Guest post from Dijuana Lewis
The role American health insurance companies play in providing affordable access to health care continues to be at the center of the health care debate in this country. While rising health insurance premiums are a key point of these discussions, the reasons for these increases are often missed. Health insurance premiums increase or decrease based on annual health benefit costs, which are estimated at the beginning of a policy year. After reimbursements to hospitals, physicians, pharmacies and other providers, insurers use premium dollars to foster quality care initiatives. This includes valuable investments in prevention, health IT, clinical research and, most importantly, wellness programs that help improve health outcomes and reduce future health care costs for the consumer.
The wellness trend in the health care industry is growing as consumers and employers alike search for ways to become increasingly proactive and control costs. Comprehensive wellness programs that offer nurse hotlines, care management assistance, worksite healthy lifestyles campaigns and preventive care reminders for screenings and immunizations can change the way health care providers, employers and consumers approach health care, and they ultimately enhance health outcomes and prevent health costs from spiraling out of control. When evaluating efforts to reduce costs and improve the quality of care, it is important to note that year-to-year increases in health care costs in 2007 were actually the lowest they have been in six years.
Dijuana Lewis is president and CEO of WellPoint’s Comprehensive Health Solutions Business Unit, which includes provider relations, care and disease management, and WellPoint’s pharmacy benefits management company, NextRx, and its specialty pharmacy, PrecisionRx Specialty Solutions. Throughout her WellPoint tenure, Ms. Lewis has had wide-ranging responsibility for management of utilization/medical management staff to assure proper benefit administration for the membership; case management and disease management to improve the health of the member population; and cost of care trends for Northeast Market states. Additionally, she was responsible for the oversight and direction of all quality improvement initiatives; physician, hospital and ancillary contracting; and servicing to meet network development access needs.