Anthem exec supports employer plans

DENVER – The vice president of Colorado’s largest health insurer said he believes the incoming Obama administration will make some needed changes in the nation’s health-care system but will likely continue a focus on employer-sponsored health plans through private insurance companies.

Lewis Emanuelson, vice president of sales and account management for Anthem Blue Cross and Blue Shield in Colorado, said his assessment of President-elect Barack Obama’s proposed health-care program is that it will hit many of the right notes when it comes to shoring up a system becoming ever more costly to businesses, families and individuals.

“He’s saying keep employers involved, which is the right thing to do,” Emanuelson said. “We are a huge supporter of pay-for-performance, and that’s one thing he’s advocating that we really support.”

That’s a change from the current system, which basically has insurance companies and doctors making reimbursement deals on a volume basis – how many patients they see – instead of incentives being paid on quality outcomes.

Emanuelson also credits Obama’s plan for advocating a paperless, electronic records system that one study showed could save $77 billion per year. He also notes Obama’s proposal to give small business and families tax credits to help cover their health-care costs as a good idea.

A rising chorus for a single-payer, universal care system is something that will not likely happen any time soon because of the ongoing financial crisis, Emanuelson said.

“There’s a lot of good ideas there (in Obama’s proposal) but some things that won’t be easy to accomplish,” he said. “For example, it’s going to be difficult to do universal care and reduce costs at the same time.”

For the foreseeable future, Emanuelson said it’s going to be up to private insurance companies to do all they can to contain costs through innovative health plans. “The bottom line is all providers can’t charge what they want to charge,” he said. “It’s going to be very difficult to keep the costs in check as we’re trying to do with out cost-containment initiatives.”

SmartSense for uninsured

Last month, Anthem unveiled its “SmartSense” individual health plan to help provide affordable coverage to early retirees, students and the 18 percent of Coloradans who are uninsured. The plan, which went into effect Nov. 15, offers premiums from $33 to $178 per month for a healthy, 25-year-old male.

“It’s a no-frills, but not a bare-bones, plan,´ said John Martie, Anthem in Colorado’s president, in announcing the plan. “Anthem’s goal is to reduce the percentage of Coloradans who are uninsured. As we move forward, we’ll continue to focus on providing affordable plans that maintain the high-quality and value-added benefits consumers have come to expect from us.”

Emanuelson said that philosophy has helped Anthem become Colorado’s biggest insurer with almost 900,000 members in the state. “Our focus has always been to try to contain or mitigate the rising cost of health care,” he said.

One way of doing that, Emanuelson noted, is to have “contractual agreements to control the way in which our providers are charging our members, which helps bring down the cost of health care.”

While individual products, such as SmartSense, offer more affordable rates, some have criticized such plans as another blow to employer-sponsored plans, which have been losing members because of rising premiums for small business groups.

Emanuelson said he doubts that SmartSense or similar plans will pull many young, healthy workers out of an employer-sponsored plan and result in that plan becoming more expensive for those left under it.

“Most employers contribute substantially to the cost of employer plans – typically about 80 percent of that cost – and the benefits they provide are substantially richer than a SmartSense package,” he said. “It would really surprise me if that happened.”

Dramatic impact over 30 years

Emanuelson said private insurance companies such as Anthem are trying their best to hold down the cost of insurance so more people can afford to be their customers. He said a look back to the 1970s would show that’s what has been happening.

“There was a time in the late ’70s that health-care costs were going up 20 to 25 percent year after year – that was pretty typical,” he said. “Today, our health-care trends are in the low double-digits – 10 to 12 percent. That’s dramatically different than 30 years ago. So we think we’re having a pretty dramatic impact on keeping costs down.”

Emanuelson acknowledges that private insurance companies are frequently criticized for contributing to the rising cost of insurance coverage but said everyone has a role to play in holding costs down.

He notes that for every $1 paid to the insurance company, 85 cents is paid to the health-care professional providing care. And those paying the premiums could do much more in changing their lifestyle to reduce their need for health care, he said.

Emanuelson said he knows private insurance will continue to be criticized because “it’s easy to villainize us.”

“But I don’t think (private insurance) will go extinct,” he said. “We are not an inexpensive item and people do need and rely on us every day. There’s so much out there in terms of wants and expectations compared to what’s realistic.”

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