CAMI Recommends Immediate Actions to Improve Transparency and Function of the US Healthcare System
It is abundantly clear, based on the flurry of stories regarding denied insurance claims on social media and in the news in recent weeks, that the United States’ healthcare system lacks transparency and isn’t functioning well for many Americans.
Americans are stymied for lack of an effective way to challenge the often life or death decisions of powerful insurance companies.
Our mission at CAMI is to help the government work better for the American people, and the nationwide spotlight on the US healthcare system right now is an opportunity and opening for important change.
As many Americans know, the US healthcare system is made up of a mix of public and private, for-profit and nonprofit insurers. While much of the national conversation right now is focused on employer-provided insurance, there are also three systems that coexist with employer-provided insurance:
Medicare
A federal health insurance program primarily for people 65 and older, as well as for some younger people with disabilities or specific conditions.
Medicaid
A joint federal and state program providing coverage for low-income individuals and families.
Veterans Health Administration (VA)
A part of the US Department of Veterans Affairs, providing coverage for veterans.
These government-run health insurance programs do not coordinate to share information systems, even though some Americans are dually eligible and many of the patient populations overlap.
CAMI has identified immediate actions that can be taken to begin effecting change, utilizing innovation to make our government-run health insurance programs more efficient, effective, and transparent:
First and foremost, change the appeals process to allow meaningful challenges by patients
Don’t require patients to go back to the insurance provider to challenge a claim that is denied.
Instead, automatically escalate denied claims to a contractor/independent entity to perform the appeals process.
Secondly, only allow independent, conflict-free contractors to help patients (specifically Medicare beneficiaries) choose a health plan that best suits their needs
Lastly, there must be healthcare price transparency
The lack of transparency in pricing makes it difficult for patients to make informed decisions about their coverage.
Because Medicare, Medicaid, and the VA are government-run health insurance programs, the government has the authority to make these changes and contribute to a healthcare system run more transparently and effectively for the American people.