I’ve been saying it for years (and in 3D and Technicolor in my new book Healthcare Beyond Reform): The Standard Model of Healthcare (the traditional unmodified fee-for-service, commodified, defined-benefit payment system) is broken and doomed. It’s fascinating to hear that even the CEO of Aetna, Mark Bertolini, said exactly that recently at a major healthcare technology conference — and that Forbes, a bastion of business and the private approach to everything, would publish an article on his remarks. At Health 2.0 last fall, Bertolini said that he no longer thinks of Aetna as an insurance company, but primarily  as an information company. This time, he made these main points:

  • The end of medical underwriting in the ACA, combined with other demographic, regulatory, and economic factors, made health insurers’ business model increasingly untenable.
  • These changes will not go away, one way or another, no matter what the Supreme Court does, no matter who is elected in November. These changes are directly tied not just to legislation but to underlying demographic and economic realities
  • This is not a terrible thing.  “We got pulled through the crucible against our will and have been reshaped because of it,” he said. “For most of what has already been implemented, it has been a pretty good thing.”
  • Health insurers are unlikely to disappear. But their primary role in the future will be using new technologies to help accountable health systems serve their customers and drive out costs — and the health systems, not the health insurers, will increasingly be the face, the brand, of that improvement.  “We can use technology to make it easier for the consumer. Convenience is the new word for quality.”

He is right on every count, and that is not news. What is news is who is saying it. When the CEOs of companies like Aetna and Cigna, and the CEOs of the many Blues that I have been working with in recent months, show that they understand the size, shape, and power of the changes we are all surfing together, that to me is one more clear sign that this change is happening. There will be no going back.