The Path Forward For The Health Insurance Industry

Almost all of my colleagues in the health insurance industry believe 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 senseless killing.

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 U.S. 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.”

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

Health insurers messed up when they carelessly introduced unnecessary delays to care and ignored plan enrollees’ personal circumstances.

Health insurers messed up when they stopped working as patients’ advocates when they faced life-altering medical conditions and instead washed their hands of responsibility.

And, more recently, they messed up when they stood behind tired industry talking points—or said nothing at all—when people needed an acknowledgment of their suffering and 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 people like me who work in health insurance set out on their professional journeys, they often did so with an eye toward making things better for people. But, along the way, our Frankenstein healthcare system took them in directions they individually or collectively never wanted to go.

And they must make things better—quickly.

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

When they need help—in the form of an authorization or a referral—health insurers must act not in the days or weeks that have become “normalized” but instead act with the real-time urgency that a patient feels when their 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, U.S. 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.

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 people needed fewer services in the first place because health insurers succeeded at keeping patients 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. The health insurance industry’s policy advocacy should be focused on long-term enrollment and portability of coverage so that they can invest more deeply in your health.

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

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

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

They say they work as your advocate, but people have to sometimes fight them 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 month, it’s time for U.S. health insurance companies like mine 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.