By CAROLYN SNOW, CPCU, director, insurance risk management, for Humana Inc.
One is the general lack of understanding of the true cost of care. Faced with surgery, it is harder for consumers to discover which hospital has the best success rates for heart surgery or if it is possible to have knee surgery at a lower cost at one facility or another.
The situation is complicated by in- and out-of-network issues and where their physician has hospital privileges. Purchasing health insurance is usually a financial decision but when people need care, they are facing medical and emotional issues, especially in an emergency situation. Easy-to-understand cost and performance information would be very beneficial to consumers.
As a nation, we are getting older, fatter and sicker. Two out of three Americans are overweight, so wellness programs and their continued development are important to health insurance companies. Most carriers offer plans that include wellness consultants to help employer groups manage their costs through employee health surveys, fitness and nutrition programs designed for the entire family. Humana, for example, has developed FreeWheelin', a bike program for employer groups.
More than 70 percent of today's health costs go toward preventable, chronic disease and wellness programs can have a direct impact on these costs.
Funding for medical research, clinical programs and new drug development is also a concern.My home state, Kentucky, has one of the highest rates of heart disease in the United States, but there is some exciting new research under way in the world's first clinical trial using adult cardiac stem cells to try to regenerate dead heart muscle.
Like most states, Kentucky has a budget deficit, so programs like this may be cut back or not available in the future. Many families and funds, which support university and hospital clinical research, were hit hard by the recent investment scandals.
Healthy and properly executed risk management programs are important in any economy, but this economy presents a big challenge to risk managers to be even more creative in delivering programs and plans that support the organization's business goals. We may not be able to tear down silos on our own but by working strategically across department lines, we can at least tunnel through them
April 15, 2009
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