On the Cusp of Reason or Insanity…
Emerging Themes and Trends in Health Care
March 21, 2006 • Health Care Leadership Forum

Indepth feature:

Dr. Archelle Georgiou spoke at the March 20, 2007 forum. Dr. Georgiou was in town as a guest of the Health Care Leadership Forum, a partnership of health organizations and leaders in Calhoun County whose mission is to foster education among healthcare leaders. Dr. Georgiou talked with various community groups about emerging trends and themes in healthcare. As executive vice president at UnitedHealth Group, one of the largest insurers in the country, she has a bird's eye view of the drivers changing healthcare.

She said most of us play a role in the rising cost, without even being aware of it.

"When a patient hears about a new, breakthrough medication, of course they want it," according to Dr. Georgiou. But for every new drug, there is a high price tag that needs to be paid by somebody, she said.

Rise and Fall

"There are inflators and deflators affecting the cost of healthcare," she said.  

Inflators include new technologies, treatments and pharmaceuticals. For instance, there are some wonderful new treatments for conditions that dramatically improve quality of life, but they are also incredibly expensive.

"Another inflator is cost shifting," she said. "More people are uninsured, so more hospitals and doctors shift the cost to paying customers to offset what the uninsured are not able to pay."

And, she said, we have an overall declining health status in the nation, with obesity being at the top of the list. "We know that 64 percent of Americans are either overweight or obese and this leads to so many conditions including diabetes, heart disease and hypertension," according to Dr. Georgiou.

On the other side of the equation, there are deflators to the rising health costs, and these include consumerism, transparency and wellness programs. Years ago, many insurance plans included a one-number, flat co-payment when a patient went to the pharmacy to fill a prescription. What has been introduced in the last ten years are multi-tiered pharmacy payments. The first tier includes the lowest amount of co-payment for generic drugs. Tier two includes preferred brand name drugs and the third tier includes all other drugs. The consumer has the choice to pay the lesser amount or a higher amount depending on the type or brand of medication needed.  

Transparency has many levels as well, according to Dr. Georgiou. For instance, there can be a huge variance in cost and quality from one physician to the next and one hospital to the next.  

"The internet has facilitated having access to information to help drive choice," said Dr. Georgiou.  

Data is available to help balance the decisions of access with cost and quality.  Dr. Georgiou said she believes it's important to have local access to facilities for routine procedures, "but with more complex procedures the balance of cost and quality and access can change a little bit."

Another deflator to rising costs is wellness programs, which can counteract some of the negative lifestyle choices being made and help patients to lead healthier lives. There are online lifestyle coaches, health assessments, and other tools available through UnitedHealth and other insurers.

On The Horizon

Health information technology really drives efficiency in healthcare, she said.   One area in which this can be seen is personal health records, a secure, online history of a person's medical information.   She said PHRs can reduce medical test duplication, possible drug interactions and increase overall patient care.

"Having your health history online and accessible 24 hours a day, seven days a week is a great convenience," said Dr. Georgiou.   "In addition, it can help physicians communicate with one another and helps patients to better interact with their physicians."

Health information technology is a major agenda item both from the federal and private side, according to Dr. Georgiou.  

"There was an Executive Order from the President putting goals around health information technology," she said.  "From the federal to the private level, there is a need for a more integrated system."

Every American should have a personal health record, according to Dr. Georgiou.  

"Whether it is used with UnitedHealth or another company, it's important for every person to have control over their healthcare information," she said. "Many, if not all, of the major insurers will be offering them this year.   Even those Americans who do not have insurance can go online to create a personal health record for free at www.healthatoz.com ."

She said that there are three reasons everyone should have PHR--convenience, quality and affordability.  

"You will have all your health history in case of emergency," she said.  

If you are traveling and have an urgent medical need or even a cough or cold, you'll have access to all the health information that is important. Even when close to home, she said that health information is routinely needed. For instance, most parents need access to their child's immunization record five times per year.   Typically, it involves making several phone calls to the physician office, then waiting for a fax or the mail, and then there's the added burden when a charge is assessed.  

"A personal health record can make life easier," according to Dr. Georgiou.

Also, it puts patients in a better position to have a dialogue with their physician, she said.   And, having an electronic record of your health history can be vitally important when disaster strikes.

"There were many cancer patients who were moved during Hurricane Katrina who had to start their therapy all over again, because there was no record of their treatment to date," said Dr. Georgiou.

Having your own copy of your medical history provides safety and security when paper gets destroyed, she said.

Change on the Way

One innovation in healthcare information technology is a magnetic stripe on the back of a person's insurance card. With one swipe of the card in a physician's office the patient knows what his or her co-payment obligation is right away. Also, medical information can be carried and transferred in the same way, and likely will be in the future.

Another area of change is in value-based benefit plan design. For instance, if there is value-added service that an insurer wants to promote because it makes good sense for the patient and the company, the co-payment will be lower. For those more elective services, there would be a higher deductible. The same would be true for a pharmaceutical benefit.

"We might only ask for a $5 co-payment for an ACE inhibitor," explained Dr. Georgiou, "but ask for $25 for an acne medication. The idea is to really look at the value of a health service. Hopefully, we will take away the barriers to care that exist for really important services."  

Dr. Georgiou said there are even more changes on the horizon.

"At no other time have I seen healthcare rise to the top of the national agenda, both at the individual and the federal level," said Dr. Georgiou.  "In the end, we are all responsible for improving the health status of the nation. We need to take action to improve health and the healthcare system. It's not what someone else has to do, it's what we all have to do."

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Mission: to foster education among healthcare leaders of Calhoun County.
Purpose: to assemble community healthcare leadership in order to strengthen the understanding of health care and lead to enhanced healthcare decision making for the community as well as individual organizations.