The Future of Transparency: Can Data Fix Health Care? [Part 1]

The following is Part One of a five-part series recapping a live webinar hosted by BenefitsPRO and sponsored by Artemis Health. The webcast, “The Future of Transparency: Can Data Fix Health Care?” featured panelists Jim Blachek, co-founder and principal at the Benefits Group; Lester Morales, CEO of Next Impact; and David Contorno, founder and CEO of E Powered Benefits. Eric Silverman, founder of Voluntary Disruption, moderated. Slides and audio are available on-demand. 

Benefits advisors and their clients have data to impact employee health and shape the future of healthcare. The panelists share examples of how they leverage benefits data to achieve desired results. Healthcare data alone is good. But data alone cannot fix healthcare. Employees, employers and advisors deriving actionable insights from that data is what will lead to changing the current system of healthcare.

Paul Wilson: Hi everyone, my name is Paul Wilson and I'm editor-in-chief of BenefitsPRO. Welcome to today's webcast, "The Future of Transparency: Can Data Fix Healthcare?" This event is brought to you by Artemis Health and presented by BenefitsPRO. Let's get to today's topic. Innovative employers and their benefits advisors know that a key way to stay ahead of many of the challenges facing employee healthcare lies in the data, and they must evolve to keep up. By using data to increase transparency and uncover insights that can truly make a difference in both cost and quality, you will bend the cost curve, provide employees with better care, and help lead the industry into a much needed transformation.

Thank you Grant and thank you BenefitsPRO and Artemis Health for putting this on. I'm really excited to have our speakers weigh in with their insight and advice on where the next five to 10 years will go. Let's get this thing kicked off. As you hopefully see on the screen right now, the first question is:

“Over the next 5 to 10 years what are the biggest changes that will affect the way we use employee healthcare data?”

I'm going to start with our favorite friend, Mr. David Contorno, as I know he's chomping at the bit to get talking. David?

David Contorno: Who me? Thanks Eric, and thanks to Paul and the Artemis team. I think data is heavily underutilized in the healthcare space, and I think it's one of the opportunities. However, I want to caveat that by saying, there are consultants and even employers out there who use data. And they have access to data. 

One large employer example is Walmart. I've worked with them and I've spoken with them, and they have one of the large carriers for their administrator and their network, and they have tremendous data, but the challenge in our current environment was even Walmart, the largest employer in the country, maybe one of the largest in the world went to their administrator and their carrier and their network who again at a large national brand and said, "Hey, our data shows that a huge proportion of the dollars to doctors is going to the doctors that we've identified as the bottom 3% within your network."

And Walmart asked for them to please remove the bottom 3% of the doctors from their employees’ access. That's all they wanted, the bottom 3% of quality doctors removed from the network, so their employees couldn't go to those low quality doctors. And that carrier said, "I'm sorry, we can't do that, that violates our contracts with our providers."

What I want to really set the stage for is data is important. If you don't do something different with that data, or if all of your data is backwards looking without you really being able to fundamentally insight change in the healthcare space with that data, then all you're really doing is showing your clients or your employers how messed up our healthcare system is. And not giving them any direction to fix it, and there is a way to fix it, and data is the way to not only identify how to fix it, but more importantly measure what those fixes are doing. This is crucial and this is really important to the future of our healthcare landscape.

Eric Silverman: Awesome, awesome. Lester, let me hear your thoughts on this question, specifically about the question itself and also maybe some input based on what David talked about.

Lester Morales: So, I agree with David for sure. I put this into three buckets as we look at the biggest changes and what might drive those changes. I think legislatively, obviously will drive some of this. We've already seen some things around, surprise billing and obviously things in the RX world. I think legislatively we will start to get things cooking here.

That's hopefully a good thing to then drive the second piece of it. Hey if it's being talked about at the top levels, then I think the biggest level of influence, is everybody probably listening to this call, are the advisors who represent a big chunk of the employers that need the demand to add transparency.

Obviously David touched on the Walmart thing. But I think everybody on this phone needs to take what legislation might do, what we all know is the right thing, and demand that they supply the data. These are things like forcing the carriers to do so through contractual arrangements.

I think the demand of it from the advisors is going to be the second thing, and then I want to say the third thing is we got to do something with it. And at the end of the day I think clients are dying for people like the audience on this phone to tell them to do something. We got to tell them to do something, because if we get access to the data and nothing's done with it, to David's point, then we've just exposed something and did nothing with it.

Legislation, demand, and do something with it, are the three buckets I would have everybody think about.

Eric Silverman: Thank you Lester. Jim, did you have anything you wanted to add on this at all? Because I wanted to ask David a quick question.

Jim Blachek: I'll defer to Dave.

Eric Silverman: Dave, I was just curious, do you have anything to add to what Lester just said, or did we want to move onto the next question?

David Contorno: No, I mean I agree with everything Lester said. The only slightly different take is while I know legislative efforts can have an impact, I don't believe the answer to our problems is going to come from either the government, Washington DC or some large tower of a large insurance carrier’s office, or of a large health system office. 

Really, to me what I focus on is building up that demand on the consultant side, so I, as you likely know, mentor and co-consult with many brokers and consultants around the country to help them build plans that actually do make a difference, and I think the right fix is going to come from broker/consultants, and thereby employer, ultimately employer demand.

“Can data itself fix healthcare?”

Eric Silverman: Guys, can data itself fix healthcare? Just the data alone?

David Contorno: No, I don't think data can fix it, and here's why. First of all, if you have access to data you're likely self insured, and if you're self insured, you're likely with a large carrier for your administrator, and/or a large carrier for your network at least, and probably a large PBM, the large networks and the large PBMs control 80 plus percent of the market. 

When they [large networks and PBMs] sit inside your health plan, they also control 80 plus percent of the cost and utilization. You've relinquished all control for at least 80% of your spend to do anything about it regardless of what the data shows. Again, I go back to that Walmart example, where the largest employer, and the largest customer of that insurance company who I'm resisting really hard to not say the name of, said no to Walmart wanting to remove the bottom 3% of quality.

So, if they won't even agree to that, the doctor's that are actively hurting patients, what makes us think that any data is going to convince any carrier to do anything different when Walmart couldn't get it done?

Eric Silverman: Jim, what do you think about that? Can data itself fix healthcare?

Jim Blachek: The data is great, but if you don't act on the data no change will ever occur. We have to understand the data, and then be able to make the changes that need to occur to affect what end result we want. 

Eric Silverman: Speaking of that Jim, let me continue this next question with you, how can we leverage data and insights today to prepare for these potential changes?

Jim Blachek: Yeah, today's the best day to make change, and as a broker advisor, if we don't make changes and begin to change how we work with employers to help them, then health care's never going to get fixed. 

We need to work with employers, and employers need to understand that if we don't make those changes, or don't make those recommendations to change, then health care is unaffordable, and we're continuing down that path of a system that's broken and needs to be fixed.

Future blog posts continue the conversation. Stay tuned!