Change Health Care Now Mike McCallister President and Chief Executive Officer Humana Inc.
We Are Spending Inefficiently Percent of GDP Spending per capita Japan  ($2,077, 7.8%) U.S.  ($5,267, 14.6%) Adapted from ...
It’s Hurting The American Economy <ul><li>Employers’ number-one priority is to control health care costs </li></ul>Control...
We Must Align New Roles
All The Participants Must Transform Employers Consumers Providers Government Health Benefits Companies
<ul><li>Incorporate best practices   </li></ul><ul><li>Turn loose smart health plans to lower costs and improve experience...
Consumers <ul><li>Be active consumers, not passive users </li></ul><ul><li>Demand simplicity, transparency and guidance </...
Providers <ul><li>Abandon the past </li></ul><ul><li>45% of doctors don’t practice  evidence-based medicine </li></ul><ul>...
Government <ul><li>Enable best practices and efficiencies throughout the system </li></ul><ul><li>Partner with the private...
<ul><li>Put the consumer first </li></ul><ul><li>Standardize for industry-wide efficiency </li></ul><ul><li>Compete on val...
<ul><li>Health care proposals are abundant  </li></ul><ul><li>Most are long-term, with little chance of being adopted </li...
<ul><li>Standardization </li></ul><ul><li>Consumer responsibility </li></ul><ul><li>Business leadership </li></ul>Three-Pr...
<ul><li>Standardization can lead to value and efficiency   </li></ul><ul><li>Encourage all payers to join Availity, a  web...
Standardization <ul><li>Evolving from administrative efficiency to consumer value </li></ul><ul><li>Ongoing payer impact <...
<ul><li>Become a passionate self-advocate </li></ul><ul><ul><li>45% of Americans get the wrong care –  don’t be one of the...
Consumer Responsibility <ul><li>Find health information online </li></ul><ul><ul><li>Become proficient on a Website that c...
<ul><li>Leadership leads to value-creation </li></ul><ul><li>Reward consumer engagement </li></ul><ul><li>Insist on transp...
Business Leadership <ul><li>Business Health Care Group of Southeast Wisconsin </li></ul><ul><ul><li>Formed in response to ...
 
