Tuesday, January 31, 2012

Good bye Health Insurance Companies? We can only hope.

Dumb Ron Johnson stupidly continues to rail on The Affordable Care Act, even though the CBO figures it'll save a trillion dollars or more over a 20 year period; cover a lot more people; get rid of pre-existing condition death sentences; and force reform. 

In fact, if it wasn't for Obama's plan, innovation would not be rumbling along. Story after story of the changes, improvement and money savings have been well documented. The best sum total of these stories is below, where health insurers are tossed to trash bin of history. NYTimes:
Here’s a bold prediction … By 2020, the American health insurance industry will be extinct. Insurance companies will be replaced by accountable care organizations — groups of doctors, hospitals and other health care providers who come together to provide the full range of medical care for patients.

Already, most insurance companies barely function as insurers. Most non-elderly Americans — or 60 percent of Americans with employer-provided health insurance — work for companies that are self-insured. In these cases it is the employer, not the insurance company that assumes most of the risk of paying for the medical care of employees and their families. All that insurance companies do is process billing claims. For individuals and small businesses, health insurance companies usually do provide insurance.

A new system is on its way, one that will make insurance companies unnecessary … thanks to the accountable care organizations provided for by the health care reform act, a new system is on its way, one that will make insurance companies unnecessary. Accountable care organizations will increase coordination of patient’s care and shift the focus of medicine away from treating sickness and toward keeping people healthy.

Because most physicians and hospitals today are paid on a fee-for-service basis, medical care is organized around treating a specific episode of illness rather than the whole patient. This system encourages overtreatment and leads to mistakes and miscommunication when patients are sent between their primary care doctors, specialists and hospitals. In contrast, accountable care organizations will typically be paid a fixed amount per patient, along with bonuses for achieving quality targets. The organizations will make money by keeping their patients healthy and out of the hospital and by avoiding unnecessary tests, drugs and procedures. Thus, they will actually have a financial incentive to hire that nurse for follow-ups.

In addition to providing better and more efficient care, A.C.O.’s will also make health insurers superfluous. Because they will each be responsible for a large group of patients (typically more than 15,000), they will pool the risk of patients who have higher-than-average costs with those with lower costs. And with the end of fee-for-service payments, insurance companies will no longer be needed to handle complicated billing and claims processing, nor will they need to be paid a fee for doing so. Payments can flow directly from an employer, Medicare or Medicaid to the accountable care organizations.

A.C.O.’s are not simply a return to the health maintenance organizations of the 1990s. H.M.O.’s were often large national corporations far removed from their members. In contrast, A.C.O.’s will consist of local health care providers working as a team to take care of patients who are likely to be members for years at a time. A final bonus of A.C.O.’s is that they will lead to a better form of competition in health care markets. Today, consumers have to choose among insurance plans with a bewildering array of copayments, deductibles and annual out of pocket maximums — choices that few of us are any good at making. In the A.C.O. model, consumers will choose a primary care physician and the team of doctors and hospitals that are in the same group. Choosing a doctor and provider group is a responsibility that consumers want to have and are likely to be much better at.

A few health insurers see this asteroid coming. Wellpoint, for example, bought the clinic operator CareMore for $800 million last summer to make the transition into the A.C.O. business.

1 comment:

  1. highly doubt it but it does raise a valid point. Programs like PCIP Preexisting condition insurance plans are really gaining awareness now for thosee with ailments cant get coverage elsewheres. At least for now take advantage. Check eligibility at the site http://Preexistingconditioninsuranceplan.com - As for 2020 who knows but for now get covered with whats available.