and turn them into solutions.


Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at

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