For Profit healthcare at its best ?

Humana reveals to investors how it pays physicians

From the Article:

As part of what Humana CEO Michael McCallister described as his company’s plans to push an integrated care delivery model “as far and as fast as we can take it,” the insurer said it wanted to satisfy investors by showing its progress in some way.

The company’s earnings report showed an increase from 900 to 1,600 employed primary care health care professionals, who will be paid by capitation, assuming both upside and downside risks

Nethery said the goal is to move more physicians to the highest (financial)  category of risk.

“What we have talked to investors about is that with the integrated care delivery model, we get the most effective care for the member at the least cost when the provider is in a full-risk (financial) arrangement. The provider is fully engaged, given lots of data to help them to ensure the member gets a high-quality experience. And the member satisfaction rates are the highest in those type of arrangements,” she said

What the hell is a high-quality experience and how does this relate to a pt’s quality of life and disease management ?


3 Responses

  1. Make them happy – give them their drugs, surgery, whatever they want – as much as their plan pays for, without spending too much of Humana’s dime, and it’s all good.

  2. Sounds like metrics for everyone!! Anyone working in healthcare is screwed, not just the docs.

  3. It sounds like the physicians will be screwed. It appears, to me, to be a scheme to let the docs take all the risks and Humana reap the profits. Under this type scheme, it would not surprise me see a mass exodus of physicians from their profession.

    Here is some of the ‘gobbledy-gook’ put out by Humana:
    ‘integrated care delivery model’, ‘most effective care’, ‘least cost’, ‘provider is in a full-risk (financial) arrangement’, ‘provider is fully engaged’, ‘given lots of data’, ‘member gets a high-quality experience’, ‘member satisfaction rates are the highest in those type of arrangements’

    You try and determine what it means for a ‘provider to be fully engaged’? I think most physicians today see lots of patients and are probably are being pressured to see more. I expect they are fully engaged in what they do. So, Humana is essentially saying that physicians, under the current healthcare system, are not fully involved in what they are doing. I expect if you asked them that they would say they are very involved. The risk, which is the basis of insurance, is to be spread to the physician. In other words, the physicians and other healthcare providers will take on the risks that have normally been the domain of insurance companies.

    All this crap makes perfect sense to the insurance companies because they came up with these lame brain ideas to screw the healthcare providers, spread the risk to them, and increase the insurance companies profits. Heck…the insurance companies will not be risking anything. They will just sit back and rack in the money while the providers take all the risk and do all the work.

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