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Cooperation is key to reining in the cost of health care, top insurance official says

Health insurers need to work with hospitals, doctors, employers and consumers to rein in the cost of services and improve the medical delivery system, the head of the national BlueCross BlueShield Association said Friday in Buffalo.

The United States spends too much on health care and the reimbursement model must shift from one that pays for every procedure or service performed to one that rewards the best outcomes, said Scott P. Serota, the association’s president and CEO.

“We need to pay for results,” said Serota, the keynote speaker at a forum on federal health care reform that drew 175 people to BlueCross BlueShield of Western New York’s downtown Buffalo headquarters.

The insurer and the Buffalo Niagara Partnership hosted the “Health Care Reform: What’s Been Accomplished? What’s Next?” event as stakeholders here and elsewhere prepare for the Nov. 15 start of the second open enrollment period for the health insurance marketplaces.

The Blues, which insure one-third of Americans, were closely involved in the process of drafting the Affordable Care Act, Serota said. The association doesn’t agree with everything in the law but, he said, “We have committed to make this work for all Americans.”

Serota was joined by several other speakers. Kelly K. Smith, director of the Small Business Marketplace for the state Department of Health, reviewed data from the first year of the NY State of Health insurance exchange.

She said the state found that a large portion of the people who enrolled for 2014 through the exchange previously were uninsured, including 93 percent of Medicaid enrollees. That wasn’t because they were newly eligible for Medicaid, she said, but because they found it easier to enroll in the program through the exchange.

In 2014, 62 percent of exchange enrollees in New York signed up for a government-sponsored plan, either Medicaid or Child Health Plus, and just 38 percent in a private health plan. The state is looking to boost the number of enrollees in the private plans for 2015, Smith said.

The Affordable Care Act has brought added costs and administrative burdens to employers, said Mike Gaal, an actuary and health benefits consultant with Milliman.

Gaal said he doesn’t expect too many employers to drop health benefits for full-time workers, a move that would send their workers to shop for coverage on the exchange.

That’s because workers who lose their insurance, which is part of their compensation package, would expect cash compensation in return, and dropping health benefits makes it harder for a company to compete for workers with another business that does offer insurance, he said.

From the provider’s perspective, hospital systems are under pressure from government and private payers to slow the growth in spending on health care services, including eliminating as much as 25 percent of Kaleida Health’s admissions, said Dr. David P. Hughes, executive vice president and chief medical officer of Kaleida Health.

Also joining the panel were David W. Anderson, president & CEO of BlueCross BlueShield of Western New York; Dr. Evelyn Hurvitz, senior partner with Integrity Health Group and vice chair of the physician leadership board; and Donald R. Ingalls, vice president of state and federal relations for BlueCross BlueShield of Western New York.

Panel moderators were Dottie Gallagher-Cohen, president and CEO of the partnership, and Jerry Zremski, Washington bureau chief of The Buffalo News. The event was open to partnership members and guests of BlueCross BlueShield.