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Getting what we need in health care

The Rolling Stones tell us, “You can’t always get what you want, but if you try sometime you find, you get what you need.”

You don’t have to be a curator at the Rock and Roll Hall of Fame to know that they were of course singing about 21st century health care in the United States. OK… probably not… but the lyrics ring true.

In health care, we sometimes still can’t get what we want (magic weight loss pills) but what do we need?

Simplification. Whether it’s medical insurance or the smartphone, consumers need products that offer simplification and savings. An Anthem Blue Cross and Blue Shield survey asked Americans what products make their lives easier and the findings revealed that integrated products and services are highly valued – for example, the smartphone (74 percent), printer/copier/scanner (64 percent) and the toaster oven (36 percent). And, when it comes to insurance, consumers overwhelmingly (81 percent) said it would be extremely helpful to trust the same carrier to provide their dental, vision and health coverage.

Time. Half of the consumers surveyed (50 percent) said that figuring out costs is the most time-consuming aspect of health management. Two in five also said it’s time-consuming to find health care providers that accept their insurance (41 percent) and to get their doctors to talk with each other to coordinate care (39 percent).

Value. Survey respondents said a range of factors are important to consider when evaluating health benefits, but they most frequently point to cost as being an extremely important aspect (67 percent), followed by comprehensiveness of coverage (61 percent), customer service (60 percent) and ease of use (58 percent). Additionally, 86 percent would expect to save time, save money or receive improved care if they had integrated dental, vision and medical benefits with the same insurance carrier.

Employers providing health benefits share these concerns and are looking for products that offer their employees exceptional value. However, with federal health care reform and ever-changing health care dynamics it can feel difficult to keep up. If your company’s benefits are getting more complex rather than easier to understand, here are a few questions to ask your insurance broker.

  • How are health care providers in our network compensated?  Forward-thinking health care systems and insurers are instituting shared savings agreements that incentivize doctors to provide the right care, at the right place, at the right time. The old “fee-for-service” model compensated health care providers based solely on the number of services they delivered, without regard for efficiency. Shared savings corrects this by aligning incentives to reduce costs and improve quality.
  • Do the health systems within our network collaborate with one another? Increasingly, health care provider systems are forming alliances with one another to share best practices, enhance data sharing and improve continuity of care. Two notable alliances in Wisconsin are AboutHealth and Integrated Health Network of Wisconsin (IHN). AboutHealth is made up of the systems of: Aspirus, Aurora Health Care, Bellin Health, Gundersen Health, Marshfield Clinic, ProHealth Care, ThedaCare, and UW Health. IHN is consists of Agnesian HealthCare, Columbia St. Mary’s, Froedtert & the Medical College of Wisconsin, Hospital Sisters Health System, Ministry Health Care, SSM Health, and Wheaton Franciscan Healthcare. The geographic breadth and scale of these alliances stands to usher in rapid improvements in patient care and ease of access across our state.
  • Are the providers in our network leaders in terms of both cost AND quality? Lowest cost is always the most attractive but it might not provide the best value. What you want is the best “total cost of care.” Work with your broker to make sure your network gives you access to providers offering the best combination of cost, quality and efficiency. If you’re not familiar with cost and quality variations in health care, a couple great places to start is by looking at the data available from the Wisconsin Health Information Organization (WHIO) and the Wisconsin Collaborative for Health Care Quality (WCHQ).

It’s true that we are still a long way from getting what we want. However, it’s important to recognize that we are beginning to get what we need. Insurers and providers are working together like never before to accelerate payment innovation and care delivery redesign in order to produce a simpler, more efficient health care system for consumers. Before you make your next health benefits decision, don’t be afraid to shop around and ask tough questions. If you don’t, you may be leaving both time and money on the table – and that’s not what you want or need.


Survey data used above presents the findings of a telephone survey conducted among 1,005 adults, 503 men and 502 women 18 years of age and older, living in the continental United States.  Interviewing for this ORC International CARAVAN® Survey was completed on July 10-13, 2014. 605 interviews were from the landline sample and 400 interviews from the cell phone sample.

The margin of error for the total sample is ±3.0 percent at the 95% confidence level.  This means that if we were to replicate the study, we would expect to get the same results within 3.0 percentage points 95 times out of 100.


ⁱCorporate Executive Board (2012). To Keep Your Customers, Keep It Simple

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Paul Nobile President
Nobile is a 20-year veteran of the insurance industry whose experience includes time with Rush Prudential Health Plans, Aetna, and United Healthcare. Prior to joining Anthem, Nobile served as the Director of Sales and Account Management for the Midwest region at UniCare, a health benefits company based in Chicago and owned by Anthem’s parent company and also ran UniCare’s Eastern Region with offices.

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