Reduce choice of provider — insurance saves money

choicePatients like a choice of healthcare providers but never are willing to pay much for that opportunity.  Recently, insurance companies have taken advantage of shrinking the available panel of physicians to select those that are both less expensive and provide higher quality.  The higher quality part is obviously secondary.

Electa Draper of the Denver Post reported 7/27/14 “Coloradans could lose medical choices, but save money”.  The essence of the article was a report on the United Healthcare (UHC) plan to “narrow the panel” of available physicians.  $100 per month is reported as the possible  savings for subscribers to the plan.

UHC is the largest insurance carrier in the US.  This national strategy to “narrow the panel” will save someone some money; but, the amount of leverage this gives to quality is nebulous.  This huge insurance company could raise US healthcare quality to number 25 from number 26 in the world — sadly they don’t have much ambition for international competition.

The lack of transparency is striking:

  • will all the cost savings be passed on to the consumer?
  • will CEO Stephen Hemsley’s salary go higher than $106 milllion?
  • physicians seem easy to squeeze for money; what about drug companies, device makers and hospitals?
  • what quality measures cause physicians to be excluded?
  • forcing patients to change doctors as employers change insurance plans is common practice — when will this stop?
  • will UHC or any insurance company saying they intend to improve quality also reduce errors?  Will they stand shoulder to shoulder with physicians who are named in medical error suits?
  • will UHC reduce patient waiting times?
  • will UHC drop Medicare patients and stick with younger healthier patients?

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  1. #1 by frankscotto on August 1, 2014 - 1:11 PM

    RMHP has a broad network of over 15,000 Colorado physicians and 107 hospitals. https://rmhp.org

    • #2 by qualityhealthcareplease on August 1, 2014 - 2:16 PM

      Thanks for commenting. RMHP is indeed a network but it’s insurance products were not included in the Colorado Connect website last year. I think they will appear this year. Unfortunately, the star quality rating is not known yet. Sadly, the products are not listed with the US News health plan listing. Having a network is really not sufficient without the quality to back it up. Do all the providers have a common health record? Is pharmacy integrated? What percent of your providers take new patients? Do all the primary care providers allow transition to Medicare when the time comes?

  2. #3 by qualityhealthcareplease on July 30, 2014 - 9:20 AM

    Thanks for the comment. I agree with your notion “we might as well go with the cheaper alternative”. I have never seen insurance companies monitor waiting times for appointments — so only when there are a huge number of complaints will they find out the panel is too small. It would be interesting to know if insurers have figured that out.

  3. #4 by dewe67 on July 28, 2014 - 3:59 PM

    Theoretically it’s valuable to have a choice of providers, but since there’s little correlation between cost and quality (as you have pointed out on the Health Business Blog) we might as well go with the cheaper alternative.

    Health plans offering narrow networks certainly understand the financial tradeoffs. As you wrote, $2 per visit is about what it’s worth to a patient to have their choice. https://qualityhealthcareplease.wordpress.com/2013/08/15/choice-of-doctors-what-is-choice-worth/

    I agree it is undesirable and disruptive to have to switch providers or health plans from year to year.

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