Diabetes, congestive heart failure, and heart disease are increasingly conditions of the poor. And the poorer one is, the more common the condition.(free reg req)
Most health plans have little experience dealing with poor folks with chronic health problems.
They’d better start learning.
The health insurance system will be dramatically altered within a few years. Argue if you like, that’s my prediction and I’m sticking to it. Health plans’ financial performance will be driven not by how well they select risks, but by their ability to actually ‘manage’ care.
Health plans exposure to poorer folks is effectively limited through medical underwriting of individual and small group policies; and unless they qualify for a governmental program poorer people just can’t afford the insurance premiums and out-of-pocket costs.
If universal coverage is part of the new health system (and that’s where my bets are placed) that all changes.
Who’s best situated to succeed in the new world?
I’m leaning towards Aetna. They have done more than any other national health plan to prepare – gaining expertise in data mining, developing programs specific to disease states common among lower-income folks, and participating in CMS pilot programs targeting the chronically ill.
Aetna has also been the first of the big health plans to provide members with tools to figure out the costs of their medical conditions.
While UnitedHealthgoup, Wellpoint/Anthem, Coventry and others have dabbled in this work, none appear to have embraced it as thoroughly as Aetna.
What does this mean for you?
Go long on Aetna.
Problem is, Aetna is such a poor payor to the Physicians many of them do not want to participate with them any longer. So all of their managed care will go unnoticed if nobody wants them.
My employer has Aetna and frankly I am ashamed of what they pay the Dr I go to. And I pay more of the visit on the co-portion then Aetna does. If this is how they manage care, meaning get out of paying things, then yes, Aetna is ahead of the game.
So for the docs in your world- “many” is the same as “nobody”? Well that is certainly an interesting logical leap.
And you are ashamed that your doctor is paid so little? Why? You make up the difference. Your doctor doesn’t care as long as you make up the difference. And after all, your employer–not the insurance company–decides what your plan will pay.
But this debate long ago descended from the factual and logical into the emotional and psychological.
You want the government to manage your health care? Why? Because the government bureaucrats will be much more attentive to your needs than the insurance company bureaucrats will?
Stella:
I am in the healthcare field and privy to how many Dr’s have contracts with Aetna in my area.
And if you knew anything about contracts, then the difference I make up with my co-portion is the agreed upon price Aetna set with the Physician who are on the plan. Yes, my employer sets the copay amount, doesn’t change the agreed upon amount the Dr is forced to take by participating. Some of them cannot get out of participating due to corporate decisions they cannot change.
Sounds like you work for Aetna, you sound pretty defensive. Need to get your facts straight, though.
I did not say I wanted Government to manage my Healthcare, so not sure where you pulled that out.
“I am in the healtcare field and have privy ”
Well, alrighty then.
“the agreed upon price Aetna set with the Physician”
Since you’re the one who’s privy, I suppose you can explain how any insurance company can “set” an “agreed-upon” price? If the price is not worth it to the docs, the docs would not play. (And a few are indeed deciding not to play). The vast majority of docs agree to play. They are “forced” to accept nothing that they have not agreed to. Also, your remark about “corporate decisions they cannot change” is disturbing. Are you suggesting that doctors are so malleable? God forbid.
BTW, I am an accountant. I have privy to a fair number of physicians’ incomes. They’re all doing somewhat better than quite well–I’m sure that is no surprise to you.
“I did not say I wanted Government to manage my Healthcare”
True, nor did I. I did ask you three questions: You want the government to manage your health care? Why? Because the government bureaucrats will be much more attentive to your needs than the insurance company bureaucrats will?
If you don’t want the government managing your health care, wouldn’t the appropriate response be “no”?
You just sound like you want to argue with people
My company for years has dealt with Humana for health insurance. Today we found out that in 2008 we will be switching to Aetna healthcare. My biggest concern is that I will be losing the Mayo clinic doctor I have been with for 4 years. Does anyone know if Aetna works with Mayo clinic? It would be a real bummer if I have to go looking for a new doctor when I have been so happy with the way I am treated at Mayo clinic.
“Does anyone know if Aetna works with Mayo clinic?”
Go to Aetna.com and look for the link that lets you search for specific hospitals in their network. Most of the big health plans have this kind of search facility.
Or, you could just call Mayo and ask them.
“You just sound like you want to argue with people”
What kind of a comment is that? does it make sense for an insured person to feel “ashamed” at the amount that their physician is paid for services?
I worked for Aetna and had a first-hand view of their informatics work and disease management programs. Aetna does indeed have an edge over other health insurance companies in that their data are centralized in a warehouse and readily available for analysis.
And, they do indeed put those data to use in the initiatives you listed. However, the folks at Aetna, like those at other H.I. companies, have little incentive to make those programs work well, since they are a direct cost to the bottom line. The programs are more good marketing efforts rather than careful programs designed to genuinely improve outcomes.
Although Aetna arguably may be a bit ahead, other H.I. companies have similar efforts. For example, Wellpoint has connected small fraction of compensation to patient’s outcomes, although it is unclear exactly how they will do so.
United Health patients with severe CHF are monitored by Secure Horizons that puts an electronic scale in the patient’s home. It is connected to small monitoring device which asks daily yes/no questions. A phone jack is supplie so it sends data by home phone. Data includes patient name, weight and answers to Y/N questions asked at each morning wakeup time and just before bedtime- twice daily. The recipient is a corps of registered nurses in Nevada and other states. They notify family doctor and calls patient by phone when weight increases (fluid retention). A chart is fax’d to family doctor and nurse makes phone call to patient to discuss problem and plan of action.
Allan, Winston-Salem, NC
I might add that the nurses are very knowledgable and listen to patient’s problem patiently and suggest solutions available. I enjoy talking with them.