A Path Forward For The US Health Insurance Industry

Almost everyone who works in the health insurance industry believes they are promoting affordability and access to care.

It is clear that what the health insurance industry believes about itself matters little to an angry public whose bitter outrage was unmasked following United Healthcare CEO Brian Thompson’s unforgivable murder.

They are outraged that health insurers pay inadequately for needed services.

They are outraged that health insurers deny or delay necessary services in pursuit of profits.

And they and their doctors are outraged and fatigued by the non-stop battle with insurers to obtain coverage for what they need to live.

How we got here requires a complicated tour of the history of US healthcare policy—but “how” matters little right now. What’s clearer than ever is that health insurers need to quickly rebuild trust with the American public.

From where will this trust come? It starts with ending the denial. And saying out loud: “we messed up.”

We messed up when we started selling high-deductible insurance plans that turned patients into consumers and told them that they needed “skin in the game.”

We messed up when we carelessly introduced unnecessary delays to your care and ignored your personal circumstances.

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We messed up when we stopped working as your advocate when you faced life-altering medical conditions and instead washed our hands of responsibility.

And, more recently, we messed up when we stood behind tired industry talking points—or said nothing at all—when you needed an acknowledgment of your suffering and your pain.

The healing must begin with saying out loud what every aggrieved person needs to hear when they have been wronged: “we are sorry.”

When we set out on our professional journeys, we did so with an eye towards making things better for you. But, along the way, our Frankenstein healthcare system took us in directions we individually or collectively never wanted to go.

And we must make things better—quickly.

A first place to start is to dramatically improve your everyday experience of care.

When you need our help—in the form of an authorization or a referral—we must act not in the days or weeks that have become “normalized” but instead act with the real-time urgency that you feel when your life is in the balance. Too many people feel like their insurer stands between them and a necessary or life-saving treatment. And that’s wrong.

While there is justified skepticism about artificial intelligence being used to deny coverage, it can help enable approvals to help facilitate care in the moment that it is needed.

A second opportunity is delivering more transparency.

At every step of the way, US healthcare confuses and obfuscates. The fear of surprise medical bills and uncovered services has become a harmful deterrent for people seeking medical care. Members of my own family will, on occasion, delay necessary care because, like millions of Americans, they are afraid of the bill they might face on the other side.

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To regain the trust that health insurers and health systems have both depleted, both groups must partner to give people greater transparency into the true expenses that they face at the point of service and stand by it. The price transparency rules implemented in 2021 were a step in the right direction—but there is more work to do to make this information simpler, more consumer friendly, and more reliable. Absent such transparency, we are failing at the most basic imperative of any business that none of us would tolerate in any other context: telling you what something costs before you buy it.

A third opportunity is a greater focus on prevention and chronic disease management.

Health insurance companies manage costs through negotiating prices on services. But what if we needed fewer services in the first place because we succeeded at keeping you healthy?

The science of chronic disease management and prevention has advanced considerably. And yet health insurers—including federally funded Medicare and Medicaid—routinely pay more to manage the costly complications of chronic disease than primary care that is focused on preventing those complications.

How different would our national burden illness be if health insurers thought more about long-term health and well-being than annual actuarial cycles? Because coverage is tied to employment and people turnover employers rapidly, this has been difficult to execute on. Our industry’s policy advocacy should be focused on long-term enrollment and portability of coverage so that we can invest more deeply in your health.

A final opportunity is to more authentically commit to being who we say we are.

Health insurers say we simplify your healthcare experience and often fail to do so.

We say we care for you as a “whole person” but create discontinuities in your care.

We say we work as your advocate, but you have to sometimes fight us every step of the way.

Every industry has self-perpetuating narratives and apocryphal stories of societal impact.

In the wake of the events of the last few weeks, it’s time for US health insurance companies to acknowledge that our narrative is tired and broken.

And to say out loud what everyone needs to hear right now: we are sorry and we can and will be better.