Local businesses and employees are paying too much for health care and want a simpler, more transparent system.
That was the overwhelming message business leaders shared Thursday in a rare forum with leaders of all four of Lancaster County’s major health systems.
The three-hour meeting — attended by close to a hundred people — was organized by the nonprofit Central Penn Business Group on Health, an independent Lancaster Chamber affiliate.
Here are four main takeaways from the discussion.
Key concerns are cost, complexity and transparency
Employers were asked to discuss their health care challenges in small groups, then summarize them to the health system leaders.
Responses from the dozen groups were nearly unanimous: Health care costs too much for them and their employees, administering and using the plans is too complicated, and they’re looking for more transparency and more control.
The organization’s latest survey found that for 2018, individual premiums for job-based health insurance average $6,732 in this region, of which employees pay $1,284. For family plans, premiums average $19,512, of which employees pay $6,228.
Competition doesn’t necessarily lower health care costs
An attendee asked if increased competition in the local health care market lowers cost and increases quality.
The health system leaders responded that research generally shows competition in health care can increase quality but doesn’t necessarily lower costs.
Jan Bergen, president and CEO of Penn Medicine Lancaster General Health, said mergers and acquisitions also often raise costs instead of lowering them — but that joining Penn Medicine didn’t “alter our cost structure in any way.”
Alan Brechbill, executive vice president and COO of Penn State Health, said it argued a couple of years ago that affiliating with what used to be PinnacleHealth could lower costs in the region, but the Federal Trade Commission didn’t allow that deal.
Brooks Turkel, president of UPMC Pinnacle Lancaster division, said in closing its Lancaster city hospital at the end of the month, UPMC Pinnacle is also giving up an open heart surgery program here, avoiding “the duplication of a very expensive service.”
And conversely, here are the 10 congressional districts where competition *increased* the most from ’10-’17:WA06MI07PA04MD01TX34TX01AZ08NJ02CO05PA16— John Graves (@johngraves9) March 6, 2019
Keeping people out of hospitals
Asked about what they’re doing to address high costs, the health system leaders repeatedly noted efforts to keep patients out of hospitals and emergency rooms when less-expensive care is appropriate, and to prevent and manage chronic diseases.
“You’re swimming upstream if you don’t have your employees connected with a primary care practice,” Bergen said.
Turkel said UPMC’s approach centers on its health plan and providers working together.
Carrie Willetts, senior vice president of WellSpan Health and president of WellSpan Ephrata Community Hospital, said the system recently held focus groups with several dozen Central Pennsylvania employers.
She also mentioned a virtual prenatal care program that the system estimates replaced hundreds of in-person obstetrician visits.
Brechbill noted that his system has been partnering with insurer Highmark for more than a year and working hard to expand offerings beyond its academic medical center in Hershey.
“I think you’re going to see more of us in the future,” he said.
Look at joint replacements
Attendees also heard from Joe Martin, executive director of the independent state agency Pennsylvania Health Care Cost Containment Council.
He said in the past seven years, hospitals in the area have tackled tough problems and seen significant decreases to in-hospital deaths for six conditions, and on readmissions for seven conditions.
Martin noted that the cost of hip and knee replacements here is similar to other places in the state but — even after accounting for gender differences and the large number of seniors here — the rate of hip and knee replacements for local residents is higher than the rest of the state.
“It’s something that should be looked at in this area,” he said.