Insurance Plans Piloting Primary Care Programs

Healthcare operations continue to stride forward in new directions; Forbes published an article this week detailing how BCBSGA, UHC and Aetna are running pilot programs where they are directly employing providers that circumnavigate the existing healthcare delivery systems.  From the plans’ perspective; exerting more control on the delivery system has led to reportedly positive impacts; including improved quality metrics and reduced cost.  While this is certainly an admirable objective and a focus of the overall healthcare model being rolled out today from CMS to all other payers; there is no universality in measuring these objectives and how the health plans are meeting these goals is a matter of self-analysis and reporting.

What is particularly concerning about this is that health plans have full knowledge of the provider rates that they have established in every market giving them a significant competitive advantage to ensure that they are driving patient volume to their own physicians and clinics.  From a regulatory perspective regarding anti-competitive rate setting; it will be fascinating to follow any legal challenges that health plans may face in the coming years based on the redirection of services away from established providers in their markets.

While this is not something that we anticipate will be rolled out anytime soon; it is imperative to monitor the developments and understand the impact that it could have on your business as plans push into this new realm.