Providers, Payers: Are They Really All That Different Nowadays?

Editor's note: H&HN Staff Writer Marty Stempniak is blogging this week from America's Health Insurance Plans' Fall Forum 2012.

CHICAGO — I'm a journalist by trade and still relatively new to this health care thing, but I'm always hearing shadowy talk about how insurers and hospitals generally don't get along. But sitting in the audience at the first session of AHIP's Fall Forum 2012 on Monday, I could've sworn I was listening to hospital people and not their supposed adversaries. Sure, they called customers "members" instead of "patients," but I heard all the same buzz phrases such as population health, patient engagement and accountable care.

One of the big challenges in health care is compiling data on all the millions of members (or patients, if you will) flooding the system, and using it in a way that engages them in maintaining their health, said Eileen Cianciolo, vice president of informatics and reporting technology for the consulting firm Krames StayWell. And unlike in years past, both health plans and hospitals are chasing that same goal, Cianciolo said, and have an opportunity to collaborate like never before.

"The differences between them are really starting to narrow and to blend," she said, later adding, "I think we have a great opportunity in the health care industry for hospitals and for health plans to come together in a way that we could combine our data and get a more comprehensive picture of an individual."

On Monday, speaker after speaker laid out possible ways to share info and find ways to engage the consumer. Rajiv Kumar — M.D. and cofounder/CEO of the employee-wellness platform ShapeUp — talked about the "social dynamics of health." Studies have proven that obesity can be contagious. If your bud goes out for a cheeseburger, there's a good chance you're joining, and having one too. So why not harness that fact in the opposite direction, and get people to socialize around exercise and eating healthy?

Blue Cross Blue Shield of Michigan has taken that idea to the next step with a program called "Connect 2Bfit." With it, Blue Cross members can build a network with friends and family (both inside and outside of the health plan), set health goals to share with others, and challenge them to random fitness feats. Another program, Healthy Blue Outcomes, rewards patients for completing a health assessment and meeting certain health measures.

But how do hospitals feel about payers getting so involved in their patients' lives, asked one attendee. Ten years ago, one physician slammed his clipboard down in disgust at such initiatives, said Cindy Bjorkquist, director of wellness, care management and health promotion programs development at BCBSM.

"He said, 'How dare you think, as a wellness and care management individual, that you are going to change the behavior of my patients. How dare you. I'm the physician. I own that relationship,'" she said. "So now 12 years later, there's a completely different mindset in the physician community."

Now, BCBSM is approaching docs with ideas, and telling them that they're going to engage members to visit their doctor and get them to lead the push toward wellness. "We think it's so important that our members see their physician and have that conversation," she said.

It's all part of the push to treat health care more like retail, Rob Klein, president of Klein & Partners, said earlier in the session. Patients/members want to be able to look up doctors on Angie's List, get text messages about appointments and see a provider during odd hours. Way back when, patients may have been willing to sit for an hour waiting for the doc to see them, he said, but not anymore. Walgreens is going to change everything, he thinks.

"They get retail. Health care, we don't get it," Klein said. At a recent handful of patient focus groups, "Everyone of them said, 'Don't these physicians realize my time is just as important as theirs?' And they're starting to walk out now on appointments if they're waiting too long. That never happened 10, 15 years ago. They're acting like customers now more than patients, and that's a game changer."

Watch out for more coverage on AHIP's Fall Forum on Wednesday and Thursday. Oh, and I'll be covering the insurance beat for H&HN, so feel free to drop me a line if you have a story idea or just want to chat.