It’s October. That means Halloween and something even scarier — insurance premium increases.
This year, people in the individual market will face hikes even higher than usual thanks to the federal government’s concerted effort to undermine the marketplace.
Small businesses in New Jersey also feel the fright. Plans now offered in the Small Employer market have fewer out-of-network options, and higher out-of-pocket costs. We all know that ever-rising health costs have a dampening effect on wages and economic growth. These are real concerns.
Yet despite the challenges, small businesses in New Jersey still want to provide quality health insurance to their employees.
The answer is for all of us to get real about reducing the total cost of care and improving health care quality. These are not opposing goals.
Recently I attended the National Affordability Summit sponsored by the Network for Regional Healthcare Improvement and brought along some New Jersey leaders in health care:
- Jennifer G. Velez, JD, Senior Vice President, Community and Behavioral Health at RWJBarnabas Health
- Dan Fabius, DO, Vice President, Clinical Informatics at Continuum Health and a practicing physician
- Mary Ann Christopher, MSN, Chief of Clinical Operations and Transformation at Horizon Blue Cross Blue Shield of New Jersey
- Carl Rathjen, MPA, Director of Value Based Transformation at Horizon Blue Cross Blue Shield of New Jersey
We traveled to Washington, D.C., and met at the Ronald Reagan Building, down the street from both the Capitol and the White House. Other multi-stakeholder groups from around the country joined us to focus on the affordability conundrum.
One of the many topics explored was the enormous variability on prices. A simple X-ray can cost triple the amount at one setting versus another. And changing the venue for a procedure from in-patient to outpatient can save untold millions.
At the summit, experts spoke about what’s driving costs and what innovations are really working. We discussed which of the new models of care are showing better results for patients and saving money.
Experts spoke about how we can leverage health care cost information regionally and nationally to achieve affordability. Just sharing the data we have, however imperfect, highlights the differences in clinical practice patterns and the vast waste in the system.
Throughout the day, our Garden State contingent talked about the need to wring out the 30 percent of waste in our health care system — money spent on care that does not help patients and sometimes hurts them. We acknowledged this approach, though necessary, will have very real and unwanted repercussions to some communities.
What happens to jobs when hospitals close? Hospitals often are the largest employer in some cities and communities. They provide sought-after jobs. We will need strong leadership and focused jobs programs to retrain and deploy today’s health care workforce to provide community-based care or other services.
To advance this critical discussion, the Quality Institute’s winter conference will focus on: “Getting to Affordability — Is Data and Transparency the Answer?” I’m excited to tell you that our keynote speaker is Niall Brennan, BA, MPP, former Chief Data Officer at CMS and now Executive Director of the Health Care Cost Institute, an organization that uses large payer data sets to create cost and quality insights and research.
Invited guests and members of the Quality Institute are welcome to join us as we discuss the road to affordability.