Tough road ahead: A Q&A with Suzanne Delbanco
Catalyst for Payment Reform's Suzanne Delbanco addresses the challenges health care consolidation is creating for employers.
The same is true for the health care industry, where even businesses once immune to the effects of economic recession are now stumbling. But the expectation is those that are able to weather the storm will come back even stronger.
Related: Employers’ disruptive purchasing strategies are, well, disruptive
BenefitsPRO reached out to Suzanne Delbanco, executive director at Catalyst for Payment Reform, to get her perspective on the market forces shaping our industry now and in the years ahead.
Why do employers need to be worried about health care consolidation?
It’s not just about prices, it’s also about the ability to be targeted when connecting employees to high-value providers. A dominant provider has the ability to put in contract terms with a health insurance plan that restricts other ways that employers can get better value, such as tiering providers or steering patients to particular providers. A dominant provider can say you are not allowed to share data, create benefit incentives, or anything that steers patients away from me.
When you have markets that are too consolidated, there tend to be fewer options for employers. Less competition tends to mean less pressure on the providers to innovate and improve the patient experience and quality.
How has the pandemic changed the health care landscape?
There’s been a precipitous drop in health care utilization, which has left many providers with a serious drop in revenue. Independent practices and small and rural hospitals are very likely to be acquired. We’re expecting to see a lot more consolidation.
In addition, we’re all incredibly grateful to the frontline health care workers and those putting their lives on the line to prepare for and treat COVID patients. The general feeling toward health systems is going to be much more generous. And that goes for policymakers, as well. While we previously might have been on a path to really look at policy solutions to address some of the downstream consequences of consolidation, I’m not sure how that will play now.
What opportunities for disruption do you see?
One thing that has emerged is entrepreneurial vendors offering different things than the traditional incumbent health plan. TPAs don’t have the pressure to have every provider in the network and can be much more selective about which they work with.
The other thing we’re seeing more of is carving out, semi-direct contracting. You still have your major health plan, but maybe you carve out hip replacements and contract using bundled payments based on quality.
What role do you see benefits brokers taking on in the changing health care landscape?
I think brokers can be very creative in the opportunities they offer to their clients. There’s a role in educating their clients about non-traditional options in the marketplace. We try to reach brokers and consultants, because we want to get the high-value purchasing movement to spread. They could be a very effective force in helping employers understand the dynamics in the market and consider doing things differently.
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