Private health insurers know that someday the inevitable will happen—a significant number of people will refuse or be unable to pay the high health insurance premiums the industry has shamelessly extracted for decades. Insurers also know that all of their “cost-saving” efforts over the years were simply stalling tactics, temporary appeasements to employers (payers) to make them feel like they had some control over their multi-million dollar health plans. Insurers were so confident in their relationships with employers that they even took the name “payers” for themselves. However, lately, large employers have questioned their partnerships with insurers and are taking steps to improve the health care experience for their employees and decrease their health plan budgets. But get this; they’re keeping their private health insurance plans.

Large Employers Are Tinkering With Their Health Plans And Calling It Innovation

If you read about health care even occasionally, you know about the new company, Haven. A venture created by the heads of Amazon, Berkshire Hathaway, and JPMorgan Chase. Large companies that got together to create a health insurance company with the goal of lowering health insurance and health care costs for their employees. The health insurance status quo said, have at it. Private health insurers know better than most what’s required to make health care more affordable—medical care price controls and health care trade-offs. Insurers have perfected the art of managing health care trade-offs—most benefit plan documents contain pages of excluded health care benefits. And since employers aren’t talking about price controls, with the exception of reference based pricing, which is technically a form of price controls but with numbers that are easy to manipulate, insurers aren’t that pressed about this new wave of employer health care “innovation.”


Still, we don’t know what “innovations” to expect from Haven, but based on what I’ve read so far, it involves technology. And Haven’s not the first group of large, wealthy employers exploring how technology can help control health care costs. According to a very informative article in Benefits News, before Haven, there was The Employer Health Innovation Roundtable (EHIR), “a grassroots group made up of nearly 60 of the country’s biggest employers that represent nearly 8 million employees.” This group includes mega companies such as Apple, Target, and Google. Basically, representatives from EHIR watch presentations from health care tech start-ups and decide if they want to pilot the “benefit” at one of their companies and report back its findings to the large group via case study or some other format.

I love technology but was immediately unimpressed with this so-called innovative way of addressing the health care problem. Health care doesn’t need more useless tech toys that benefit the already informed and engaged. Another red flag that came up when I tried to learn more about this group involves the guy who started it all, Joshua Riff. Riff, was a Target health benefits executive when he conceived of the EHIR; he now works for a health care tech start-up funded by Google and Sanofi. I would bet a buck that this health care start up presented before the Employer Health Innovation Roundtable and hired Riff to improve its chances of getting other large employers to buy its diabetes care management app. (Yes, it’s always an app…) It makes you wonder if this group is interested in reducing health care costs or if they’re just tech-obsessed.

Here’s my point, health care innovation is fine when it’s honest. If employers want to improve the health care experience with say a direct primary care program where there’s care assistance from day one and follow-up to make sure care is progressing, do it. If large employers want to band together as one to negotiate better rates with private health insurers, do it. If employers want to hire brokers and consultants to design ACOs (coordinated care networks) and reference based pricing programs, do it. But don’t tell me that any of these “innovations” will lower health care costs if you’re not also talking about health care trade-offs and determining the real cost of care so that we do not continue to pay whatever hospitals, doctors, and pharmaceutical companies want to charge.

Conclusion

It’s hard to reform or walk away from the health insurance and health care status quo when you’re an integral part of it. The desire to keep work-based health insurance in some form, limits employer cost control options. Most large employers are keeping their traditional health insurance plans and adding ancillary benefits that they hope will change how people engage with their health plan. Another thing they are keeping is their commitment to try everything else instead of pushing for health care price controls and acknowledging the importance of trade-offs to make health care affordable. I hope employer the latest health care “innovations” lead to more informed patients and lower health care costs for everyone, but I doubt it.

Tags: health care innovation, health care , health care technology, Haven, EHIR