Sunday, October 21, 2012


As a group, we will need to provide and prove that we provide quality care and service to consumers that have access to quality ratings on the internet.  -Ed


Healthcare reform law to usher in new age of consumerism

Health insurance companies are developing services, tools and communication strategies to attract and retain customers.

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Paramedic Christopher Gutierrez prepares to draw blood from a patient at the University of Miami Hospital's Emergency Department. (Joe Raedle, Getty Images / April 30, 2012)


The Patient Protection and Affordable Care Act is changing the way insurers do business. A few years from now, you may see your health plan in a different light. You might even decide you like it — even if it's not that much more affordable.

But it's not all good news: Future employers are also expected to shift more costs to employees, and consumers will generally take on more of their healthcare expenses.

"A greater role in cost sharing is really forcing consumers to take a hard look at the care they access," said Robin Gelburd, president of Fair Health, a New York City nonprofit that provides healthcare cost information.

The health reform law will bring millions of new potential customers to insurers' doorsteps starting in 2014, ushering in a new age of consumerism. New services, tools and communication strategies are being developed to attract and retain your business, much the way banks and retailers have for years.

Health insurance companies will offer perks such as health coaching, online tools and medical information you can use to help you manage your health conditions. They'll develop mobile apps to help you find the closest pharmacy in your network and then show you which drugs are covered by your plan. They're creating video and online games to help you monitor your diet and exercise. And some have set up retail stores where you can talk with a specialist about your health insurance options or hash out problems with claims.

Gelburd says most large insurers already offer online cost calculators that help patients determine what their expenses will be before they seek care. Those that don't have one soon will.

Insurers are also changing the way they pay healthcare providers, which just might improve the quality of care you receive. Moving in line with models called for in the health reform law, payment methods will reward doctors and hospitals for providing quality care — not just more care.

You'll see the lines between healthcare providers and insurance companies blurring as both join together to create new entities such as accountable care organizations, or ACOs — groups of physicians, hospitals and, in some cases, insurers — to coordinate all the care for a large group of patients.

Insurers are also eyeing businesses that will help them expand their reach in a changing market to offer an even wider range of services. Over the last year, insurers have acquired healthcare technology firms and dental and eye-care companies, among others, said Jill Daily, a senior executive with Accenture Health in New York. The consulting firm projects that insurers will invest $10 billion to $12 billion in acquiring new lines of business over the next four years.

With all these changes, what does the insurance company of the future look like?

At its core, your health plan will be an information provider, said Karen Ignagni, chief executive of America's Health Insurance Plans, an insurance industry trade group in Washington, D.C. It will offer you resources, tools and education so that you can best take care of yourself and use your health benefits like a savvy consumer.

"The future is about providing information in a digestible way to consumers so they can be empowered," Ignagni said.
"Damned if you do, damned if you don't." -Ed


State investigating medical consolidations

The California attorney general's office is seeking information about concentration among medical providers and the effect on healthcare pricing.

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A wave of consolidation among hospitals and physician groups has drawn scrutiny from the California attorney general's office amid concerns that these alliances could boost medical prices.

Some hospital chains and insurance companies in the state said they have received civil subpoenas from the attorney general's office seeking information about market concentration among medical providers and the effect on healthcare pricing.

Sharp HealthCare, which runs seven hospitals and two affiliated medical groups in the San Diego area, said it was contacted by investigators, as were some insurers such as Health Net Inc. of Woodland Hills.

"We know that a number of other health systems and hospitals in California also received subpoenas in connection with the attorney general's inquiry," Sharp said in a statement.

A spokeswoman for California Atty. Gen. Kamala Harris declined to comment. The Wall Street Journal first reported on the inquiry Friday.

The federal healthcare law pushes medical providers to collaborate more on patient care in hopes that that will reduce costs in a fragmented industry. That has driven much of the acquisition activity across California and nationwide as hospitals and large medical groups merge.

Some healthcare experts, however, worry that this consolidation will raise costs as competition lessens in certain markets.

The California Hospital Assn., an industry trade group, said it's essential for hospitals and physicians to work more closely. "Criticism of hospitals that are responding to the demands of federal and state laws is unwarranted," said C. Duane Dauner, the group's president.

Dignity Health, the state's biggest hospital chain, and Sutter Health, which has 24 hospitals in Northern California, are also under investigation, according to the Journal report. The hospital chains declined to comment.

The insurance industry supports consolidation that promotes efficiencies, according to Patrick Johnston, president of the California Assn. of Health Plans, but not if it "raises prices with no clear benefit."