Posted on 03/27/2014 10:13:38 AM PDT by Star Traveler
The problems with the implementation of the Affordable Care Act may be masking another major change in the way health care is delivered to U.S. consumers, experts believe.
At a conference in Washington on Thursday, health care and business professionals said that there’s an increasing trend in the industry toward cutting insurance companies out of the process entirely, as large, regional hospital systems move into the insurance business.
Dr. Kenneth L. Davis, CEO and president of Mount Sinai Health System, the largest health care provider in the state of New York, said that starting next year, Mt. Sinai will begin offering its own Medicare Advantage plan. It will look for other opportunities to bring premium payments directly into the hospital system, rather than filtering them through insurance companies.
Davis said he expects organizations similar to his to move in the same direction. “Inevitably the large systems are going to move to take part of the premium dollar,” he said.
(Excerpt) Read more at thefiscaltimes.com ...
The hospital is NOT cutting out the insurance company, the hospital is setting up a subsidiary that will be an insurance company. Same system, just both entities owned by the same holding company.
This could be great.. it could reduce costs, make payments easier, etc.
Or the opposite could be true: you could end up with your medical provider and your insurer in bed together, neither having any incentive to cut costs, etc.
Exhibit A: the mud-slinging eye-goughing insult-throwing groin-kicking slap-fight currently going on here in Pittsburgh between UPMC and Highmark BC/BS.
I haven’t seen that Medicare Advantage would go away. That’s Medicare “Part C” - which takes the place of — Part A, Part B and Part D. You either have Part C - or - you have the other three together.
Now ..., I’ve got Part A, Part B, Part C - and - Medigap (Medicare Supplement Insurance) — which covers 100% of anything and everything. I have nothing out-of-pocket to pay on doctors, hospitals, labs, X-rays, equipment, rehab or anything - not even any deductible. I would rather have that than Medicare Part C.
But, again, who said that Part C was disappearing?
Here’s some info on that part of Medicare ...
http://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/how-medicare-advantage-plans-work.html
When you get to Medicare age, then get what I have in Post #45, and you will be well covered.
hospitals don’t either.
As an insurance agent a med supp is superior to Medicare Advantage. Just make sure before you go on Medicare you already have relationships with key doctors such as your GP,Cardio,Endo etc.
They’ve got a hard-coded link to mine - and the bottom line result is I pay no deductible, no copay, no anything - just my premium.
I’ve always thought that a company like Wal-Mart would be what revolutionizes medical CARE. I thought a company that knows how to bring low cost goods to every corner of the nation would somehow figure out how to put urgent care or walk in clinics at affordable prices to all their stores. Much like they do with the eye glass stores.
BUT, the system is so irredeemably screwed up the system will collapse. And it has nothing to do with care. I am blessed with a good enough business and savings to cover all but the most catastrophic medical emergencies. No Obamacare for me. To those that had their plans cancelled and have deal with this mess I am sorry for you. I am sure eventually it will be a criminal offense NOT buying obamacare approved insurance and I will be threatened with prison time but until that day comes I’ll keep as far away from Obamacare as possible.
And the sad part is they really aren’t lying. They probably are being billed $671 because the pharmacist knows that’s the only way to get that combined $120 that they need to sell the drug without losing money. This is also the source of those crazy bills that hit the net periodically where the hospital is charging $100 for a cotton ball, they don’t really want $100 for a cotton ball, but they’ll get $2 out of it which will make up for something else the insurance company “discounts”.
Having worked for 20+ years at a world famous hospital I can comment on this point.This nations finest hospitals...hospitals in Boston,New Haven,NYC,Baltimore,San Francisco,etc....are,it can be said,self contained medical "meccas".For example...if you walk into the ER of,let's say,Yale New Haven Hospital with chest pain the fact that you don't know anyone there will not prevent you from getting just about the finest care available on earth regardless of how serious or how rare your problem is.In hospitals like that,and hospitals like Mount Sinai,every single medical specialty is *very* well represented.It's when you get away from these "mega hospitals" that problems of quality of care (and other problems) might arise.
Good and then break the state/local geographic monopolies allowed for hospitals. Also, allow non-doctors to own medical practices and hospitals.
Isn't that what the current insurance companies do for the hospitals now?
Imagine if each hospital had to have a department to coordinate with all the other hospitals, and to keep track of the relationships and negotiated patient fees, and to access each other's patient records.
Don't the insurance companies create networks, and broker the relationships between the network hospitals and the insurees (patients)?
Why destroy what we already have in place, and then over-burden a hospital to provide these internal B2B, non-medical services with untrained, newly hired people?
-PJ
Most individual doctors and nurses generally do. Administrators, not so much.
On the face of it sounds OK. What are the cons?
There’s not that much profit left, but there is a lot of redundancy. Insurance companies perform a valuable service and were a reaction to government policy. We need to crack open health care to the free market. Then sit back and watch prices fall and access rise and rise.
You really don’t need health insurance, just access.
It is the government that is causing a shortage in health care. Walmart is ready to enter the general practitioner market, but crony capitalists - doctors, hospitals, et al - are using their political clout to stop it.
There are several hundred laws at the state, county and local level that increase the cost of health care. Insurance companies want cheap health care too. It helps their bottom line.
“You really don’t need health insurance, just access.”
yep
It will just increase the dynamism. The more choice, the better. Healthcare mavens will solve the information overload, just like they do with travel and everything else. Why shouldn’t a pharmacist be able to prescribe? Why not a nurse? Why not a patient? Most drugs aren’t addictive or in the illicit drug trade.
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