Jul ‘11
19
Managed Care is Back – This Time For Keeps
Minnesotans have had decades of experience with “managed health care.” Like health maintenance organizations called Group Health on the Iron Range and in MSP (now Health Partners.) In 1985 we launched Medicare demonstrations, using vouchered premium support payments pegged to 95% of traditional Part A and B. We in Congress started a movement toward managing care.
Medical markets responded by (1) merging community-based HMOs into one big managed care organization (MCO) like United Health Group, or (2) converting traditional BCBS state plans to for-profits and merging them into something like Wellpoint, or (3) large physician-hospital corporations appeared in markets without much third -party purchaser power (employees). Small physician group practices fought back against these efforts to reduce utilization of unnecessary services and reduce costs. And won public opinion to their side by the mid to late 1990s.
Ten years later managed care is back. In a couple forms. (1) The PPACA authorizes change in health care delivery and payment to reward providers with a share of savings from improving the value to consumer/purchasers of medical services. At the same time doctors are joining with hospital systems to improve the cost effectiveness of their time and talent. Systems that are reaching out to insurance companies to price the improved result for consumers. (2) The logical next step is for the larger health insurance companies to go into the health or healthcare business by acquiring medical clinics, hospital systems, or both. Just like Kaiser Permanente, the CA based HMO and third largest health insurer in America.
Aetna’s strategy is to be the data systems “back room” for health systems and specialty medical and surgical organizations. United and Wellpoint, the two largest insurers at $80 billion and $54 billion revenue each, are acquiring medical clinics. United’s OptumHealth is doing everything the traditional health maintenance organization did from research, education and health management, to using its huge data base to improve care quality and effectiveness.
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