How Health Insurance Professionals Make a Difference

Key to “consumer centric” education effort in Orange County

By Phil Calhoun

Industry changes and innovations in patient wellness were hot topics at the Aug. 4 Health Care Forum sponsored by the Orange County Business Council (OCBC). The event gathered leaders from businesses in Southern California to hear from executives in top healthcare positions.

An informative panel moderated by Annette Walker, president of City of Hope Orange County featured Barry Arbuckle, president and CEO of MemorialCare; Dr. Susan Huang, CMO of Providence Southern California; Kathy Azeez-Narain, VP and chief data officer of Hoag; Dr. Todd Newton, medical director and chief of staff, Southern California Permanente Medical Group of Orange County; and Tatana Popkova, chief strategy officer, UCI Health.

The lively panel addressed many issues. One area of great interest to me was the importance of health brokers as key players in the “consumer centric” education effort. To address the many and varied needs of Orange County, medical providers are moving to increase access to care in local communities. Brokers and agents can take advantage of innovative healthcare plan benefits and increased access to care and provider resources. Panelists emphasized that health insurance professionals play a valuable role as advocates to educate employers and clients. This partnership with healthcare providers continues to be vital and was openly encouraged.

As a health insurance professional operating in Orange County and Southern California for over 25 years, I found it refreshing to hear directly from such an experienced and influential panel. Topics ranged from artificial intelligence (AI) and new technologies, to accountable care organizations (ACOs and clinical trials, as well as a provider view on COVID-19 past and future.

Here are some key points I noted which have an impact on health insurance professionals, their clients, and the ability to stay current with trends — not just in Orange County but in California and nationwide.

  • Telemedicine was a huge difference maker in the management of medical care. This is true not only for COVID-19 related issues but to manage care from a triage standpoint and enable more people to get basic levels of care while directing more urgent care needs to the most helpful levels of providers. Panelists emphasized that telemedicine is here to stay. New technologies are slowly becoming available that can enhance virtual visit capabilities for those most comfortable with this type of care. The experts observed that it is important to continue to offer face-to-face access as many older adults prefer this. Providers of care need to accommodate these preferences.

Bottom line: COVID-19 and related strains are the new normal. Medical science needs to take precedence over political concerns.

  • Health brokers were affirmed as key to the “consumer centric” education effort. To address the many and varied needs in Orange County, it is important and necessary to focus on providing appropriate benefits, access to care and education about health plans and medical provider resources. Opening the door for clients to enroll in the portals offered by health carriers and providers is becoming more valuable for everyone.Along with the medical providers moving to increase access to care in local communities, providers are looking to work with health insurance professionals to play a critical role in health education and advocacy. This role will continue to be vital to reach employers and build partnerships with health care providers.

Bottom line: Seek to work with health care systems and providers to bring their resources to your client’s workplace and the communities you serve.

  • Clinical trials and collecting and processing health care data are a significant focus for population healthcare. From diagnosis to assessment and treatment, the ability to rapidly collect and analyze data and then apply to treatment is critical. This will enable medical care providers to bring evidence-based treatment to an individual. Monitoring care in this way allows for consistent application of protocols and sharing of results can be updated rapidly and lead to far better outcomes.Collaboration was the key focus here as panelists agree that sharing of data leads to success. COVID-19 was cited as evidence of this collaborative success in Orange County.

Bottom line: Choice in providers and carrier networks will drive the decisions clients make when selecting a medical plan.Therefore, no changes are expected for some time. A growing trend is collaboration among providers of care to bring successes in care management to more patients. We will also see more doctors as employees which can drive more clients into what appears to be the financial model favored here, HMO capitation. PPOs and Medicare supplements may be impacted in this process as more doctors move to an employee status working under healthcare systems and taking direction from their employer.

  • The panel examined the impact of collective clinical trials on cancer. Many of the most challenging medical diagnosis and complex treatments cited focus on cancer, heart and other life-threatening illnesses and diseases. The message was how healthcare providers in OC are moving to a more collaborative approach where shared successes and failures lead to better long-term patient outcomes. This more peer positive approach will become the focus in OC and slowly replace the current model where every provider organization attempts to offer all types and levels of care. In addition, enhanced abilities to manage the cost of care and obtain improved outcomes are being considered, such as centers of excellence for certain types of care when it is best for the patient.

Bottom line: More study is needed on how the ACO model fits into the health carrier, health provider mix.In summary, common concerns for improving overall health, access, and affordability seem to remain the same over time. Keep an eye on all of the new technology which will continue to have an impact on improving these factors.

My big take away: This was not a health insurance professional centered event, yet there was a number of comments on how health insurance professionals DO make a difference, especially when considering how our roles affect the top concerns identified by the panelists:

1. Treatment outcomes
2. Access to care
3. Population care problem solving
4. Affordability
5. Understanding provider networks
6. Trust in the health care system overall

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PHIL CALHOUN consults with health insurance professionals on commission protection and exit planning. He is the co-owner of Integrity Advisors and publisher of Cal Broker, Phil is driven to help active health insurance professionals access the resources needed to be an advocate for their clients.

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