Health Insurer CEO Welcomes Reform

Tuesday, Aug 04,2009, 9:16:17 AM Click:

August 2 - Wendy Arnone is president and CEO of UnitedHealthcare of Wisconsin, a subsidiary of UnitedHealth Group About 900,000 people in Wisconsin are enrolled in UnitedHealthcare plans and an additional 300,000 are its plans for people covered by Medicare , BadgerCare Plus and Medicaid.

Prior to joining UnitedHealthcare, Arnone was Vice President, Excellus BlueCross BlueShield in Syracuse, NY, she also worked for HealthNow and Aetna in New York. She recently talked about some general problems of the health care reform. Below is a transcript of the conversation.

Q. You oversee the largest health insurer in Wisconsin. What do you see as some of the key issues in health care reform?

A. Health care reform has been a long time in coming. It's something that's been needed to update our health care system. The fact that the current administration has had the influence and ability to get all different kinds of constituents around the table to be talking seriously about reform is something that should be applauded.

One of the key issues is developing a sustainable and affordable model that protects choice for the consumer. What do I mean by that? Providing some form of coverage for everyone who is uninsured is something that we should be striving for. But we have to do it in such a way that it is sustainable over the long haul

Some of the ways to do that is really getting at the core costs of health care. We cannot add new coverage and new costs to the system without finding ways to take costs out of the system somewhere else. Our country cannot afford to continue to grow our health care expenses.

Probably the biggest balancing act we will have to do as a country is figure out how to get everybody covered in an affordable manner that's sustainable from a financial perspective.

Q. Health care reform will require compromises and trade-offs and some hard decisions. What are some trade-offs and compromises that health insurers could accept? And what are some of the trade-offs and compromises that all of us will need to accept for sustainable health care reform?

A. The hard decisions that need to be made can happen across the board.

First of all, at UnitedHealthcare, we welcome an opportunity to shape policy that would provide some financial incentives for beneficiaries and providers. One of the first things that come to mind is our large Medicare population. What can we do to salvage Medicare and at the same time address the uninsured and the rest of the population?

In Medicare, it would be good to see some sort of tiering based on providers' performance related to efficiency and quality. That alone could save Medicare substantial dollars -- channeling people into programs and physicians that have documented efficiency and savings and incenting members to use evidence-based care, specifically around cancer care and transplant services. Those are high-dollar services, and if we can find ways to provide incentives to channel people into the best-practicing facilities and physicians, there's savings available.

We support a system of shared responsibility. If coverage is available to everyone at an affordable price, then everyone should be required to be covered. If you have a system where you are expected to provide guaranteed-issue coverage -- that means provide a policy to anybody who applies -- the only way to offset the cost is to require everyone to have coverage. By only offering that to individuals that are, let's say, sick, people can come in and get insurance only when they need it. That's going to raise insurance costs for everyone.

If we want to have a guaranteed issue, that has to be coupled with a requirement or mandate for everyone to be covered.

Q. How can help insurers help make the health-care system more efficient?

A. One of the ways to promote efficiency and quality of care in the health-care system is to provide data and information to providers that allow them to use that to improve.

When you are a physician sitting in an office and taking care of a patient -- or let's say you are seeing 20 or 30 patients that day -- you've got your hands full. Wouldn't it be a vast improvement if physicians could have at their fingertips some detailed information on how their practice handles, for example, diabetics; people who are obese; people who smoke.

If all payers could work together to provide more information to physicians on their treatment patterns, I think physicians would find that very useful in managing cost and quality at their own practice.

Payers also can promote better use of technology, and we are involved in a lot of efforts across the country to do just that.

Q. What are some of the challenges in slowing the rise in health care spending?

A. One of our biggest challenges is that much of the rise in health care costs -- not all of it, but much of it -- is attributable to unhealthy lifestyles. These are personal choices.

As a payer, we try to promote wellness programs. But the big challenge there is you can't mandate it -- you can't mandate a healthy lifestyle. All we can do is provide the opportunity for the people who are willing to do it with enough tools to make them successful. That in itself is one of the big challenges.

Two-thirds of our population today is overweight, and half of those people are obese. One in five children today is overweight, and their life expectancy is lower than their parents for the first time. We as a nation need to try to turn that around.

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