Opening AHIP 2013 in Las Vegas, George Halvorson, chair and CEO at Kaiser Permanente and its health plan, delivered a call to action for health insurers to take a leading role in transforming the American health care system.

“We are on the cusp of a golden age of health care delivery,” he asserted. “The toolkit that is available to health care is getting better every day.” That toolkit includes better policies, technologies and outreach programs to support an interactive and patient-focused delivery system.

Huge opportunities exist today that were not available in past years, Halvorson said. For example, the home soon will be a major provider of care with home-based technologies, and payers either can stand on the sidelines, ignore the opportunities or be involved in the new agenda and help structure it.

With its enterprise electronic health records system and supporting applications, Kaiser is taking advantage of its technology tools, he noted. Mortality rates for stroke have fallen 40 percent, heart disease deaths are down 30 percent, and HIV mortalities are half the national average. “The key to that is patient-focused data that clinicians and patients can use.

Today’s fee-for-service business model is to buy each piece of care one-by-one so there is no incentive for prevention and the model actually incents volume of care and bad outcomes, Halvorson said. For instance, the national average for hospitalized patients to develop pressure ulcers is seven percent with a cost of $40,000 to treat the condition. “The business model today rewards those ulcers.” In contrast, Kaiser’s rate is down to one percent “and half of our hospitals haven’t had a pressure ulcer in over a year,” he added.

Health information technologies and the data they generate to analyze care, quality and outcomes will support medical homes, accountable care organizations and patient connectivity, all of which will bring down the cost of care and improve outcomes, Halvorson said.

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