Daniel J. Hilferty, the president and CEO of Independence Health Group, wants politicians to work together on addressing the current challenges facing the nation’s health care system.
The future of the system is uncertain as elected officials in Washington continue the debate over health care reform.
“I believe that it is incumbent upon us as citizens and it’s incumbent upon me, I believe, as leader in the health care industry to force the political dialogue to a constructive bipartisan approach,” Hilferty said during an Tribune editorial board meeting.
“We need to continue to push elected officials in Washington – be they Republican, be they Democrat — to reach across the aisle and find a solution that takes into account the best of the Affordable Care Act (ACA) and the best private sector ideas that the Republicans are trying to push.”
Since the ACA was enacted, 25 million people have gained health care insurance coverage.
“When you get beyond the politics, whether you call it the Affordable Care Act or whether you call it Obamacare, it’s been a good thing,” said Hilferty, who leads the region’s largest health insurance company.
“So let’s look at it as good start. Let’s drive up quality. Let’s get the other five percent who are uninsured into the system. Let’s focus on costs, let’s focus on quality and the United States of America can re-assume its role as the leader providing the highest quality health services at the most effective costs in the world.”
President Donald Trump’s administration has made it a priority to repeal and replace the ACA.
Despite the positive gains that have been made under the Obamacare, Hilferty acknowledged that the law needs to be fixed.
While the ACA expanded insurance accessibility to many who were previously without health coverage, the viability of the markets have deteriorated due to factors such as fewer people enrolling than expected and insufficient numbers of younger and healthier people buying coverage, which made products on exchanges more expensive.
“I would say that the ACA worked in terms of accessibility,” Hilferty said. “Long term, without fixes, the ACA is not sustainable.
“A part of that is having a case mix where some of these younger, healthier people are incentivized either through a subsidy or through a real tax credit that incentives them to get covered because they are healthier and they use less services,” he added.
“Without the mandate, the system clearly becomes less sustainable because there is no incentive to keep the younger, healthier people in.”
During the wide-ranging interview, Hilferty also addressed how Independence is working to lower health care costs.
“If you look at the Philadelphia region, we are among the top five most costly metropolitan health regions in the country so it’s incumbent upon is as an insurer to drive down those costs,” Hilferty explained.
He cited the company’s new contracts with the University of Pennsylvania Health System and Thomas Jefferson Health System as examples of helping to control costs.
“Both of them drive down the base rates that we will pay for the services that we provide (and) shift the system from a fee-for-service system, to a system where we pay for value – where we pay for outcomes,” he said.
Hilferty also spoke candidly about the different factors impacting the cost of health care in America.
“The largest cost driver facing us is the incredible drugs that are being developed, they are saving lives but the costs are unsustainable,” he stated.
Hilferty noted there are more than 700 costly pharmaceutical specialty drugs in the FDA pipeline.
“In one way shape or form — government, individual members and health insurers pay for 90 percent of the research that these pharma companies do to develop their drugs,” he said.
Despite the uncertainty surrounding health care reform, Independence plans to stay on the ACA’s insurance exchange in Philadelphia. The company is the only insurer on the exchange in Philadelphia, which currently provides Blue Cross coverage to about 140,000 people.
Independence has launched a new campaign titled “Getting Health Care Right.” The goal of the campaign is to educate the public about the nation’s health care system and highlights ideals for building an affordable, sustainable system. Some of the ideas include retaining cost-sharing subsides and preserving the current individual mandate to ensure that the risk pool has a balance of young healthy individuals signing up for coverage.
“It is not our intention to pull out,” Hilferty stated. “Because of our vision for providing coverage for as many segments of the population as possible, it would be a last resort decision to drop out the exchanges and it would be because the cost impact on the rest of our membership would be dramatic.”