A Path Forward For The US Health Insurance Industry

Nearly everyone who works in the health insurance industry believes they are improving affordability and access to care.

Apparently, what the health insurance industry thinks of itself doesn’t matter to an angry public whose intense outrage was revealed after the murder of UnitedHealthcare CEO Brian Thompson.

They are angry that health insurance companies are not paying enough for needed services.

They are angry that health insurance companies are denying or delaying necessary services in pursuit of profits.

They and their doctors are angry and exhausted from the constant battle with insurance companies to get the coverage they need to live.

How we got here requires a complex review of the history of U.S. health care policy—but the “how” doesn’t matter now. It’s clearer than ever that health insurance companies need to quickly rebuild the trust of the American public.

Where does this trust come from? It starts with ending denial. and loudly said, “We screwed up.”

We screwed up when we started selling high-deductible insurance plans, which turned patients into consumers and told them they needed “skin in the game.”

When we accidentally introduce unnecessary delays to your care and ignore your personal circumstances, we screw up.

When we stop being your advocate and shirk responsibility when you face a life-changing medical condition, we screw up.

And, lately, when we stand on tired industry talking points — or say nothing at all — when you need to acknowledge your suffering and pain, we screw up.

Healing must begin by saying out loud the words that every wronged person needs to hear when they are wronged: “We are sorry.”

As we embark on our professional journey, our purpose is to change your life for the better. But along the way, our Frankenstein health care system has taken us in directions we never imagined, individually or collectively.

We have to make things better as soon as possible.

The first place to start is to significantly improve your daily care experience.

When you need our help (in the form of a mandate or referral), we don’t act in the days or weeks that have “normalized” but rather based on the real-time urgency you feel when your life is in the balance Take action. Too many people feel their insurance companies are preventing them from getting necessary or life-saving treatment. That’s wrong.

While there are reasonable doubts about AI being used to deny coverage, it can help gain approval to help facilitate care when needed.

The second opportunity is to increase transparency.

American health care is confusing every step of the way. The fear of unexpected medical bills and uncovered services has become a harmful deterrent to people seeking medical care. My own family members sometimes put off necessary care because, like millions of Americans, they fear the bills the other person might face.

To regain the depleted trust of both health insurance companies and health systems, the two groups must work together to give people more transparency into the true costs they face for services. and stick to it. Price transparency rules implemented in 2021 are a step in the right direction, but more needs to be done to make this information simpler, more consumer-friendly, and more reliable. Without this kind of transparency, we fail to meet the most basic requirement of any business, something we would never tolerate in any other context: telling you how much something costs forward You buy it.

A third opportunity is to place a greater emphasis on prevention and chronic disease management.

Health insurance companies manage costs by negotiating service prices. But what if we needed fewer services in the first place because we were successful in keeping you healthy?

The science of chronic disease management and prevention has come a long way. However, health insurance companies, including federally funded Medicare and Medicaid, often pay more to manage the expensive complications of chronic disease than primary care, which focuses on preventing these complications.

How different would our national burden of disease be if health insurance companies considered long-term health and well-being rather than annual actuarial cycles? Enforcement is difficult because coverage is tied to employment and turnover is rapid. Our industry’s policy initiatives should focus on long-term coverage and portability of coverage so that we can invest more deeply in your health.

The final opportunity is to commit more authentically to becoming who we say we are.

Health insurance companies say we simplify your health care experience, but often fail to do so.

We say we care for you as a “whole person,” but we create disruptions in your care.

We say we’re your advocates, but sometimes you have to fight us Every step.

Every industry has self-perpetuating narratives and socially impactful fictions.

After the events of the past few weeks, it’s time for America’s health insurance companies to acknowledge that our narrative is tired and broken.

Say out loud what everyone needs to hear right now: We are sorry and we can and will do better.