Does Our Health Insurance System Really Provide Choices?

With the ACA falling apart at the seams, how are the carriers watching out for Our Interests and improving Our Outcomes?

The Wall Street Journal last week provided us with some insight regarding the big player’s interest in expanding their health care offerings and controlling their costs. A brief history is helpful.

Aetna unsuccessfully attempted to buy Humana (2015) for $37 Bil, CVS purchased Aetna (2017) for $70 Bil, CIGNA planning to buy Express Scripts (2018) $50 Bil, after failing to receive approval from regulators to buy Aetna (2017). Anthem to launch its own PBM (Pharmacy Benefits Manager) causing harm to its long term partner, Express Scripts, their biggest customer generating $17 Bil. in annual revenues. Seen as retaliation to their impending Anthem divorce, Express Scripts purchased eviCore Health Care (2017) for $3.6 Bil, Walgreens Boots Alliance had been attempting a takeover of AmerisourceBergen Corp, a large drug distributor, with grocer Albertsons Cos agreeing to buy what is left of the Rite Aid Corp.

Oh, did I mention that Amazon is an additional driver in this consolidation of power, as it becomes a competitor in health-care-equipment?

Simply stated, when competition becomes monopolized, who’s controlling Our Choices, maybe I can provide some direction.

As a Registered Employee Benefits Consultant and Financial Advisor, having the distinct privilege of working with the medical community for over 40 years, I recently had the opportunity to be introduced to two relatively new professional “disruptors” that could be a welcome transfer of power back to the small entrepreneur and most importantly, the patient and their choices, while providing reduced costs in the pursuit of Good Health, Better Outcomes, Lower Premiums and More Choices.

Disruptor #1-Physicians dealing with Chronic Care Management by Medicare, who would like to provide better patient care, complementing your current care plans by engaging patients in between office visits. As physicians, you are acutely aware of the studies proving better outcomes of monitored patients. Regrettably, the pressures of volume and care are conflicting, competing and persistent problems for the physician and patient. This surrogate assistant could extend your care into the homes of your patients, increase compliance and improve care and outcomes, resulting in more office visits, while providing for an additional income stream estimated to provide net revenue of $240 per patient.

Disruptor #2-We are all aware of shrinking plan options, network access and excessive and ever escalating premiums. This group will be changing the landscape with their wholly owned reinsurance carrier, allowing them the creative and necessary flexibility to be in tune with the current demands of your patients and, equally important, your Group Benefit Programs, allowing you to essentially create “your own Benefit Plan”. Referenced base pricing (RBP) and Smart Deductibles designed to meet the expanding needs and concerns of your practice, valued employees and overhead, which occupies the second most expensive item on your P&L.

Please check our website Blog for upcoming dinner meetings to introduce you to these “Disruptors”. Feel free to contact my office for any questions in the interim.

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