Health Plans Looking for Strategies To Curb Costs After Reform Rollout

Health insurers are expected to begin more closely monitoring individuals with costly chronic conditions after the federal health reform law is fully implemented in 2014, the New York Times reports.

Under the overhaul, insurers will no longer be permitted to deny coverage to individuals with pre-existing conditions or put lifetime limits on coverage. As a result, health insurers are expected to look for ways to control the costs of such customers. "The insurance model is fundamentally changing," Daniel Malloy of IMS Health said.

Health insurers often work with self-insured employers to manage employees' health conditions, and other employers already are demanding they do what they can to control costs. Insurers also are experimenting with strategies to identify more costly patients and those who could develop serious complications. Many insurers say the next challenge is to determine how to coordinate with an individual's physicians.

Insurers also are experimenting with different payment methods. For example, Cigna plans to pay physicians higher rates to coordinate care and is looking at ways for doctors to share in the savings generated by helping patients avoid hospital visits (Abelson, New York Times, 2/27).

susan smith
Just the collaboration piece between providers - the sharing of patient records in some sort of shared database - will have profound effects. It may take a few false starts for the technology to get there. But just think about how many duplicated and unnecessary tests will go by the wayside once care is coordinated. There's hope yet for our health care system.
Bobby Gladd
That's pretty interesting. (Read the NY Times article specifically). All assumes that SCOTUS upholds the PPACA. The AHIP/BCBSA amicus brief is instructive. They argue that the "individual mandate" is not "severable," and, should SCOTUS strike the mandate, the whole thing necessarily falls, and they want back their exclusions, recissions, individual risk rating, and free rein w/respect to MLR. i.e., reset to 2008.

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