Change was the dominant theme at CBIA’s May 10 Healthcare's Future: The Post-COVID World conference in Rocky Hill.
Across the health insurance, hospital, and biopharma sectors, the pandemic upended the way these sectors operated, and forced business leaders to rethink and challenge their former business models.
As health insurance companies transition out of COVID crisis mode, the sector is transforming, modernizing operations to ensure patients receive efficient and more affordable access to care.
In a discussion moderated by Susan Halpin, co-principal of government relations at Robinson+Cole, Anthem Blue Cross Blue Shield Connecticut president and CEO Lou Gianquinto and EmblemHealth CEO Karen Ignagni shared key insights.
Telehealth, according to Gianquinto, was utilized at more than 38 times the normal rate during the early days of the pandemic and has remained popular.
Gianquinto also noted that services like Dispatch Health are being utilized now at higher than average rates as healthcare consumerism shifts rapidly to the home setting.
The data, according to Gianquinto, shows that patients are increasingly preferring home care, especially for mental health services.
“It is now a new way of doing things,” he said. “We have to capture that.
"We have to view that as a new way to access the system.”
Ignagni echoed those comments, noting that ConnectiCare, a subsidiary of EmblemHealth, works with the state healthcare exchange and CoveredCT program to raise awareness about available resources.
“There are ways for you to get care immediately without needing to go to an emergency room,” she said.
“I think what we’ll see is a real push to make this an essential part of the benefit package.”
The shift to electronic healthcare modalities also helped the insurance industry combat cash flow problems that swarmed providers when expensive COVID treatments skyrocketed before vaccines were made widely available.
“During COVID we expedited payments, reduced administrative burdens, and we learned from that,” Ignagni said.
“We are on a quest to make all interactions with providers electronic,” she continued, and “to make things more straightforward and more predictable.”
Ignagni also expressed support for changing the widely adopted fee-for-service payment arrangement to a value model.
According to Ignagni, the cash flow problems experienced during the pandemic would have been greatly mitigated.
“If there was a value model where we [payers and providers] were aligned in a risk deal, the cash flow issue during the pandemic wouldn’t have been as big of a problem,” she said.
“[Today] we are understanding that we need a new modality which is value-based. That’s what people expect.
“From our organization’s perspective, we have the resources to meet providers where they are. That’s the excitement in the insurance industry today.”
Mental Health Focus
Gianquinto agreed, and believes that a value-based insurance design would be beneficial to patients by incentivizing better outcomes and providing a more cost-effective and predictable payment model for insurers.
Collaboration between payers and providers was the only way the system could move in this direction, according to Gianquinto, as trust, transparency, and a desire for each other to become successful are integral.
The panel also allocated a large portion of time to discuss how insurance companies are adjusting to an increase in mental and behavioral health issues as a result of the pandemic.
Lawmakers in Hartford prioritized this issue this past session, passing a number of sweeping pieces of legislation to combat the rise in suicide and mental health ailments as a result of the pandemic.
“During the pandemic, behavioral needs skyrocketed, and post-pandemic, it’s still 25% higher than pre-pandemic,” said Gianquinto.
Anthem addressed this issue head-on by expanding the reach of ACCESS Mental Health CT—a state funded program, supported by the Department of Children and Families—to have mental health professionals work in tandem with children’s primary care providers to conduct curbside counseling over the phone.
Anthem’s contract then requires reimbursement for primary and mental healthcare services that come out of the consultative services.
As more and more people take advantage of mental health services, Ignagni stressed that states must become more flexible to allow telehealth across state lines and address gaps in licensure.
“We can’t just talk about what benefits we provide,” she said, “but really expand our role from an educational perspective.”
Pullman & Comley's Steve Cowherd moderated a conversation between Hartford HealthCare president and CEO Jeff Flaks, Connecticut Children’s Medical Center president and CEO James Shmerling, and Stamford Health president and CEO Kathleen Silard about the pandemic’s lessons and the resulting innovations and changing nature of patient care.
Stamford Health, serving population needs in southeastern Connecticut and neighboring New York communities, was hit hardest when the COVID-19 pandemic first began.
Silard spoke about how the healthcare system, inundated with patients seeking care from the New York City area, needed to expand intensive care units in a matter of weeks, as well as bring more than 100 National Guard members to assist staff in treatment.
“We very quickly began to realize that our planning had to be bifurcated into two phases,” Silard said.
“One was what are we going to do over the next 24-48 hours, and next is what are we going to do over the next week, the next month?
“We had to anticipate changes that were happening so rapidly, and we would be able to deal with that.”
At Connecticut Children’s, Shmerling told the audience that while children were less physically impacted by COVID-19, the pandemic still forced the hospital to offer crucial coverage for things like early births and cancer treatment.
The drop in utilization also presented a challenge for the hospital as it had to figure out how to cover expenses, and children’s mental health issues were exacerbated by the effects of the pandemic.
“The volume of patients that would help offset some of the costs were gone,” Shmerling said, “so we had this parallel universe where we were trying to take care of children who were really sick, and at the same time trying to reduce our overhead because the revenues dropped by 50 percent.
“So we had to work with the state to get some grant funding, get a loan, and keep our head above water, while we’re taking care of these children.”
'Healthcare Is Broken'
Flaks said that COVID-19 exposed racial and socioeconomic inequities in healthcare and that the system is too expensive, not accessible enough, and needs quality improvement.
“Across the country, healthcare is broken,” Flaks said, “and the level of performance quality, consistency in performance, has to be substantially better than it is today.”
