Joan Budden looks at 2019 as a year to keep pushing for greater affordability and accessibility in health care. The president and CEO of Grand Rapids-based health plan Priority Health welcomes the greater attention and scrutiny that arose in 2018 for prescription drug costs that are becoming a major cost burden for health insurers and employers. She expects the trend to greater price transparency and consumerism to further take hold for the industry in 2019.
What’s at the top of Priority Health’s agenda for 2019?
We always need to, and we continue to focus on, making health care more affordable for people, and therefore more accessible. We are moving on three things on that: Continuing to try to lift the cloak of secrecy around the cost of care; continuing to work with our provider partners to change the way care is delivered so it can be done in a lower cost, more convenient, but equal quality setting; and we focus on keeping our own administrative costs low.
What big issues in the industry will health plans have to deal with next year?
Nationally and here in Michigan, employers are beleaguered with the cost of health care, and the contribution that escalating pharmaceutical costs are adding to that seems to be a huge issue. We’re coming up with wonderful advances in technology and medicine, but many of those are at a very high cost. What we have to do is focus on how we can offer these services to people, but still keep the overall cost of care affordable. The (Affordable Care Act) will be less in flux. I think it will settle in a little, but there probably will still be issues in policy (and) proposed changes in that space. Finally, we need to make sure we’re focusing on the health of our community. This isn’t just about making sure people get care when they get sick, but keeping them healthy.
What did you start seeing in 2018 that will gain traction in 2019?
I was pleased the see that we are at least talking about pharmaceutical costs on the national and the state level. As a society, this kind of groundswell of support emerged that we want to make sure that everybody has access to care, and so there was a heightened support of a Medicaid expansion in a very positive way. We began to talk a little bit more openly and honestly about costs and what drives those and how do we do a better job of keeping people healthy.
What do you make of the greater interest private equity has in the health care sector?
It does surprise me how much private equity there is in health care because there is such large dollars that flow through. What will be interesting to watch is will private equity actually increase competition or just drive up prices because they have shareholders they are mandated to give returns to. Will they actually be a solution or will they be adding to the problem?
We saw continued rate stabilization this year and for 2019 in premiums for the small group market with a slight average decline next year among carriers. Is that trend sustainable?
I do think it can be because we are changing. Behind the scenes, what’s driving that lower rate is changing some of the options and the way care is delivered. We’re really working with the provider community to change the structure of cost in the health care environment. Small businesses are also more willing to look at choices in terms of the cost of providers (and) more limited networks. You see that particularly in Southeast Michigan where there are a lot of different health systems and they’re competing for patients, and so narrower networks have begun to take hold a little bit more there.
What would you like to see the new governor and Legislature work on in Lansing in 2019 in terms of health care issues?
I hope that they all remain committed to retaining the Medicaid expansion and that they are focused on maintaining a competitive health care market in Michigan. They should always look at changes or suggestions with what’s best for the consumer and what would create more competition. Whenever we narrow that, it will not be in the best interests of the people we are trying to serve.
What are some of the biggest changes employers made in their employee health coverage for 2019?
(There’s) probably not as much dramatic change in coverage as there is in their approach to health care. Many more employers are going to HSAs, we all know that, and higher deductible plans. Consumers, the people they’re covering, are actually getting more actively involved in taking accountability for their health and their costs. They are shopping and they love our cost-estimating tool. That’s really becoming an increasing trend. They are becoming more tech savvy, more digitally engaged, more involved in the cost of their care and the quality of their care.
Interview conducted and condensed by Mark Sanchez.