Health insurer aiming to be more proactive
Health insurance has come a long way from the traditional role of paying out when individuals are ill to a more proactive role in managing patients’ own healthcare cost.
And not only in Bermuda is the role of the health insurer changing.
This was one of the topics discussed by Shakira Warner, population health specialist at Argus, at the Hamilton Rotary Club this week.
“Improving population health is not something that we can do alone,” Ms Warner said. “We do not have all of the skills and resources necessary. Strategic partnerships with community-based services, such as the Diabetes Reversal Programme, can improve the co-ordination and experience of care for patients by leveraging the infrastructure and expertise that exists out in the community.”
For some patients and providers, who deal with insurance companies in their traditional role, there is some frustration, Ms Warner believes.
Therefore health insurers must be open to partnering with providers to research and test new payment models that create alignment and promote value in care delivery. Ms Warner thanked Premier Health for being a pioneer in this regards.
The speech came a day after Argus reported a loss of $2.3 million, driven by rising health insurance claims.
“At Argus, we are not ashamed to say that we do not have all the answers and there are some challenges that we’ve identified,” Ms Warner said. “For example, there are limitations to our claims data — sometimes it may be incomplete, it’s a retroactive way of looking at experience of care, and it does not capture the distribution of healthcare factors, like smoking and undiagnosed hypertension, in the population.”
Other factors that can impact the cost of care and the health of individuals include ageing and technology, employment status, family support and education level.
“The Argus Thrive Programme is still relatively a siloed effort, although we are involved in community initiatives such as Healthy Schools and the Well Bermuda Partnership — alignment that extends beyond health insurance and healthcare delivery is helpful,” Ms Warner added.
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