WARWICK — Health care waste remains a challenge and opioid overdose care needs long-term direction, while federally induced instability continues to threaten Affordable Care Act reforms, panelists said at Tuesday’s Health Care Summit at the Crowne Plaza Providence-Warwick.
The first panel assembled Michael Souza, CEO, Landmark Medical Center; Stephen Farrell, CEO, UnitedHealthcare; Dr. Peter Hollmann, chief medical officer, Brown Medicine; Dr. Gus Manocchia, executive vice president/ chief medical officer, Blue Cross & Blue Shield of Rhode Island; Linda Hurley, CEO, CODAC Behavioral Healthcare and Angela Patterson, chief nurse practitioner officer, CVS MinuteClinic.
Behavior issues drive health care, said Stephen Farrell, CEO of United Healthcare, who noted about 40 percent of health care costs are the result of behavioral choices. But most of the waste, said Hollmann found in end-of-life care.
The majority of health care costs add up for care at the end of a person’s life, mostly in nursing homes,” said Hollmann, though it’s a little each year over a long period of time.
“But it does add up,” Hollmann said.
Manocchia agreed a significant element of health care spending, about 30 percent, is the result of behavior, particularly the public’s insistence on low-value or no-value care, such as annual EKG tests, vitamin D screening and prescribed antibiotics for sinus infections, which he noted is often unwarranted.
Rather, he said, the health care system, doctors and patients included, should focus on high-value care such as colorectal screening, immunization, and making sure people have a primary care physician.
Manocchia said that at just 10 percent spent on low-value care, Blue Cross & Blue Shield of Rhode Island would have spent, or wasted, $170 million last year. Considering the amount other health care insurance companies must also be wasting on low-value care, he said, “That is a huge amount of money spent every year on low value or no-value care. We have to fix it.”
The first panel also touched on advances Rhode Island has made in responding to the national opioid overdose epidemic. Linda Hurley, CEO of CODAC Behavioral Healthcare, noted that advances in the immediate treatment of overdoses has begun to stem the rate of opioid overdose deaths. However, she said the new challenge is the stigma surrounding opioid addiction.
“What has happened is, it has spilled over into treatment as well,” Hurley said, which make the use of treatments more expensive than they need to be, in part, through unnecessary regulation.
The second panel included Marie L. Ganim, R.I. Health Insurance Commissioner; Dr. Alan Kurose, CEO, Coastal Medical; Daniel Moynihan, vice president of payer relations & contracting, Lifespan; Dave Burnett, chief growth officer, Neighborhood Health Plan of Rhode Island; Angela Patterson, chief nurse practitioner officer, CVS MinuteClinic; Zachary W. Sherman, director, HealthSource RI and Marc Spooner – executive vice president, commercial and government products, Tufts Health Plan.
In the second panel, experts noted the continuing stress on the health care market repeated Congressional and Trump Administration undermining actions have placed on the system, including the Republican tax cut bill that also removed the penalty for not signing up for health care in 2019. The penalty remains for the balance of 2018, however, noted Sherman.
“I think it confuses the market,” said Ganim.
Ganim also noted that despite a federal loosening of prohibitions against short-term health insurance plans, which were developed as a short-term fix between jobs but don’t guard against pre-existing conditions or provide consumers basic care options required in Rhode Island, are not approved for sale in the Ocean State.
Spooner said that despite growing public support for a single-payer alternative to the ACA, one New England example, in Vermont, was not implemented by the governor because of the cost.
“The governor said, ‘I’m not going to implement this law,’ and that was in the state of Vermont,” Spooner said.
Still, the simplicity of a single-payer approach remains attractive for many people frustrated with the current system who wish it were simpler to navigate.
Those in favor of a single-payer system are likely thinking, “ ‘Maybe if we had one single payer, we would have that simplicity,’ ” Ganim said.
Rob Borkowski is a PBN staff writer. Email him at Borkowski@PBN.com.