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Change Health Care Now

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Change Health Care Now

  1. 1. Change Health Care Now Mike McCallister President and Chief Executive Officer Humana Inc.
  2. 2. We Are Spending Inefficiently Percent of GDP Spending per capita Japan ($2,077, 7.8%) U.S. ($5,267, 14.6%) Adapted from Anderson, GF et al. (2005) Health Affairs spent in the U.S. economy will go for health care USA Today 2/22/06 every $5 $1 out of Within a decade, “ ”
  3. 3. It’s Hurting The American Economy <ul><li>Employers’ number-one priority is to control health care costs </li></ul>Control health care costs BRT Fourth Quarter December 2006 CEO Economic Outlook Survey 51% 16% 14% 10% 7%
  4. 4. We Must Align New Roles
  5. 5. All The Participants Must Transform Employers Consumers Providers Government Health Benefits Companies
  6. 6. <ul><li>Incorporate best practices </li></ul><ul><li>Turn loose smart health plans to lower costs and improve experience (integrated solutions) </li></ul><ul><li>Encourage engagement, not dependency </li></ul><ul><li>Encourage adoption of tax-advantaged financing mechanisms, like HSAs and FSAs </li></ul>Employers Consumers Providers Government Health Benefits Companies Employers
  7. 7. Consumers <ul><li>Be active consumers, not passive users </li></ul><ul><li>Demand simplicity, transparency and guidance </li></ul><ul><li>Be engaged, pursue healthy lifestyles (behavior – 50%) </li></ul><ul><li>Plan, budget and compare plan choice and financing alternatives </li></ul>Providers Government Health Benefits Companies Employers Consumers
  8. 8. Providers <ul><li>Abandon the past </li></ul><ul><li>45% of doctors don’t practice evidence-based medicine </li></ul><ul><li>It takes an average of 10-15 years for new medical discoveries to be routinely used by frontline practices </li></ul><ul><li>Be cost-aware, not cost-driven </li></ul>Government Health Benefits Companies Employers Consumers Providers
  9. 9. Government <ul><li>Enable best practices and efficiencies throughout the system </li></ul><ul><li>Partner with the private sector to solve the problem of the uninsured </li></ul><ul><li>Electronically connect the system under a uniform standard </li></ul><ul><li>Base reimbursement on performance </li></ul><ul><li>Release the Medicare claims database </li></ul><ul><li>Give health insurers the option to compete nationally </li></ul>Employers Consumers Providers Health Benefits Companies Government
  10. 10. <ul><li>Put the consumer first </li></ul><ul><li>Standardize for industry-wide efficiency </li></ul><ul><li>Compete on value creation </li></ul><ul><li>Invest in capabilities to inform and guide </li></ul>Health Benefit Companies Employers Consumers Providers Government Health Benefits Companies
  11. 11. <ul><li>Health care proposals are abundant </li></ul><ul><li>Most are long-term, with little chance of being adopted </li></ul><ul><li>Centralized planning for 300 million Americans is unrealistic </li></ul><ul><ul><li>Doesn’t work anywhere else in the economy </li></ul></ul><ul><ul><li>Goes against the American grain </li></ul></ul><ul><li>Programs for the elderly, children and indigent are needed </li></ul><ul><li>Combination of mandates likely required </li></ul>The Big Picture
  12. 12. <ul><li>Standardization </li></ul><ul><li>Consumer responsibility </li></ul><ul><li>Business leadership </li></ul>Three-Pronged Approach
  13. 13. <ul><li>Standardization can lead to value and efficiency </li></ul><ul><li>Encourage all payers to join Availity, a web-based information exchange system </li></ul><ul><li>Developed by Humana and BCBS of Florida in 2001 </li></ul><ul><li>Designed to allow real-time administrative processing </li></ul><ul><ul><li>Eligibility, referrals, </li></ul></ul><ul><ul><li>authorizations and claims </li></ul></ul><ul><li>Adopted in Florida by 100% of hospitals and 93% of physicians </li></ul><ul><li>Estimating more than 400 million transactions in 2007 </li></ul><ul><li>Expanding into Texas, New Mexico and Illinois </li></ul>Standardization
  14. 14. Standardization <ul><li>Evolving from administrative efficiency to consumer value </li></ul><ul><li>Ongoing payer impact </li></ul><ul><ul><li>Reduced transaction costs </li></ul></ul><ul><ul><li>Call center savings </li></ul></ul><ul><ul><li>Medical cost savings </li></ul></ul><ul><li>Growing consumer benefit </li></ul><ul><ul><li>Transferability of comprehensive medical history </li></ul></ul><ul><ul><li>Real-time claims processing </li></ul></ul><ul><li>HSA administration </li></ul>
  15. 15. <ul><li>Become a passionate self-advocate </li></ul><ul><ul><li>45% of Americans get the wrong care – don’t be one of them </li></ul></ul><ul><ul><li>Be skeptical, question everyone </li></ul></ul><ul><li>Use a Family Health Budget tool </li></ul><ul><ul><li>Gain control by knowing how much you spend on health-related expenses (checkups, vaccinations, routine prescriptions etc.) </li></ul></ul><ul><ul><ul><li>Humana’s Family Health Budget tool is a simple seven-step process </li></ul></ul></ul>Consumer Responsibility Guidance for Becoming a Better Health Care Consumer
  16. 16. Consumer Responsibility <ul><li>Find health information online </li></ul><ul><ul><li>Become proficient on a Website that can answer most of your health questions </li></ul></ul><ul><li>Take a Health Assessment </li></ul><ul><ul><li>Analysis of your daily habits and family history can provide you with clearer understanding of your health status </li></ul></ul><ul><ul><li>Tool available to general population summer, 2007 </li></ul></ul>Guidance for Becoming a Better Health Care Consumer
  17. 17. <ul><li>Leadership leads to value-creation </li></ul><ul><li>Reward consumer engagement </li></ul><ul><li>Insist on transparency and accountability </li></ul><ul><li>Facilitate reform through business partnerships and alliances </li></ul>Business Leadership
  18. 18. Business Leadership <ul><li>Business Health Care Group of Southeast Wisconsin </li></ul><ul><ul><li>Formed in response to Milwaukee’s health care costs averaging 25% higher than comparable Midwest cities </li></ul></ul><ul><ul><li>Includes 200-plus companies of all sizes and 75,000 members </li></ul></ul><ul><ul><li>Exclusive use of Humana Preferred “high-performance” network </li></ul></ul><ul><ul><li>ASO clients saw health costs decline by 15% in 2006 versus 2005 </li></ul></ul>

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