Flaks echoed the comments from the CEOs on the insurance panel that the healthcare system needs to move from a fee-for-service payment model to a value-based purchasing arrangement.
He stated there are ample opportunities to partner with the business community to update the healthcare system, and that without this partnership, we will only see small incremental improvements.
Silard agreed, saying “If there was ever a moment in time for us to pause and think about doing it differently, now is that time."
Schmerling said the incentives for hospital payments are perverse, given that the hospitals don’t get paid unless people are in the hospital.
“We don’t get paid when we keep people out of the hospital,” he said, “we only get paid when they’re coming to see us.”
The system, Shmerling argued, needs to transition to a model where payment is focused on the provision of services that keep people out of the hospital and where patients receive better outcomes.
The panelists also spent time talking about workforce challenges following the height of the pandemic.
Connecticut’s labor force—the number of employed residents plus those actively looking for work—has fallen by a staggering 71,400 people since February 2020.
That is more than 40% of the country’s losses, despite Connecticut having just 1% of the population.
“Even with everything we’re doing to continue to grow the workforce, there just won’t be enough workers,” Silard said.
“We have to find ways to be creative and engage with our consumer in using our workforce to our highest capability.
“That transformational change—which comes while you’re driving the plane and taking care of patients—you have to be able to redesign it so that you can do it differently.”
Flaks highlighted Hartford HealthCare’s training programs in a number of Connecticut high schools and colleges, designed to build a pipeline of healthcare workers.
Last July, Hartford HealthCare and CBIA affiliate ReadyCT announced the formation of the Allied Health Pathway program at Hartford Public School that will provide high-quality work-based learning experiences for students interested in career opportunities in healthcare.
“Connecticut is blessed with a tremendous amount of training programs,” Flaks said. “We have massive input into the educational process.
“It’s very important to train the workforce not so much for the way it’s been, but for where it needs to be.”
Connecticut's bioscience industry is experiencing dramatic shifts, with much more innovation in store for the future.
In a panel hosted by Vicky Levy, Deloitte’s global life sciences sector leader, panelists spoke about their unique perspectives and the changes their industry is going through.
Before the COVID-19 vaccine was produced, the development of vaccinations was a long, strenuous process.
“Taking one drug to the market was $2.7 billion and 10 years of research,” Pat McCabe, managing partner at Capitol Strategies Group, said.
“Of that, one in 1,000 actually make it to the end of the road, and even if you get to the FDA [approval process], it’s about 12% of drugs that get through it.”
But that development process is being upended, Raja Mangipudy, senior vice president, head of global drug safety research and development, and head of comparative medicine at Pfizer’s Groton site, said.
“The pandemic presented an opportunity for the biopharma industry to really rethink how they’ve gone about the whole aspect of drug development,” he said.
“Pfizer firmly believes the habits of lightspeed are here to stay,” Mangipudy continued, referring to the mere nine months it took for Pfizer to develop its COVID vaccine, “and we’ll never go back to the drawing board.”
“While we may not be able to replicate that process, we should and can be able to replicate some aspects of that to the patient.”
Mangipudy said the quick development could not have been done alone.
“Underlying that speed was collaboration both within the organization, other partners, countries, and global government agencies," he said.
"There was an enormous sense of solidarity that Pfizer had the fortune to be a part of to try to make this happen.”
Eric Schadt, president and chief research and development officer at AI healthcare company Sema4, saw an unexpected opportunity in the pandemic.
“What it became was this pretty amazing experiment,” Schadt said.
"The game became how do you distinguish between those who are getting infected who are going to have a very severe acute response, versus those who are going to have no symptoms, versus those that’ll have moderate symptoms but have this long-haul type syndrome?
“The whole regulatory infrastructure loosened up, and so your ability to run things that we’ve always wanted to came at an unprecedented time and delivered this accelerated precision medicine.”
Schadt wants to leverage the medical history data Sema4 obtains to continue the progress made by Pfizer and other vaccine developers
“It’s all about the data,” he said. “How do you leverage bigger data to make better decisions faster?
“The machinery and operating system is there, and so what’s needed is the software to execute and have the effect like the vaccine had for COVID.”
McCabe did, however, warn against trying to change the industry too much, too quickly.
He talked about what the pandemic would have looked like “if the industry was not doing what it was doing over time.”
“There is a sense that we should not disrupt, but figure out a way to work better, faster, in a more affordable way, but don’t stop what’s working," he said.
“The question that people have been asking is, 'will vaccines continue to be free?' While we would all love to have that answer be yes, it’s just not realistic.
“While we all believe that everyone has the right to affordable healthcare, it comes at a cost.
“If you stifle innovation by artificially trying to control those prices, you are going to change that dynamic.”
And yet, Mangipudy said, Pfizer has taken a new outlook that is certain to change the way their business is run.
“Challenge all presumptions,” he said.
“Really focus on the simple idea of questioning why we’ve done things the way we’ve done and how we can do things differently and continue to be an ethical and legal organization that’s focused on the patient at the center.
“We’re no longer looking at developments through the lens of how we’ve done it in the past. We’re looking at development from the perspective of lightspeed.
“Obviously we will not be able to match that pace in all its senses, but it’s also giving us a reason to prioritize our programs and projects.
“It really gives us a reason to think about what our highest priorities should be.”
Healthcare’s Future: The Post-COVID World was made possible through the generous support of JPMorgan Chase Bank with additional support from Deloitte and Pullman & Comley.