The House Ways and Means Committee hearing has concluded, bringing a long day of questioning for major health insurance executives to an end.
More than nine hours of total questioning across two hearings touched on a slew of factors impacting the affordability of healthcare: the Affordable Care Act, claims denials, prior authorization and consolidation. Paul Markovich, CEO of Ascendiun, the parent company of Blue Shield of California, and one of the executives called to the panel, told Fierce Healthcare that the long debate ultimately proves that problems of this magnitude require massive changes.
“I hope what everyone takes away from this is that it’s a systemic problem that requires a systemic resolution,” he said.
Markovich was the lone representative of a nonprofit health plan on the panel, and he noted that non-for-profit Blues like Blue Shield of California cover a significant swath of Americans. And Blue Shield has taken some big swings in rethinking the traditional paradigms, with its Pharmacy Care Reimagined model as a prime example.
Blue Shield’s specific approach to redesigning the pharmacy model didn’t garner much time at the lengthy hearings, but PBMs and the cost of prescription drugs were center stage. Markovich said that ultimately the discussion centers around the need to change how different entities within the system are paid.
The same can be said for the No Surprises Act arbitration model, which insurers have raised alarms about. Both Markovich and Elevance Health CEO Gail Boudreaux spoke about a trend toward private equity-backed providers flooding the dispute resolution to secure higher payouts.
He said that while it’s a financially prudent move for these individual organizations, this behavior doesn’t positively speak to the broader cost equation.
“As soon as you start financially rewarding certain behavior you’re just going to get more of it,” he said.
Markovich said that one area where he was hoping to see more dialogue is around the role technology can play in reshaping the traditional models. Blue Shield of California has rolled out the Digital Health Record program that aims to boost care coordination and transparency as well as improve the flow of data to providers.
He said that’s an example of where health plans are leaning on tech to take wasteful spending out of the system.
The health plan executives emphasized the role that provider and pharmaceutical company pricing plays in the accelerating costs in healthcare. Ways and Means Chairman Jason Smith, R-Missouri, hinted at future hearings on the topic that would bring in voices from other parts of the healthcare system.