Managed Care - May 2008 - (Page 42) “Hello, Joe. How are you today? Let me tell you something about your hemoglobin A1C.” The information becomes much more a part of their daily fabric. MC: Does the proliferation of health care information create challenges for health plans in terms of people asking about coverage for experimental or alternative treatments? TUCKSON: One of the dilemmas our country faces is the growing mismatch between the technological sophistication and complexity of medical interventions and the scientific background provided by our educational system. This is something that we need to be concerned and very thoughtful about. We should all be advocates for better science education in our school systems. That is fundamental. Having just finished many years as chairman of the Health and Human Services Secretary’s Advisory Committee on Genetics, Health, and Society, I can tell you that the genetic revolution is upon us, full force. And the clinical, scientific, and ethical decisions that accompany that revolution present a daunting challenge for most Americans to work through. Ultimately, we are all operating our businesses around an assumption that people will be increasingly financially liable for the choices they make associated with their health care. But health plans will always be under pressure from consumers who want to ensure that they have access to every possible choice and alternative as they try to protect, maintain, and restore their health. MC: Are today’s coverage innovations sending different messages to members, with consumerdirected health care asking them to have a financial stake in their decisions and other approaches covering drugs for chronic illnesses almost fully? TUCKSON: I don’t see a tension there. We are trying to find a way to maximize the opportunity for optimal health outcomes at a price that is affordable for individuals and purchasers to sustain. We are all in a fundamental relationship together, and we have to keep the premise of what this is about in front of us. There will be different ways of achieving that mission. Some people will push the envelope for access to services that are not supported by evidence and science. Those kinds of things are not sustainable in the long run. On the other hand, it may well be sus- tainable, if you look at this from the big perspective, to make access to certain things essentially free. For example, making diabetes-related testing strips available without a copayment increases compliance with therapeutic regimens and decreases the secondary consequences downstream, avoiding hospitalization. Those are the kinds of discussions our industry is having, and we are looking at that very carefully. MC: Employers and employer coalitions spend a lot of time talking about and promoting prevention and quality, but insurers tell us that when it comes time to negotiate the contracts, it’s all about price. Do you find this to be true? TUCKSON: There is no question that purchasers expect our industry to be able to organize health care assets in such a way as to support optimal health outcomes as a fundamental “baked-in” component of what we do for them. Customers and purchasers often give us the opportunity to make the case for differentiated total added value, not just cost. On a practical level, we are partners with purchasers not only on the affordability part of the equation, but on the quality-related agenda. MC: Can you describe UnitedHealth’s medical home pilot programs and the key advantages you see to this approach to primary care? TUCKSON: We all have to be concerned about the challenges to the long-term viability of primary care. The dwindling interest on the part of young professionals in entering primary care fields, the high levels of dissatisfaction and frustration of professionals in these disciplines, and the absence of full recognition of the value of primary care are all things to be concerned about. As a result, we have been working closely with the American Academy of Family Physicians, the American Academy of Pediatrics, and the American College of Physicians to help realize their vision of the medical home model. We have been implementing pilots throughout the country, both by ourselves and in partnership with other insurers. The medical home model will only really be successful if all of us are working together to express it. This is a terrific example of our industry finding a way of doing something very important that is fundamental to the benefit of our society and that ultimately will make a tangible difference to physicians and patients. MC 42 MANAGED CARE / MAY 2008
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