Alaskans serve as test market for Premera Pulse platform
A new platform devised by Premera Blue Cross Blue Shield opens opportunities not only for the insured, but to help crack the conundrum of high medical costs.
Alaskans enrolled in the individual and employer-sponsored insurance market with Premera can tap into an app that makes it easier to track their health care. Results will feed into a year-long pilot program before Premera opens the service to its Washington state customers.
Designed in partnership with Vim, a healthcare tech company based in San Francisco, Premera Pulse is available to all Alaskans covered under Premera’s health insurance.
The new service is meant to overcome the challenges patients face when searching for the right, “high-value” provider. In turn, Premera will be collecting information from consumer-driven decisions on health care providers and doctors.
Premera Blue Cross Blue Shied Alaska President Jim Grazko released news about the app at a time that coincided with a “Blueprint for Improving Our Nation’s Health System Performance.”
The plan authored by five state governors — Gov. Bill Walker joined with Ohio Gov. John Kasich, Colorado Gov. John Hickenlooper, Pennsylvania Gov. Tom Wolf and Nevada Gov. Brian Sandoval — includes what they consider a good plan for solving problems left behind from a tattered Affordable Care Act.
In their blueprint, the governors present four guiding principals for transforming their health care systems. One of the aims is to “recognize state innovations in value-based care.”
That’s the direction the new app is also headed, Grazko said.
“This engages them before they go to a hospital or to see a doctor. It’s not an app you download. It’s not a website, and it’s not a texting service. But it’s a little of all those things,” he said.
To access the app, Premera customers will be given a link that allows a one-time sign in. They will then be able to find in-network care (doctors that take Premera insurance), schedule appointments, access medication lists, get reminders about important preventive care visits, set up convenient appointment reminders and rate doctors after visits.
Nearly 10,000 people have signed up already and more than 300 booked doctor visits through the app, Grazko said.
“When enough people do the survey afterwards, that will be information you can use as well,” Grazko said.
A prompt asks, “’would you like to see how others in your area, how their visit went?’ It will allow you to know if they had long wait times, if they felt listened to… ”
Premera can collect information from the “experience” recorded in the survey.
Premera includes all the physicians in its network and will get a better idea of which providers offer “high-value” care. For example, the insurance company knows of Anchorage providers it already has categorized as providing good health care services that effectively increase their patients’ health. The move is away from fees-for services and toward incentivizing “quality,” Grazko said.
“This is getting us toward increasing the value of health care, the whole value-based reimbursement approach,” Grazko said. “These providers are not doing unnecessary tests. They are only doing the care necessary at the time.”
Providers go by standard check-lists before determining which tests are necessary. So it’s easy enough to find patterns among providers and facilities that pad their finances through unnecessary procedures, Grazko said.
They can also track the customer’s health to determine how it’s faring. The doctor is likely to get some credit if your overall health improves.
“Health status is higher or lower than standard and in general and over time, you can detect differences,” Grazko said.
This also heads in the direction of paying doctors for outcomes.
“It’s in our sights, not too far down the road,” Grazko said. “We’ve already identified some primary care providers by tracking outcomes.”
The goal is to shift to a payment methodology that keeps a person out of the hospital. “If you keep your population healthy rather than just cranking through tests and scans — that’s the next generation. It’s value-based reimbursement,” Grazko said.
The governors’ blueprint was written with the goal of producing better outcomes at a lower cost to governments.
In Alaska, increasing health care costs for public employees and Medicaid is the single greatest expense in the budget; this session an additional $100 million has been requested by Walker as part of the state’s fiscal year 2018 supplemental budget.
The current unrestricted general fund budget for 2018 Medicaid is $564.2 million.
According to the blueprint, “governors understand that while some issues may temporarily divide us, on most issues we can find agreement,” including that it’s largely up to individual states to transform their own health care systems.
One of the core beliefs expressed in the paper is that “we can and must achieve multiple, complementary objectives.” The best approach is to “address multiple objectives simultaneously.”
The paper contends states can “lead by example” using Medicaid and state employee benefits (and to a lesser extent, individual and small group markets) as a catalyst for change.
The strategy proposed for improving health care services is that the states “must align consumer and provider incentives, encourage more competition and innovation, (and) reform insurance markets,” much as Alaska has done in its Alaska Reinsurance Program, or ARP.
The creation of the ARP with $55 million in state funds in 2016 led to a smaller premium hike than expected in 2017 and a decrease in premiums of more than 20 percent in 2018 for about 16,000 Alaskans in the individual market.
The Division of Insurance filed for a waiver from the federal Health and Human Services Department in December 2016 to use the federal savings from reduced Affordable Care Act premium tax credits to help offset the price of the reinsurance program. The savings in premium subsidies are key as the waiver must be budget neutral.
Under the waiver, the ARP will receive $332 million in federal appropriations over five years, the Centers for Medicare and Medicaid Services and the U.S. Treasury Department announced in July 2017.
It’s logical that now with the ARP program assisting the Alaska individual insurance market, the next step is to get costs under control. The governors want to reduce the incentives for medical providers to overuse marginal or unnecessary services within “high cost episodes of care,” which means emergency situations.
Grazko said it’s no accident that government and private enterprise are finding the same words and concepts.
“The ACA didn’t control costs; it was a set of insurance regulations,” Grazko said. “In switching to a value-based contract for large group coverage, the key is to get costs down.”
To read the Bipartisan Blueprint for Improving Our Nation’s Health System Performance, go to:
Naomi Klouda can be reached at firstname.lastname@example.org.