Last quarter we reported that we fully expected the reform debate to be squarely behind us and to have ushered in a new era in U.S. healthcare delivery. At the time of going to press, a decisive vote is looming but we are no closer to the reality of reformed care than last year and may not know the impact for many quarters to come regardless of how the vote goes.
That said, value-based concepts (high efficiency, lower cost, efficacious medicine) is gaining momentum. Last quarter we gave some attention to discussing Value-Based Purchasing and within that context, the advent of ‘narrow networks’. That time has arrived. UnitedHealthcare has announced the launch of UnitedHealthcare Core, a PPO alternative to network HMO products in the Chicago and Northwest Indiana markets which has as one of its features, a narrower network of participants than the traditional benefit plans. To make the grade, providers need to have admitting privileges at a UnitedHealthcare Core participating hospital to be in-network for this plan.
Not content to build programs in collaboration with their physician networks, Payers are going direct to consumers with ‘wellness’ programs. I attended the Managed Care Business Forum in Washington, DC, a few weeks ago and was left asking myself ‘where’s (doctor) Waldo?’. Disease management programs, wellness coaching, smoking cessation, nutritional counseling – you name it, and the Payers are working with non-physician third parties to deliver it. Cutting the physician out of the picture? It would certainly appear so.
So what can be done? Some Payers are paying attention and do value the patient-physician relationship and there is an opportunity for physicians to utilize the programs that support good clinical care (you’ll find a few in the comments on the following pages). While some programs extend the care that physicians can deliver, we are concerned that several are positioned to substitute for it so discuss with your patients what third-party programs may be available to them through their employer or insurer, and make sure that they understand that these should be in addition to, not instead of, your relationship.
With the advent of spring, here’s hoping the reform debate will be squarely behind us by next quarter and that there will be some good news on the horizon for physicians and their patients alike.
Click on the Q4, 2009 image to the left or link below to download the full report. We welcome your feedback so please send any comments you may have to us via our Contact Form.