Reimbursement
Every organization looking at someone else's business thinks there is a tremendous amount of waste, and believes they could do it better if given the opportunity. This is just as true in healthcare as any other industry.
In the last few weeks there's been good, bad and ugly news for Medicare Advantage (MA) plans. On one hand, the program has never been stronger and quality metrics are surging in the right direction; on the other, the industry is sucking it up on following the rules of its biggest customer, the Centers for Medicare & Medicaid Services.
Many health insurers have spent close to a century operating under fee-for-service and are now changing course. Some new payers founded post-health reform, however, are trying to hit the value-based ground running.
Of all the things to try to build a better business for in healthcare, the nation's fourth-largest Blue Cross insurer is focusing on one of life's most crucial processes.
Insurance industry margins are only about 5 to 6 percent and it is a notoriously difficult business to run. Still, providers are increasingly moving into the insurance industry, and for some, it has been a good addition to their business model.
Encouraging employer programs for health and prevention with one hand, the federal government is trying with the other hand to stake out a limit to what can be required of employees. And it's getting a bit fractious in the wellness space.
Figuring out when members are covered by different types of insurance can be a struggle, or not even possible. It's a source of waste and confusion that some insurers are trying to root out.
In coming years, health systems will likely take on more risk for the health outcomes of their patient populations. If they are looking to prepare for the inevitable, support programs for Type 2 diabetes may be a good place to start.
UnitedHealth continued its shopping spree on Tuesday with Optum, the group's technology and services subsidiary, agreeing to pay $600 million to acquire Alere Inc.'s condition management and wellness subsidiaries.
The raison d'etre and central function of health insurers has had a slow time coming into the 21st century. But with both providers and patients demanding a better experience, the impetus for progress could bring a critical mass.