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Health Insurers Rolling Out Programs To Doctors and Hospitals to Help Keep the Cost Down With Even Additional Focus on Admission

Posted Oct 08 2010 4:15pm

We all know about the new Medicare rules and guidelines too but I had to somewhat chuckle a little when I read the line below from the Aetna executive who basically had dreams of eliminating the need all together for hospitalization and that goal might be a little too over-zealous because that won’t happen any time.  Actually folks making statements as such kind of scare me a bit as I wonder where their sense of reality lies beyond statistics.

"The best discount and the best way to lower costs...is to obviate the need for the hospitalization all together," said Aetna's chief medical officer, Dr. Lonny Reisman. "We're insinuating ourselves more and more in the actual care of the patient."

These are tough times as hospitals on the other hand look at how many admissions they have and get paid for in order to keep the doors open when it comes to covering the fixed costs.  The AMA is kind enough to remind us too of the 65,000 folks in California that will be getting their average increase of just under 19% this month on Aetna premiums.  In New York Aetna was fined $850,000 to settle charges including incomplete disclosures, so more algorithms to question.

We all know there is money to be saved with prevention but it’s not 100% as people are born with diseases and afflictions that prevention might help with treatment processes but it won’t eradicate the problem.  This whole issue since some of the new laws have taken effect is getting interesting as we have Wellpoint trying to convince employers to grandfather their agreements, so not much will change.

Further more I look at things at the link below to where the insurers have such an overhead of red tap (much they created internally) that they jump on this bandwagon to get subsidies for retirees too young for Medicare.  In other words we will let the feds take care of this money issue before they get you entirely at 65 if you decide to retire and want health insurance. 

I guess HHS was backed into a corner here and couldn’t do much else, but if I were an employee of one of those 2 companies and was thinking about an early retirement, it certainly sends a message about how much I would valued, not much once a determination is made to retire, you’re history and don’t bug us about health insurance anymore.  Here’s one more example in addition to the article below.

It will be interesting to see through all of the new programs and contracts if patient care and location comes into play too as that has been a real sticky point in the past with people having to travel great distances to see someone in network as we head a bit backwards to the HMO business models which were really not all that bad, but now with incentives going even further, time will tell how all this will play out.  BD

Health insurer Aetna Inc. (AET) is developing plans to pay a major San Diego medical group enhanced fees for providing extra services to keep patients healthier, and to share any resulting cost savings.

With a similar cost-saving goal, UnitedHealth Group Inc. (UNH) has started to base payments to its network providers partly on cost and quality measures, and Cigna Corp. (CI) guarantees corporate clients it will lower employee health risks.

Fueled by the weak economy, the health overhaul and anxious clients, insurers are taking steps to lower medical costs, including introducing new pay structures to encourage care that averts hospitalizations. They are also offering employers narrower, lower-cost provider networks, prodding enrollees to form healthier habits and pick less expensive doctors, and getting tougher in hospital price negotiations.

"The best discount and the best way to lower costs...is to obviate the need for the hospitalization all together," said Aetna's chief medical officer, Dr. Lonny Reisman. "We're insinuating ourselves more and more in the actual care of the patient."

UnitedHealth's commercial UnitedHealthcare business is testing the medical-home concept with some 50 practices in five states.

UnitedHealthcare Chief Medical Officer Dr. Sam Ho said the early signs are promising that the patients are getting more complete care by receiving more preventative services like diabetes and breast-cancer screening. Early results indicate people are staying healthier on an outpatient basis for longer, he said.

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