Aetna's Ron Williams Speaks -- And Actually Says Something
This Fortune interview with Aetna CEO Ron Williams is a few days old, but as it just popped up in my RSS reader, it is, as they say, new to me. Since it's pretty rare to see someone like Williams candidly discuss the health-plan business, its problems and some intriguing -- if not always entirely plausible -- ideas for how both health insurance and the broader American healthcare system might be improved, I thought I'd take a moment to touch on some of the highlights.
Williams starts off with some fairly doctrinaire views on escalating healthcare costs, which he suggests -- echoing Harvard economist David Cutler, who's also an adviser to Barack Obama -- are largely a reflection of Americans' insatiable appetite for more medical care and more high-tech treatments. That's a debatable proposition, to say the least, given the distinct possibility that as much of a third of U.S. healthcare spending is wasted on overtreatment that doesn't make people better and may well make them worse.
Still, once Williams gets past that point, he enters some interesting territory. For instance, he claims that Aetna has devoted a tremendous amount of time and effort to address what he considers the "real cost drivers" in healthcare -- namely, poor-quality healthcare and the lack of evidence-based medicine and dissemination of "best practices" throughout the medical profession.
[W]e've invested an enormous amount in technology and innovation to get at the real cost drivers in health care, which we believe to be poor quality and lack of clinical decision support. Physicians today don't have any real decision support tools.Aetna is trying to create such a system, although Williams acknowledges that it's an imperfect first step:[One example would be] the idea that best practices as determined by, say, cardiac specialists would be available in computers that physicians could access along with your complete medical history, to apply with their clinical judgment to make certain you're getting the best quality of care. Today that doesn't exist.
In the interim we do believe - and it's a big part of our strategy - that we can use the information and data that we have. For example, we know every physician that you've seen if you're one of our members. We know that you had lab tests conducted, and we know the actual lab values for those tests. We also know the prescriptions that have been filled and therefore the medication that you're on. We can apply that to computer decision support rules and determine, for example, that you have a cardiac condition and that when you saw a dermatologist, you neglected to mention that. The dermatologist writes a prescription that interacts with your condition. We have the ability to use that data to reach out to your physician. It's an imperfect solution. It's not as great as having the whole system connected, but I think it will have a very significant impact on the quality of health care.He also embraces the notion that individual patients need better information on how doctors and hospitals price their services, as well as how well they're doing at treating other patients:
At Aetna, in 35 markets, you can go online and know what your physician will charge you before you see that physician. That's helpful for a routine service, but when it comes to, say, a serious cardiac condition, what you really want to know is whether this is a high-quality physician. We think there is data available. There's going to be a huge transformation in this area.You'll hear no arguments from me on the usefulness of all this, particularly as more people shoulder a greater part of their own healthcare costs, typically through high-deductible plans coupled with health-savings accounts. The main problem is that even patients "empowered" this way aren't likely to bring much market power to bear on some of the biggest chunks of medical spending, especially emergency care, treatment of chronic disease such as diabetes and "heroic" end-of-life measures. (It's also increasingly clear that most people aren't really equipped to "become their own doctor" in ways that would really have a major impact on healthcare costs.)[...]
I think it will be possible [to compare and choose doctors using online quality data] within three to five years. Important efforts are under way, with the collaboration of physicians, to agree on quality standards. There's collaboration in the industry for all health plans to pool their data to create very rich data sets. So consumers could look at a set of performance indicators that physicians think are appropriate, and be able to judge how their physicians fare.
The only other observation I'd offer here is that Aetna's own online-information systems, while apparently well beyond than those of many other insurers, are still woefully inadequate to the task Williams wants them to take on. Since I've been in an Aetna health plan since 1999, I know first-hand that Aetna's online Navigator system is clunky, slow and often downright user-hostile. (I could explain why, but it's really a whole other post, and not a short one.) Aetna's technology is certainly better than nothing, and the insurer is upgrading it slowly -- for instance, it now contains the cost data Williams describes, although it's very difficult to use and not particularly comprehensive -- but it's still well short of where Aetna would like you to think it is.
In any case, the Aetna CEO has a variety of other interesting observations on the problem of the uninsured, why insurers think they can be trusted with your medical information, and how tax treatment of insurance ought to be revised. So if you're interested in geeking out on the subject, by all means you should read the whole thing. If you still want more, Williams goes into additional detail in an interview he gave to WSJ.com a while back, which you can catch on the Aetna Web site in both video and transcript form.