Rita E. Numerof, PhD, is the president of Numerof & Associates, a firm that helps businesses across the healthcare sector define and implement strategies for winning in dynamic markets. For more than 25 years, she has helped executives understand the implications of an evolving healthcare market. Working with leaders in the healthcare space, she has consulted with everyone from top academic and community hospital systems, payers, and Fortune 500 pharmaceutical, device, and diagnostics companies. She is the coauthor of several books, most recently, "Bringing Value to Healthcare: Practical Steps for Getting to a Market-Based Model" (2016).
Humana recently announced it would waive cost-sharing for primary care and behavioral health appointments to incentivize its Medicare Advantage beneficiaries to resume their usual health care activities.
This a commendable move by the insurer, as behavioral health hasn’t historically been a top priority in the payer space. But that’s not the only reason for which Humana deserves recognition.
On Tuesday, May 5, Humana chief executive officer Bruce Broussard appeared on CNBC’s “Closing Bell” with an important message: “You’re going to see a different health-care system as a result of the virus that is going to be much more distributed in the ability to deliver care.”
The “different health-care system” Broussard is describing is exactly the 1 health care reformers have advocated for years, to little avail, primarily because of significant pushback from deeply entrenched care delivery organizations and the organizations that represent them.
For these organizations, health care’s fee-for-service business model worked well. They were able to make money so long as they had heads in beds, and independent of whether the people in those beds had high- or low-quality outcomes.
This is problematic for a multitude of reasons, many of which are unbeknownst to the average health care consumer. The average health care consumer gets their insurance from their employer, goes to the health care provider their employer’s insurance plan points them to, and tends to not bat an eye at the bill unless they have an outrageously high co-pay or surprise medical bill.
Kaiser Health News’ Bill of the Month series began raising awareness of the latter last year. But nothing has showed consumers just how fundamentally flawed American health care is, nor how badly bureaucracy stymies progress, like Covid-19.
Astonishingly, during a global health care crisis where their ERs are swamped, hospitals are begging for bailouts because emergency services like those required to treat Covid-19 aren’t their main source of revenue. Elective surgeries are where they make their money, even though hospitals were never meant to be destinations of choice!
Equally astonishing is how quickly industry was able to innovate once the CMS eased up on certain regulations. Telehealth isn’t new. However, so many Americans either weren’t aware of it, or weren’t able to access it before CMS realized the incredible value it offered to pandemic response. As it enables individuals with minor symptoms or other concerns to contact a physician from the relative safety of their homes, CMS decided to not only make telehealth utilization easier, but to even encourage it.
This push for people to stay out of care delivery organizations’ brick-and-mortar offices unless absolutely necessary will undoubtedly make consumers think twice about visiting a provider in person; which is not to say that individuals will vehemently avoid physicians’ offices for the foreseeable future, but to point out that if they have the option to do so, they will choose the more convenient route.
Next to convenience, they will also question cost and quality. With some services and procedures usually performed in hospitals shifting to ambulatory surgery centers (ASCs) so that hospitals could better accommodate Covid-19 patients, consumers are going to ask themselves why they’d pay a hospital more if they could receive the same quality of care in a less expensive setting.
Consumers aren’t necessarily going to get more critical of health care — in fact, they’ve never shown more support for our nation’s medical professionals – but Covid-19 is going to make them get smarter about it. And if health care payers and providers want to find future success, they best follow in Humana’s footsteps, subscribing to the fact that health care will never be the same.