Oregon Health Insurance CEO Forum or Let your Children grow up to be Actuaries and not Naturopaths

Last week, I attended the Oregon Health Forum CEO round table, the well attended annual gathering where we get to see how truly collaborative (or cozy) the health insurance industry in Oregon is. Six of the top local seven insurance plans were represented on stage as well as the local head of United Healthcare, who is generally viewed as the Darth Vader of health insurance. The CEO’s had mostly similar views about the direction of the health care industry, and supported each other’s comments (except no one said “I’d like to support what the gentleman from United said”). Here is a summary:

• There was a real call for the average American to more actively participate in their health care decisions. For example Oregon House Bill 2213 required that insurance carriers produce a tool that provides estimates of the cost of the top 30 procedures based on the individual's insurance coverage. However, my blog receives 20 times more traffic than those tools (and I don’t break triple digits). Americans have largely been shielded from both the financial impact and the necessary information to make health care decisions. Like retirement savings, both of those things need to change.
• The CEO's discussed a new product intended to engage Americans that was developed by the Oregon Coalition of Healthcare Purchasers. It’s a value-based design supported by Jack Wennberg’s research with the Dartmouth Atlas. The plan design covers preventive services and those that treat chronic diseases so the individual pays little to nothing for those valued services. However, services like spine surgery for back pain or global nuclear thermodynamic three dimensional imaging that provide questionable value for the dollar on a population level will be more expensive. You call that rationing but it’s really recognizing there are limited health care dollars and using consumerism or market forces.
• One CEO mentioned that there are 43 mandates for different benefits (like hearing aids for children) or eligibility (coverage of domestic partners) in Oregon. He suggested re-evaluating the mandates to see if they add unnecessary costs to the system. However, I have questioned if mandates 1) are covered by most insurance companies anyway, 2) really add up to significant savings compared to reduction of global nuclear thermal imaging, and 3) represent a failure of market forces to address a community need.
• One CEO described their efforts to engage providers by providing information such as how many of their cardiac patients have come in for preventive services or diabetic patients who have their blood sugar within range. The only Chief Medical Officer who was there couldn’t help himself from saying, “I would loathe to receive that kind of letter from an insurance company.” However, physicians don’t have the ability or time to consistently track that information easily while insurance companies do.
• I have developed my Bingo game at these events where I wait for the first CEO to mention the importance of caring for children in the most completely tangential off topic manner. Mentioning the importance of touching the lives of children is probably in the public relations guide for every industry that faces a skeptical public. Kaiser Permanente scored the Bingo this year. At least, it hasn't gotten so bad that insurance CEO's have to talk about warm puppies and ice cream.
• A medical student at the college of naturopathic medicine asked if the CEO's had considered providing coverage for naturopathic services due to the primary care shortage and pointed out that Washington and Vermont mandate this coverage. The expression on everyone's face clearly said, "No we haven't. Not at all and we probably won't think about it in the future." The Chief Medical Officer broke the silence with a quick, "That's a good thing to consider." Personally, I can't disagree as I don't know if covering naturopathy will add even more costs to the system or improve access to primary care. However, for those still considering the course of study, if covering naturopathy hasn't been discussed in Oregon, that's not promising for more traditional states.
  
• Instead of naturopathy, those with a quantitative skills should look at actuarial science. Most health care reform calls for increased actuarial evaluations and the value-based models will further increase the work. It's got a strong future. Sure, there are still jokes like "What do you call an actuary talking to someone else? Popular." For most of my co-workers, our children aren't going to be encouraged to become doctors but instead become actuaries.