I have had several dealings with the benefits managers/HR managers of large corporations and other large organizations over my career. I have one over-arching conclusion about what motivates these people: they will never be a source of disruptive innovation in healthcare.
I find them to be passive people. They are fundamentally people pleasers. They derive joy from helping their employees navigate their insurance plans, figure out deductibles and co-pays, explain benefits packages, etc. I find their knowledge of healthcare costs, outcomes, and alternatives to be little greater than the general public. When one talks about pushing back against insurance company or hospital system excesses, their eyes get wide and their pulses quicken (I assume. I confess I’ve never actually measured their pulses). For them to think about ANY attempt to make any major changes in their typical annual offerings, they see hordes of angry employees lining up outside their doors and they refuse to consider major changes.
A lot of them work under the CFO, who could turn to them and order them to find innovative solutions. But when challenged to do this, all the CFOs I’ve talked to throw up their hands and say,”We have a great HR/benefits team who manage all this. Talk to them.”
Every few years, the CFO gets upset at the annual rate of inflation for health insurance. They turn to the HR people and ask why it’s so bad. The HR people then apply their universal dodge to protect their emotional flank, “We’ve hired new consultants who come with great new analytics and cost-containment programs.” Those consultants stick around two to four years, then new consultants are hired and the cycle repeats itself. I’m also convinced that the health insurance consultants profit from making sure that the exorbitantly expensive dysfunctional healthcare system stays dysfunctional.
It doesn’t have to be this way. Here is a story about a brave HR person in Montana. She was a former insurance company employee who knew of its excesses. She negotiated for better and more transparent rates and got what she asked for.
The moral of this story is that it is possible for payers to push back against the excesses of insurance companies, hospital systems, drug companies, and ologists. It just takes a little knowledge and a lot of moxie. This is in woefully short supply in American business and governments.
Considering how many major corporations there are, the S&P 500 has 500 and doesn’t touch the surface, expecting any meaningful reform to come from corporations would be like herding cats. Where might it come from instead? Our elected Senators and Congressmen number 535, but like those benefit managers, they don’t want a lot of unhappy constituents. The State Insurance Commissioners number 50 and within each state they number 1. Depending on the size of the state, they may have good relations with their legislatures or they may antagonize each other, but much insurance regulation takes place at the state level. Our malpractice policies are regulated as are our automobile policies. The number of carriers in each state will also vary a lot by state size. The downside, of course, is that paid lobbyists are highly cost effective for the companies, but if any reform is to take place in the forseeable future it seems better to focus there than on HR staff who need to look at expediency as well as value.
I wish I had a great answer, but there is such a gulf between the deep understanding required by healthcare people to propose and carry out disruptive reform and the business/political side of corporate and government life that thinks business solutions will make our system sane. At some point, the CFOs and CEOs have got to look at their benefits people and ask, “What have you people been doing the last 30 years while healthcare costs have more than doubled in real dollars?”