The difficulties that health technology innovators will have breaking into the health care industry were no more clearly illustrated than by the talk given by Dr. Sam Ho, Chief Medical Officer of United Health Benefits Group, on the third day of San Francisco-based health incubator Rock Health’s Health Innovation Summit. After two days of exciting stuff about design and development, CEO day presented the cruel reality of the market .
Dr. Ho began by admitting the system was broken. Payments, he admitted, didn’t align with objectives, and outcomes were an afterthought. But now things are in the process of change, partly because of the passage of Obamacare (although he didn’t mention it by name), partly because of the too-temporary tenure of Dr. Donald Berwick at CMS, and partly because in a worldwide recession, we can’t afford our health care costs any longer.
So the big players, fearing innovation from without, have decided to try to innovate from within, and came up with a slogan called “The “Triple Aim:” a slogan that embraces how to improve the individual experience, improve population health, and control inflation of per capita costs. Dr. Ho believes these three aims are separate now, but they must be aligned to succeed.
For United Health, this means Care Management Programs, Transparency and Premium Designation Programs, Hi Performing Preferred Networks, Value-Based Benefits, and Value-Based Contracting. These can be read as forms of rationing and cost shifting by the more cynical among us. However, for him, it mans developing more and more incentives for changing consumer behavior. For example, patent premiums will get lower and benefits richer if consumers enroll in a diabetes plan and stick to it. If they manage their blood pressure or lipid levels, they will also have richer benefits. But what if they try and fail? I’m all for outcomes-based medicine, but we have to be careful we are measuring things that are within the control of either patient or provider. And how do we judge?
