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 Today in Health IT, we are discussing insurers face backlash in wake of UnitedHealth attack. My name is Sarah Richardson. I'm a former CIO for several healthcare systems, most notably within HCA and Optum, now president of the This Week Health 229 Executive Development Community, where we host a set of channels and events dedicated to transforming healthcare, one connection at a time, and I am joined by Kate Gamble, Managing Editor here at This Week Health.

Kate, welcome to the show. Thank you, Sarah. Happy to be here. This one's big and timely. Insurers are facing backlash in wake of the UnitedHealth attack.

The recent fatal shooting of UnitedHealthcare CEO Brian Thompson has prompted health insurers to reassess and enhance executive security measures. This incident has intensified public scrutiny of the industry, highlighting a deep seated frustration with insurance practices. Some key points I want to cover, Kate, and we'll jump into the dialogue, is enhanced security measures, the public backlash, and the operational impact from the things that have happened because of this shooting.

Very specifically, Other companies, Blue Cross Blue Shield, CVS, as an example, they've removed executive information from their websites and are re evaluating security protocols. From a public perspective, it sparked widespread criticism of health insurers, with many expressing grievances over claims, denials, and perceived barriers to care.

And then also insurer practices, such as reversal of controversial policies like time limits on anesthesia coverage, Which we saw even the day after the shooting. Tell me more about some of the research you've been doing on this topic. So yeah, this is such a polarizing story. It's been everywhere and for a reason.

And one of the pieces I read was a blog from Tommy Mitchell, who's a family physician and wellness coach, who wrote, Thompson's death has pulled back the curtain on something we've all known deep down. America's health care system is failing. Every day we hear heartbreaking stories of people denied life saving treatments like cancer care, not because those treatments don't exist, but because somebody decided they weren't cost effective.

This isn't just a health care problem, it's a crisis of humanity. And those are really powerful words, but this is the type of reaction we're hearing, and What that tells me is that there are systemic issues that need to be addressed, but it also tells me that people are really passionate about this, and that means that not just the big insurers, but health systems have to make sure that they're protecting leaders physically.

And also protecting data against potential threats. And it means that if you're a CIO or other leader, you have to be prepared to adjust IT systems to accommodate changes in policies and practices resulting from increased scrutiny. Yes, the CIO's role in the middle of a lot of these pieces is going to be that direct impact of how you manage the information of your executives, how your policies protect people.

But more than that, it's also the perspective of the fact that some health systems also have their own insurance plans. So if you're in one of those organizations, how can health insurers address public grievances and improve transparency in their operations? Yeah, that's a really good point. There are a lot of those systems and what they're dealing with very different from not even standalone, but just health systems that are purely providing care.

So some of the things they can do, it starts with proactive communication. Insurers need to establish open lines of communication with customers using clear language to explain coverage, claims processes, and denials. And then there's also customer centric initiatives. So developing programs that address common frustrations, such as expedited claims resolution and simplified prior authorization procedures, and of course, regular transparency reports, publishing the data on approvals, denials, and customer satisfaction to show accountability and identify areas for improvement.

And then finally, stakeholder engagement. So involving patients, providers, and advocacy groups in conversations about policy changes and operational practices to foster trust and collaboration. Because that's what's missing, right? whole trust piece. It is. And then I think about how technology protects executive information and organizational security.

You touched on it. Enhanced data protection, advanced cyber security measures such as encryption, multi factor authentication, that secure sense of information about executives and employees. It's also just really good cyber hygiene. I do not know how many times we have touched on encryption and multi factor authentication as Baseline requirements in any organization.

And when you have real time monitoring to look for threats, detect anomalies and breaches before they escalate, it's going to be important access control. So there's limited access to sensitive data based on roles and responsibilities. So the only authorized personnel can view some of these executive details always goes back to the crisis management.

Protocols and systems. Do you have digital platforms that enable rapid communication and response during a security incident that safeguards physical and cyber assets? So much of that planning and the time that goes into What happens when there's any kind of an incident that enacts what we would consider crisis management?

