“Payers have not really delivered on what we — customers — want. We want streamlined plans. We want affordable plans. We want plans customized to our needs. And we aren’t seeing them,” says NEJM Catalyst New Marketplace Theme Leader Leemore Dafny. “At the same time,” she adds, “I can see that we employers are not necessarily engaging in the way that one needs to engage in order to get that kind of transformation.”
She asks what Lynn Garbee, Senior Director of Reimbursement and Collaborative Care at Cigna HealthCare, would like to see employers do to enable some of the exciting transformation payers are trying to promote.
“I would like employers to jump into the value-based reimbursement world with two feet. I feel like they’re doing it half-heartedly,” Garbee says. “I’d like them to actually collaborate with us, in trying to create a healthy workforce in the first place, with a culture of health, as a lifestyle decision.”
“I also want to see employers incent their employees to connect with a PCP that we have in a value-based arrangement, that PCP guiding their care and incentivized to do the right outcome for them,” she says. “We’re making it easy for them now. We have a PCP within 15 miles for 92% of our employees. That’s a lot.”
Garbee adds that they’re also making it easy through their concierge to guide the employers to providers, specifically collaborating with them and providing better care. “We want our employers to take advantage of that, but we feel like they’re not coming halfway to engage with the products that would get them to those kinds of providers. We’re building the networks and the reimbursement; we want them to help to motivate and light up their employees to really take advantage of it,” she says.
Garbee believes employers have the opportunity to string products together — behavioral, medical, pharmaceutical, vision — but often, they keep them distinct. “We can do more together, than we would with those [kept] apart,” she says.
Finally, Garbee explains that the way they’re evaluated is very much still like it was 10 or 15 years ago — by unit cost. “The way we’d like to be evaluated is how we’re keeping the patient population healthy with risk-adjustment PMPMs. That’s much more indicative of moving to a better health outcome world,” Garbee says.
From the NEJM Catalyst event Navigating Payment Reform for Providers, Payers, and Pharma, held at Harvard Business School, November 2, 2017.