The health care landscape has changed dramatically over the five years Cincy Magazine, the West Chester + Liberty Chamber Alliance and Humana have held the annual Healthcare Summit.

The Affordable Care Act, thought controversial, is entering its second year of extending insurance to more individuals. Innovation continues to drive advances in care, while providers are building more and more facilities to be closer to prospective patients.

Still, one thing that hasn’t changed is that individuals and businesses continue to struggle with health care costs.

“It’s become very difficult to predict what your costs are going to be beyond your current policy,” says Jeff Cryder, chief financial officer at Blue Ash tech firm iSqFt Inc. “That makes it very difficult for those of us who have to shepherd resources to make spending decisions on capital deployment in the business.”

Cryder was one of the panelists at the 2014 Healthcare Summit, which brought 250 to the Sharonville Convention Center. He was joined by Dr. Rick Lofgren, president and CEO of UC Health, and Jim Schwab, president and CEO of Interact for Health and InterAct for Change, in a discussion of health care trends and challenges led by moderator Dr. Derek van Amerongen, vice president and chief medical officer for Humana of Ohio. Predicting the future, the panel agreed, is particularly difficult in health care.

Five years ago, for example, it was generally thought hospitals would need to double the size of their emergency departments to cope with the onset of mandatory health care, says Dr. Lofgren. “Now, five years later, emergency department business is down around the region and down by a fair amount,” he says.

The decline has been driven by the increase in high deductible insurance premiums rather than the Affordable Care Act, he says. Market forces are reshaping health care faster than legislative changes, he says.

“It’s incumbent on the industry to think about ways to redesign health care delivery systems in ways that are effective, meet the needs of all citizens and are affordable,” he says.

In the wake of the Affordable Care Act, Interact for Health, the nonprofit formerly known as the Health Foundation of Greater Cincinnati, has shifted its focus to helping people make healthier choices in the 20-county region it serves, says Schwab.

For example, funding walking trails and bike paths to encourage exercise and funding 22 health centers in Cincinnati schools to provide basic health services and education to help students make healthier choices.

Helping people live healthier lives is worthwhile but it may not have much impact on overall health care costs, says Dr. Lofgren.

“The economic reality is that it’s not going to save money, certainly in the short run,” he says. “The reality is 10 percent of population spends 70 percent of the [health care] money. If you look at the U.S. system that’s true.” It’s the same in Denmark, Canada and Australia, he adds.

“If you go through the list of [health] spending, you’ll find very little that’s preventable in the short run, but it is manageable,” he says.

If that ratio is true around the world, Dr. van Amerongen asked, why is it that U.S. health care spending is two or three times higher per capita?

It depends on what segment of the population you look at, Dr. Lofgren says.

“If you look at people between 20 and 65 and compare our health care costs relative to the rest of the world, we are about twice as much,” he says.

“One thing I’d say is that as a wealthy nation, maybe that’s acceptable. Where you really see a change in health care costs is for those 65 and over. We’re three or four times more expensive than the rest of the world.”

If U.S. health care spending for those over 65 was only twice as much as the rest of the world, that would generate savings of between $350 billion and $400 billion, he says.

Wellness programs are increasingly standard in most company health insurance programs, but Cryder says a survey of iSqFt employees found they were overwhelmingly more concerned with the size of their payroll deduction for their health insurance than the wellness program.

Wellness programs don’t drive a reduction in insurance premiums for employers, but Dr. Lofgren says that they do create a healthier and more productive workforce. “That’s the return on investment for employers, not a drop in premiums,” he says.

Schwab says he’s not yet ready to write off efforts to improve population health on a large scale.

“The difference is the length of time,” he says. “Population initiatives probably take a decade or more to have an impact.”

Healthcare Summit Re-Cap

Dr. Derek van Amerongen is vice president and chief medical officer for Humana of Ohio. He oversees the medical management and strategy for one of the nation’s most innovative health plans. Dr. van Amerongen has written and presented extensively on managed care and health topics. He is on the faculty of Xavier University in the School of Health Administration. He has been recognized for his teaching contributions at both the Johns Hopkins Hospital and the University of Cincinnati School of Medicine, where he is an associate professor in the Department of Obstetrics and Gynecology.

Jeff Cryder is the chief financial officer of iSqFt, a Blue Ash-based provider of online construction management technology. He is responsible for safeguarding the company’s assets, managing business risk, shareholder relations and, with his team of professionals, providing accurate, timely and relevant financial reporting. Jeff’s experience began in the Cincinnati office of Arthur Andersen, where he was active in the firm’s local construction industry practice.

Dr. Rick Lofgren is president and CEO of UC Health, the region’s only academic health care facility, including UC Medical Center and West Chester Hospital. He is a board-certified internal medicine physician and administrator with 35 years of experience in health care. Most recently he was senior vice president and chief clinical officer for University HealthSystem Consortium, an alliance of 120 academic medical center and 299 of their affiliated hospitals, in Chicago.

Jim Schwab is president and CEO and board member of Interact for Health and InterAct for Change, the former Health Foundation of Greater Cincinnati, which funds efforts to help people live healthier lives. He is a former Cincinnati market president for US Bank and continues to serve on its Cincinnati advisory board. He is the former chairman of the board of TriHealth and Bethesda Inc. and currently a board member of the Health Collaborative and the Health Policy Institute of Ohio.