Lessons From a $618,616 Death
PW_B143072
Attached is an important article in Business Week by Amanda Bennett titled, “ Lessons From a $618,616 Death.” The story of Terence Foley and his family is a tragic one, and it is one we know plays out every day for our members battling cancer, heart disease or other chronic illnesses. In the health reform debate, it is easy to engage in a 30,000-foot dialogue without seeing what this one family’s story so clearly illuminates. The economic reality of Terence Foley’s seven-year struggle with kidney cancer demonstrates how insurers, physicians, hospitals, pharmaceutical companies, and even we as patients contribute to an unsustainable system that threatens the financial foundation of the very care that kept Mr. Foley alive. Health care reform may create greater access, but if we want to keep innovative treatments available, we need to keep them affordable. |
(Click to Access Article - 1.05 MB)
|
The story reflects the value to this family of having health insurance and their ability to access cutting-edge treatment. We were pleased to read that our rates were in many cases lower than those of a major competitor. This is a testament to our analytic capabilities, our actuarial soundness, our strength in contracting, and our historically strong local relationships with physicians and hospitals. But I’d also like to share with you a few of the ways we are improving the quality and safety of care, while keeping innovation affordable.
We want our members to receive coverage for the most appropriate care available, and our more than 4,000 nurses and clinical associates are the frontline support for our members. As member advocates, our nurses' primary job is to listen. Only then can we help navigate the complex health care system and help members and their families make the best treatment decisions for their clinical and financial conditions. We are also educating members and physicians about radiation safety, helping to ensure that expensive imaging services, like the ones Terence Foley received, do not create undue financial or health risks compared to the effective alternatives. In the world of new pharmaceuticals and treatments, we carefully monitor the scientific pipeline, evaluating the research and convening national experts to create our coverage policies. Yet even with these programs, we recognize these are small steps in the right direction and we need to do more. We need to pay physicians and hospitals differently, to focus on quality and value versus quantity and volume. We’re launching new payment programs for “accountable care organizations” and bundling payments to encourage physicians to better balance treatment costs with the probability of improved health outcomes. We are also investing millions in developing the world’s most comprehensive health information system to identify every Terence Foley in our membership and create access to evidence-based and cost-effective care options.
Mrs. Foley recognized the economic impact of her husband’s care only after stepping back to review the 5,000 documents received from providers, insurers and hospitals. We monitor, collect and analyze that information every day. It is our responsibility to encourage informed physician-patient dialogue regarding the risk/benefits/effectiveness of available treatment options and what is best for each patient’s health and financial status. By doing so, by controlling costs and encouraging evidence-based decisions, we are keeping health care affordable for thousands of families across the country and ensuring the continued availability of all that clinical innovation has to offer.
|
