Not surprisingly, health insurance companies are taking it on the proverbial chin as the health care reform debate continues. It seems most people, including President Obama himself, are quick to demonize insurers as the primary culprits in the nation’s health care crisis. Well, that’s simply not fair. Not all insurance companies are alike, and painting them all with a broad brush of blame misses quite a few important points.

For various reasons, our society views health insurance companies with great cynicism. Their inherent unpopularity has created the perception that every one of them is disreputable. This is the exact same reasoning that says all athletes take steroids, all physicians are inept, all politicians are untrustworthy, and so on.  They are all uninformed, unreasonable generalizations based on anecdotal information about the activities of a minority of a population. The fact is, not all health insurers are the same. Like athletes, physicians, politicians and human beings in general, each organization has its own character, beliefs and approach. Yes, some are monolithic national organizations, but others are much smaller and more community focused. Some are run by physicians; some are for-profit and others not-for-profit. This is an extremely important fact to consider as we scrutinize the health insurance industry and its role in the future of health care reform.

Another distinction that needs to be made, particularly by the president, is that although most insurance companies oppose certain elements of reform plans (namely the government-run plan option), they’re not against reform altogether. Our experience at MEDecision over the past few months has been that insurers are eager to fix the system, but most simply have different opinions on how to best do that. Unfortunately, it seems those that disagree with the president’s ideas are being cast as “the opposition,” which calls to mind the Bush administration’s “if-you’re-not-with-us-you’re-against-us” attitude toward any who questioned its anti-terrorism strategies. All of the nuance that the president brought to his speech on race during his campaign, and to his speech to the Islamic world in Cairo, seems to have disappeared when he and his administration speak of health care reform; a return to discourse in which everything is starkly black or white, patently good or evil is harming our efforts at reform.

In recent decades, virtually all of the innovation in health care management and delivery has come from the private insurance industry, so much so that the government has tried to adopt many of the same practices for Medicare and Medicaid. Private insurers have been at the forefront of implementing care management initiatives that proactively foster wellness in an effort to maintain costs, alleviate waste and facilitate healthier lifestyles for their members. They have supported the development of new medical technologies and drugs. And they have shouldered the financial burden of cost-shifting when the government underpays physicians and hospitals through Medicare and Medicaid reimbursements. These are all very strong contributions to a system that, despite its serious flaws, is widely considered to be the one which drives almost all medical advances and drug development used to treat the world.  Insurance companies aren’t without their imperfections but branding them as the problem is shortsighted. In truth, they have done more in the way of finding solutions than most people are aware and are eager to be involved in reforming the system in a manner that is fair and equitable for all.  

“'Frequent Fliers' Add Billions to Hospital Bills,” a June 30 article in the Washington Post, discusses the frequent flier phenomenon, which is something we at MEDecision are quite familiar with. As the article explains, frequent fliers are patients that have been treated and discharged from hospitals but, for various reasons, repeatedly show up again (usually in the ER) seeking additional treatment that often results in readmission.  A major strain on the system and a source of significant expense, the frequent flier issue is gaining increased attention as health care reform efforts progress.

At MEDecision, we’ve concluded over the years that health IT can play a big part in alleviating the frequent flier problem. EHRs would give ER doctors a much clearer and more complete picture of the patient, which in many cases might mean avoiding duplicate tests or unnecessary procedures or altogether averting readmission. As the article suggests, docs would have better interactions with patients to determine, for example, if the patient is taking their medication or if they have seen their primary physician in a timely fashion after being discharged.

Beyond these sorts of anecdotal examples, EHRs are also key to promoting wellness. As the study referenced in this iHealth Beat article seems to suggest, having more robust clinical data enables health plans to better monitor members with chronic illnesses and communicate with them as necessary to ensure they’re taking the necessary measures to stay healthy. A case manager could monitor the patient’s pharmacy activity, see that they haven’t filled the discharge prescription and contact them to ensure that they do. This could ultimately help avoid that return visit to the ER. The same goes for follow-up physician appointments and other problems that result in frequent flier visits. By deploying EHRs and other technologies to facilitate the sharing of information among all of the entities on the patient’s health care team, we can help people understand their conditions and encourage them to be more vigilant about staying healthy.

As we move further along the path of health care reform, it’s interesting to see more broken parts of the system gain attention. But it’s equally as reassuring to know that technology has the power to help reverse many, if not all, of them.