Summary - CareFirst: A Partner in Health

In a briefing on Tuesday February 12th, 2019, CareFirst’s president and CEO, Brian Pieninck discussed the future of healthcare and what role CareFirst will play in actualizing that future. One important part of the conversation was pharmaceutical costs, which is the highest cost category for CareFirst, making up 33 percent of their total spending. These costs are also rising faster than any other category and part of the problem is the opaque supply chain dynamic. While the intention is not to stifle innovation due to the importance of developing new treatments and technologies, total cost management needs to be controlled, for which pharmaceuticals are the biggest concern. No other aspect of consumer purchasing works the way the drug industry does. People have the right to transparency and accessibility so that they can compare prices and make informed decisions about what they are buying. CareFirst believes that the government needs to lock arms with industry in order to develop public and private partnerships to create a sustainable dynamic. As public perception continues to change on this issue, people will demand something different and CareFirst wants to be a part of the solution.

The aging population bubble is a challenge looming over the future of healthcare. It will tax our already limited resources. That is why CareFirst is committed to expanding their presence into government programs. CareFirst has not been a part of Medicare or Medicaid of over two decades, but they recognize the importance of their role in addressing the issue of the aging population. Many people in the community are born into CareFirst, can choose it as their university insurance, and as their employer-sponsored insurance, but must change when they age into Medicare. CareFirst wants to be able to work with people as they more through the continuum of retirement. This interconnectedness is important in managing care and information over time. As people grow and age, their needs change as well and CareFirst is prepared to learn form Medicare and Medicaid to address the needs of people at different stages of their lives, as they face different challenges.

Pieninck also discussed the current public health crisis of mental health, behavioral health, and substance use disorder. A major part of the problem is how society views healthcare and weighs physical illness and injury more heavily than mental and behavioral health issues. There is also the issue of provider shortage, which is problematic in ensuring timely care. The key will be to build access, infrastructure, and awareness. CareFirst believes that virtual care, social care, and self-care will be important parts of the solution. Virtual care can be used to increase access and provide more prompt care. Education on self-care will be vital to changing perceptions of mental and behavioral health issues, training people on how to manage their conditions, and teaching people to recognize when care is needed. Social care is especially important in treating mental health conditions, as these conditions are so often linked to the social determinants of health.

Currently, we live in a sick-care system. Many factors affect the trajectory of someone’s life, and this can manifest into degrees of sickness. CareFirst believes in addressing the root causes of illness and managing them over time to move toward a culture of well-care. They gave over $38 million last year to organizations working to address different social determinants, with nutrition and education being key issues they focused in on. Payors are not the only answer to addressing the social determinants, but we need partnerships to pool resources and deal with the issues from all angles. Primary care should have a strong role in making these changes. Because primary care is so fundamental to the transition into a culture of wellness, the primary care shortage is a serious problem. Not only paying primary care providers more, but many factors, including changing how we think about out healthcare system, will need to be addressed to solve the problem. CareFirst believes in the importance of keeping primary care doctors independent. There is a need to broaden the definition of primary care to include family and community care as well as nurse practitioners and physician assistants operating at the top of their license. Primary care practitioners have a unique position at the front end of the funnel that allows for them to screen for social determinants and unnecessary care to make the health system more effective. It is important that people are getting the right care at the right place at the right time, and primary care providers can help to ensure that happens.

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