Making healthcare work better

By Dr. John Espinola
Tuesday, January 08, 2019

Over the last three years, we’ve been asking our customers for their opinions every chance we get. Their responses almost always fall into one of four categories:

  • They weren’t always getting the care they needed,
  • They were sometimes getting care they didn’t need
  • They weren’t always getting the experience and health outcomes they deserved. 
  • All this made them think they were paying too much. 

Health insurers have typically been seen as slow to change and more focused on themselves than their customers. Premera is different – we’re a collaborative partner with our members in their healthcare, with our employer groups in their benefit strategies, and with our providers in moving to a value-based healthcare system. As we re-imagine what making healthcare work better looks like in the future, we’re partnering with others and looking at how we can purchase healthcare differently, transform payment methodologies, and continue to focus on building strong, local relationships that can meet the needs and demands of our customers. That’s not going to be easy. But we’re up for the challenge.

Our members and employer groups are asking us to find ways to help get their healthcare costs in check.  For employers, healthcare benefit costs for their employees continue to trend upward, causing groups to find other ways to reduce those costs, sometimes by restricting benefits. Taking up the cause on behalf of our customers became our purpose: making healthcare work better. Since we made that pivot, we’ve focused on ways we can collaborate with provider partners to improve quality and reduce unneeded treatments and began to change payment methodologies. We’ve also worked with our employer groups to help them find ways to structure health benefit plans so they can continue to offer health benefits to their employees. 

We’re partnering with our providers to find effective lower cost alternatives to high cost medications and reduce the risks associated with unnecessary scans. We’re providing our members with more information on quality and cost and sharing details on finding high performing providers, simplifying schedules through mobile apps, and cost tools so they can make a more informed decision about their healthcare. We’re looking at opportunities to streamline our systems, making it easier for provider offices to get the information they need quickly and accurately. We’re also focused on some other unique initiatives, like offering the first insurer-offered Total Joint Replacement Bundled Payment Request for Proposal. This is expected to not only save employers and members money, but also result in better health outcomes due to quality standards and provider guarantees.

And we’re not done finding new ways to ensure our customers have quality care at a fair price. In June of 2018, we announced a new collaboration with MultiCare Health System. Focused on Pierce County, we’re introducing a health plan that merges healthcare with insurance, saving employers and families money while reducing confusion that too often comes with medical care. It’s a first-in-the-Northwest partnership where an independent health plan and independent health system share a vested interest in making sure members get the care needed and avoid the care they don’t. The goal with this collaboration is to explore ways we can work together to make the health care experience simpler and easier for patients and health plan customers, while lowering out of pocket costs. Using MultiCare Connected Care’s clinically integrated network, we estimate that this new health plan, Peak Care, could save employers as much as 15 percent off the cost of a traditional preferred provider organization or PPO plan.

Why did we do it? As Bill Robertson, President and CEO of MultiCare put it, “MultiCare is always looking for new and innovative ways to help patients get the care they need, and we’re pleased to find a like-minded ally in Premera. Together, we’ll develop new ways to provide care while delivering better outcomes at a lower cost. We’re excited about the new opportunities this partnership will create.”

We know our customers want healthcare to work better, employers want to pay less for better quality, and our providers want a fair price for providing quality healthcare to their patients. At Premera, we take that charge seriously, and you’ll find that the work ahead will bring challenges and change as we transform our business to meet our purpose of making healthcare work better.

This is part of a series on making healthcare work better and the initiatives Premera is focusing on to drive costs down and make healthcare simple and easy.

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