First posted 10/06/11 on Not Running a Hospital
A propos of the story below, see this comment from a piece by Paul Ginsburg in the New England Journal of Medicine.
The unchecked market power of some providers promises to become increasingly problematic for private payers. And if market approaches prove insufficient to solve a problem of this magnitude, regulatory intervention becomes more likely.
Why is this is a big deal?
Here’s what I predicted last April, with regard to the negotiation between the state’s largest insurer and the state’s largest provider group:
Look for the following “victory” announcement in the coming months:
Continue reading “As Predicted”
First published 3/17/11 on [Not] Running A Hospital
A recent report by the Massachusetts Inspector General raises a thoughtful concern about the implementation of global payments in the state.
In the effort to contain health care costs, much discourse has centered on moving from a predominantly fee-for-service system to one based mainly on global payments to providers organized as Accountable Care Organizations (“ACO”). There is little doubt that fee-for-service reimbursements create incentives for providers to increase utilization of health care services, with obvious inflationary consequences. But moving to an ACO global payment system, if not done properly, also has the potential to inflate health care costs dramatically.
Continue reading “The Inspector General Observes”
First published 3/21/11 on [Not] Running A Hospital
A story in the Washington Post talks about health insurance companies seeking new lines of unregulated business as the profitability of health insurance falls and as more and more requirements are placed on that line of business as a result of the federal health reform law. Here’s an excerpt: “Insurers have moved into technology, health-care delivery, physician management, workplace wellness, financial services and overseas ventures in wide-ranging efforts to mitigate the new rules imposed by the law.”
Continue reading “Insurance Companies Dancing Without Touching”