Brad Marsh and I talked about that recently. He teaches a course where seven weeks of an eight week course is the planning for what happens if there is an incident, and only one week is dedicated to the actual incident response because all of it what happens is in the details of the planning based on what might happen.

Yeah, absolutely. And we also have to talk about policy reforms and the reforms in insurer practices that can enhance patient care and satisfaction. And it starts with , streamlining claims processes. This is one of the biggest issues we've been hearing about in the last few days. The need to simplify claim submission and review to minimize delays and frustrations for patients and providers.

And I feel like it sounds simple, but It's much more complicated that, but it needs to be done. It takes too long and it results in too much frustration. And then eliminating arbitrary limits. That's another big one. So reconsider restrictive policies such as time limits on specific services to align with patient care needs.

And then, Also looking at value based care models, shifting from volume based reimbursement to value based care that prioritizes outcomes and patient satisfaction, and digital health solutions. So investing in telehealth and other tools to improve accessibility, reduce costs, and meet the evolving needs of patients.

Just from your opinion, do these sound like pie in the sky things, or can we actually get there realistically? Some of them are going to be harder than others. However, the streamlined claims processing component, again, this is where the advocacy within the health system, whether they have a plan or they're using other insurers for their patients, which is going to be a huge mix.

You got Medicare, you got Medicaid, you got commercial, you've got combinations of some of the above. And when the prior authorization And the claim submission and the transparency and how much services are going to cost is something you're having in a conversation with the patient up front. I've learned, you and I've been in this industry a long time, we have learned to say, how much is this going to cost?

What is covered by my deductible or my insurance? What is my co pay going to be? Et cetera. I now ask for that up front. And I've had care significantly delayed while they try to figure out how much it's actually going to cost. And if you just pay your co pay and then you go get the cortisone shot for your hip as an example, welcome to my world right now, then I ended up paying like 700.

For my cortisone shot recently, because it wasn't actually covered and it had to be approved. And I'm like, you gotta be kidding me. So it was fine, except that's a lot of money in anyone's universe. And so when we have to know how to navigate and still not have the outcomes we're looking for, I have this huge push for advocacy to help the everyday patient because everybody's a patient and it's our responsibility bringing these conversations forward and making it commonplace to say, ask how much it's going to cost ahead of time and then making sure as technologists that we think about what does it look like in a system to remove these limits on These different policies, how do we move into value based care model, which Craig Richerville and I wrote an article about recently.

And then are the digital health solutions doing what you and I talk about often? Access, equity, cost reduction, and meeting the evolving needs of patients. Same, when we consider this, yes, they are possible. Some are pie in the sky. It's going to be grassroots. Start at your local hospital systems.

Yeah, that's the best way to start. And just as a side note, when we think about preventative care, and we're starting to learn how big that is, how important that is, something like that, making it easier for people to get approvals for screenings, even if they don't meet all the criteria yet. If we want a healthier population, we're going to have to do things like this.

And I agree with what you said, advocacy is the most important step to take right now. Yep, making sure that there's the top three or four questions that people know to ask when they go to their doctor and having that be part of the conversation every single time. And those patient bill of rights and the different advocacy perspectives couldn't agree with you more.

It's going to be a continued conversation throughout next year. We'll follow it closely, we'll bring our ideas, our thoughts, and our research forward. And we always love the feedback too. So if there are perspectives that you want us to consider and cover, reach out to us. We will be sure to include those in a future conversation.

Again, these perspectives emphasize the importance of aligning health insurance practices with transparency, innovation, and centric policies. If we can address these, insurers can rebuild trust, improve security, And create a more equitable and efficient healthcare system. It's going to take a long time.

That's why we're involved. Share this podcast with a friend or a colleague. Use it as a foundation for daily or weekly discussions on the topics that are relevant to 📍 you and the industry. They can subscribe wherever you listen to podcast. Kate, thank you for joining me today. Thank you, Sarah. Thanks for listening.

That's all for now.