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Opinion: “Any willing payer” legislation is anti-competitive and would compromise innovation and true reform

Danville, Pa. – Geisinger Health System respects and is sensitive to public concerns regarding health care delivery and payment reform, and looks forward to the opportunity to work together with the state legislature and others on effective ways to continue improving patient care and health care delivery in Pennsylvania.Unfortunately, the “any willing payer” legislation as written in House Bill 1621 and House Bill 1622 will impede rather than advance this effort; and Geisinger strongly opposes this legislation.

Geisinger has long been recognized by the White House, Congress and the national media for our innovation, health reform initiatives and our ability to provide quality health care outcomes for an overall lower cost. Our efforts have been successful because of our vertically integrated structure—our system includes both a delivery and an insurance component—as well as our focus on identifying and eliminating the 35 percent or more of health care services on average across the country that add no value to patients’ outcomes. Without having the ability to balance both the insurer and provider components, we would not have the comprehensive information and financial stability to test new and innovative ways to ensure that patients receive the highest quality and most coordinated care possible.

Patient-centered innovation is what vertically integrated delivery systems are able to pioneer, and what the government and other health care systems try to adopt and imitate. House bills 1621 and 1622 would greatly restrict Geisinger’s ability to continue providing delivery system transformation.

While Geisinger understands the described goals of this legislation, we have several serious concerns regarding the forced contracting and further government intervention in health care that this legislation represents. Selective and exclusive network contracting is a fundamental part of the competitive process; and a free, competitive market results in and forces providers to minimize costs and maximize value for patients and members. This legislation, contrarily, is anticompetitive and would compromise innovation and perpetuate outdated payer contracting and payment methodologies. Further, it is counter to the national trend of integration and the creation of formal “continuums of care” that have numerous proven patient, employer, payer and provider benefits.

While advocates of “any willing payer” language understandably seek greater consumer choice, this legislation would prohibit efficient contracting and ultimately be counterproductive to this goal. There is nothing in this legislation that addresses the issue of payment reform; it merely forces a contract on an integrated delivery system. In addition, there is nothing in this legislation that addresses one of the core principles of meaningful reform—value—paying for quality rather than quantity and tying provider reimbursements to real outcomes.

Value is receiving a quality service and outcomes for a reasonable cost. Evaluating value includes addressing the quality of the service, the outcomes and the cost. This legislation does the opposite by prohibiting hospitals that are part of an integrated delivery system from receiving any consideration regarding the quality of their service when negotiating rates with insurers.

The reality is that we desperately need actual and dramatic health care reform. The structure, delivery and payment of health care services, both historically and currently, are unsustainable. We hope that the legislature sees the value in the stakeholder process and will work in a bipartisan fashion with the Pennsylvania Department of Health and the health care community to develop comprehensive health care policy. The goal of all health care policy should be to support delivery system innovations that can help turn the tide toward achieving the triple aim of improving the experience of health care, improving health status, and containing costs through more integrated, less costly and higher quality care.

(Frank J. Trembulak is Executive Vice President and Chief Operating Officer at Geisinger Health System, an integrated health services organization widely recognized for its innovative use of the electronic health record and the development of innovative care models. Geisinger consistently garners national accolades for integration, quality and service. For more information visit www.geisinger.org or follow the latest Geisinger news and more on Twitter and Facebook.