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Picturing a world with transparent health care costs

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Posted January 30, 2012 by Mark Gaunya at 08:03AM. Comments (211)

Mr. Gaunya goes to Washington . . . and comes home renewed with confidence and appreciation.

Each year, the National Association of Health Underwriters holds a legislative “fly-in” called Capitol Conference.  Well over 1,000 brokers, consultants and employee benefit professionals make the annual pilgrimage to DC to share best practices, educate their legislators and build long-lasting relationships by supporting our profession and the clients and consumers we serve.

As the President of the Massachusetts Association of Health Underwriters, I look forward to this trip every year because it gives me the opportunity to work with my colleagues and make a difference to over 100,000 brokers, consultants and employee benefit professionals and the millions of people they protect through insurance and financial services.

After a couple of challenging and often frustrating years culminating with the passage of the Patient Protection and Affordable Care Act, we returned to the Hill with two specific messages:

1. The Medical Loss Ratio (MLR) provision needs to be amended to exclude broker compensation

2. Support transparency by requiring the disclosure of cost & quality information to help consumers make informed choices

What happened?

We gained considerable ground by the time we left DC – securing commitment for 20+ more Congressmen to support H.R. 1206 in the House of Representatives and receiving word that the Senate would be introducing a companion bill. 

On the third and final day of our meeting, it was announced that a bill modeled after H.R. 1206 will be sponsored by Sens. Mary Landrieu (D-LA), Johnny Isakson (D-GA) and Bill Nelson (D-NE).  The new legislation will not be identical to H.R. 1206, but instead will include minor targeted improvements based on the market’s response to the MLR requirements over the past year.  The lead co-sponsors of H.R. 1206, Reps. Mike Rogers (R-MI) and John Barrow (D-GA), have indicated their support for the updated Senate measure.

This is tangible proof that our legislators understand and value our role as trusted advisors to employers and consumers for health insurance and comprehensive employee benefits.  It provides relief to thousands of small businesses who employ benefit professionals that make a difference in lives of their clients every day . . . and it demonstrates the power of working together toward a common set of ideals.

If you refer back to my first blog, it will not surprise you that I’m writing about transparency.  Without it, we will NEVER solve the problem of rising healthcare costs.  What did we do about it at this Capitol Conference?  We sharpened our focus and delivered a message that is being well received from both sides of the aisle. 

Our clients want to make informed health care choices and we need to equip them with easy to understand information.  How?  Let’s start with making the language health care providers and insurers use to talk to each other visible to the American public . . . procedural or billing codes (CPT and ICD-9).  Rather than “reform” the way providers are paid (like the last blog I wrote), let’s make contracted costs transparent to the consumer so BEFORE they seek the care they need in non-emergency situations, they use that information to look for the best value weighing both cost and quality.  And rather than waiting for quality to be defined and used as a reason not to expose cost, let’s support transparency first and let the market and competitive pressure sort out how quality is measured.

Can you imagine a world where the “new norm” required insurers and providers to disclose what they charge upfront so consumers could make informed decisions, avoid unnecessary care and helps us understand that care can be expensive but not necessarily better in value?  I can see it .. . I hope you can too.  Next time you see your State NAHU Chapter volunteers, thank them for making a difference, they are working hard for you.

Did you attend the conference? Share your reflections on it in the comments.

Gaunya, GBA, is principal at Methuen, Mass.-based Borislow Insurance. He can be reached at 978-689-8200 or mark@borislow.com

 

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