When you reach the summit, what do you do once you get there? Sit back and enjoy the view? Or look for new mountains to conquer? After being named senior vice president/chief strategy officer for Keenan, a multi-line insurance brokerage and consulting firm in Torrance , Calif. , Henry R. Loubet, responded this way: "I'm broadening my horizons by taking advantage of the depth of the overall background that I have in the world of healthcare and managed care."

At Keenan, Loubet is responsible for product development, business development, labor relations, marketing and overall corporate strategy. He also is chairman of a Keenan subsidiary called Innovative Care Services (ICS), that offers disability management, leave-of-absence programs and return-to-work programs.

In 1989, as senior vice president and regional executive of Health Net, Loubet helped create one of California 's first state-wide health plans, with 500,000 members. Subsequently, as president of Foundation Health of California, and CEO of UnitedHealthcare, Western Region, he continued to hone his healthcare and thought-leadership skills. Almost a decade later, Loubet's strategic direction as vice chairman/chief operating officer of the online pharmacy DrugEmporium.com, helped position it for a successful buyout within two years of its launch.

Not all of Loubet's ventures are limited to the healthcare field. After purchasing some prime real estate in Napa Valley in 1998, he began making high-quality wine. "I really enjoy the whole aspect of wine making and settling down from the frenetic pace of healthcare. I define it as a hobby, rather than a profession," he says.

Loubet also founded a non-profit golf program for disadvantaged youth called Ace Kids Golf in 1989 that operates in Northern California .

"It's been an exciting adventure," he says. "I take great pride in the number of successes we have had with kids who did not even know where to grab the golf club or who didn't know anything about the game and have gone on to play golf in college.

"In all my professional and personally driven endeavors, whether it is with the healthcare industry, non-profits or wine making, I am driven by a genuine desire and passion to make a difference, to be a leader and an innovator," Loubet says.

Q. Do you see a future in traditional HMO products?

A. HMO products are time-tested relative to providing value and for the services delivered, and really serve as the primary managed care product today, along with PPOs, to millions of Americans in both the commercial sector as well as Medicaid and Medicare. [HMOs] have a proven track record in delivering cost-effective, high-quality care. In addition, the recent Medicare reforms seem to have revitalized the HMO market, and as the generation that 'grew up' in HMOs moves into retirement, this kind of managed care delivery will continue to exist and be popular with retirees. Ultimately, HMOs will continue to be a major product in the insurance industry.

Q. What are your thoughts on consumer-directed care?

A. Consumerism must be viewed in a larger perspective, beyond only being a type of healthcare product like consumer-directed health plans. It is about the cultivation of tools, and the power of knowledge being wielded by consumers to effectively operate within the provider delivery system and to make the adjustments needed to affordably access the care they need. It is the type of healthcare delivery that puts the consumer in the center of the healthcare navigational experience. It focuses on accountability, transparency and taking responsibility for one's health. The consumer is much more directly impacted economically by the decisions they make in accessing healthcare.

Q. What role will employers play in healthcare? Do you see more or fewer employers embracing self-funding?

A. Employers are getting much more involved. Clearly, there is a lot of economic pressure employers face with more of their revenue going to providing health benefits. Certainly employer coalitions such as the Pacific Business Group on Health and others have really gone a long way to try to drive a lot of change and innovation around healthcare delivery. They have tried to influence health plans and providers to be more responsive in terms of transparency, accountability and financial performance.

The cost escalation in healthcare is likely to increase the need for the improved flexibility and innovation that self-funding provides for employers in creating benefit designs and financial models that work more efficiently for them. Self-funding provides a degree of insulation from the trend of state mandates and specified plan designs, which often lead to additional costs. Employers increasingly want to have their own experience be the driver for the cost of these benefit plans and thus more employers will embrace self-funding.

Q. Does transferring financial responsibility to patients with costly diseases result in better or worse care?

A. For cost-sharing to be effective, we need to put measures in place to ensure that patients continue to receive appropriate healthcare and pharmaceutical benefits. I am definitely concerned with patients with severe and costly diseases having to share a disproportionate financial responsibility deterring them from receiving available healthcare services and appropriate pharmaceutical interventions. I do believe, however, that a reasonable level of patient financial responsibility leads to cost-effective care and thus there is a balance that needs to be achieved.

Q. How should we deal with high-cost biopharmaceuticals and emerging technologies?

A. Specialty care management programs will give rise to a new breed of pharmacy management services that will focus on high-cost and emerging biopharmaceuticals delivered in a more transparent and efficient manner while ensuring appropriate and high-quality care. The time is now to improve the way drug benefits and new technologies are designed, provided and managed, with evidence-based criteria and centers of excellence to ensure highest quality, effective healthcare delivery at the appropriate cost.

Q. What are the key initiatives now underway that will grow exponentially in the next year?

A. Pay-for-performance [P4P], which promotes incentives to align the interests of various healthcare stakeholders, has taken on great momentum nationwide. Payment methods to physicians and hospitals include increasing payment on P4P methodology, i.e., incentive payments tie financial rewards to outcomes. Physicians are rewarded and paid based on the quality of services provided, clinical outcomes, patient experience and healthcare IT adoption and success—all in an effort to improve quality, accountability and affordability for healthcare consumers. I am a founding board member of the California-based Integrated Healthcare Assn., considered the foremost leader in the field of P4P organizations.

• An increase in cost sharing for health plan commercial members will continue, but the trend will slow given the rapid acceleration of benefit buy downs over the past few years. We are seeing the growing trend of employees taking more financial responsibility for their healthcare costs because benefit levels are decreasing as premiums increase. At some point, this trend will level out as benefit design demands from employees push for stabilization.

• Transparency of pricing, quality and data continues to increase for hospitals and physicians, driven by employers and governmental pressures to provide this information, and new healthcare technologies that make this possible.

• Growth in consumer-directed health plans with HSAs and HRAs continues, but at rates lower than predicted. Hybrid insurance [HMO and PPO] plans incorporating consumer tools are emerging as new health plan models. HMO and PPO plans are beginning to incorporate consumer tools that help them make wise healthcare purchasing decisions and help them truly take the individual reins of responsibility for their healthcare.

• Regional Health Information Organizations [RHIOs], which include the key stakeholders in the healthcare community, will serve as a stimulator of healthcare IT growth and development as applications including electronic health records, medication management, administrative efficiencies and related initiatives gain steam. They will become the repository or clearinghouse for these initiatives.

• Wellness and health promotion programs with stronger financial incentives including health risk assessments, smoking cessation, obesity management and other programs with differentiated employee premiums charged increase in popularity. These programs will be integrated with disease management programs in order to have a much more comprehensive approach toward managing high-risk patients.