New Marketplace
Resolving the Payer-Employer Disconnect (03:03)

What’s keeping payers from becoming health brokers? What stands in their way?

“We need to collaborate more with our employer partners, and we need to sit down and think about reform of how we pay,” says Lynn Garbee, Cigna’s Senior Director of Reimbursement and Collaborative Care. “There’s a lot of room for us to really transform, to use the data, but I’ll just be quite candid that most people who work in health plans have worked in health plans for decades. We need more outside-in thinking.”

NEJM Catalyst New Marketplace Theme Leader Leemore Dafny asks Garbee about collaborating with employers to get them to agree with reference pricing, where a price is fixed for a certain procedure or therapy and then the member is exposed to any costs beyond that price. “Are you saying that you can’t get [employers] to come to the table, or they just don’t care enough about controlling the spend to deal with the education that is required for their workers, and the upset that it can cause?”

“I don’t think employers are willing to do a reference-based price in a lot of cases because of that exposure that they would have on the upside,” says Garbee. But she notes that payers are seeing more efforts at reference-based benefits, which place deductibles or coinsurance on top of the allowance and allow that coverage for employees.

“Just thinking differently about things like social determinants, that would change how they pay for health care, to really maybe get a better outcome and make it more affordable,” says Garbee. “We haven’t gotten that far yet in discussing that with our employers. And I think we as an industry suffer from our insular thinking — thinking in just a health care [kind of] way.”

Bob Galvin, CEO for Equity Healthcare, adds, “No other country is asking its citizens or employees to be this smart about the kind of health care that they choose. It’s not like this is easy to do and you can just do it.”

Galvin recalls that at employee focus groups he conducted on clinician quality and choosing clinicians, the number one complaint was, “I’m so confused; I need a navigator.” They weren’t concerned about choosing a doctor, but they didn’t understand “what that bill means, I can’t get the doctor’s office to call me back, etc.,” says Galvin. “And if you solve that need for me, I will be such a grateful employee.”

“We’re a little bit disconnected with where people outside of this room and this stream are. It makes those kind of things tough to do,” he says.

From the NEJM Catalyst event Navigating Payment Reform for Providers, Payers, and Pharma, held at Harvard Business School, November 2, 2017.

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