Could this be our future?

http://www.washingtonpost.com/business/some-hospital-networks-also-become-insurers/2012/08/25/53e90a72-eb1d-11e1-b811-09036bcb182b_story.html

Obamacare has mandated the formation of ACO’s (Accountable Care Organizations). Think of Kaiser model on the west coast. Where the ACO is at financial risk for providing care to the patients they are assigned to provide healthcare to. For those not paying attention, hospitals having been buying up physician practices… one here… one there…doing so in such a matter that the Dept of Justice is not noticing that some/many of these hospitals are creating monopolies in many markets.

Here is a quote from the article… Michael Dowling, who runs one of New York’s largest hospital networks, is preparing to turn his business model on its head: He wants to keep his hospital beds empty, rather than full.

The new “game plan” is to spend as little as possible per patient/year.. while not compromising the patient’s quality of life or life expectancy. Since medications are estimated to be 10%-12% of the total spent on healthcare… could medications and compliance become the new “cost saving” venue.

We don’t have enough GP’s/FP’s or other secondary healthcare professionals to deal with all of the increased one-on-one patient interactions, particularly if 30-50 million are thrown into the “insured pool” … many/most with untold number of long term unmet healthcare needs..

Could the PBM’s find themselves on the outside looking in… as the chains that don’t have such PBM structure develop one.. either individually or collectively? Could these ACO’s go into competition with the community Pharmacies… like Kaiser does?

It seems interesting that – according to that article – this whole program is to begin implementation in 2015 …just at what is estimated to be the cusp of the RPH surplus/year starts to max out.

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