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It’s Insurance Carriers versus Medical Providers
Dr. David Edward Marcinko; MBA CMP™
[Publisher-in-Chief]
Some of the benefits for corporate America (payers), who supply the majority of health insurance to employees (insureds) through managed care organizations [MCOs] are listed below.
MCO Carrier Benefits
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Known medical expenses (fixed; not variable costs) to companies
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MD/provider’s bear the risk and benefits of patient compliance, not corporations
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Less administrative staff needs since medical claims are no longer reviewed
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Costs are reduced through economies of scale
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Patients are controlled and MD’s carefully managed.
Medical Provider Benefits
The following is a brief list of the benefits physicians supposedly may derive by participating in managed care plans:
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Stable patient load and predictable cash flows
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Potential referrals and community visibility
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Reduced office expenses, liability and utilization review
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Reputation equivalency (i.e., all doctors in the plan are good).
Assessment
Conclusion
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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:
- PRACTICES: www.BusinessofMedicalPractice.com
- HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
- CLINICS: http://www.crcpress.com/product/isbn/9781439879900
- ADVISORS: www.CertifiedMedicalPlanner.org
- FINANCE: Financial Planning for Physicians and Advisors
- INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
- Dictionary of Health Economics and Finance
- Dictionary of Health Information Technology and Security
- Dictionary of Health Insurance and Managed Care
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Filed under: Managed Care | Tagged: Managed Care |
The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants 
Troubles Never Seem to End for UHG!
Did you know that New York Attorney General Andrew Cuomo filed lawsuits last month against the UnitedHealth Group [UHG] for allegedly using rigged date when calculating industry standard “reasonable and customary” rates for coverage of out-of network medical expenses?
-Ann
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Consolidation of the Managed Care Industry
[A Decade Later]
According to Robert James Cimasi of Health Capital Consultants LLC, in St. Louis MO, managed care organizations (MCOs) are beginning to push their way into smaller markets, offering broader provider networks in the process. While there is nothing new about mergers in the managed care arena, for years providers have expressed concerns about the steady consolidation.
Moreover, an American Medical Association (AMA) report entitled “Competition in Health Insurance: A Comprehensive Study of U.S. Markets, 2010 Update,” a single insurer dominates in most of the nation’s markets. An AMA study of metropolitan areas in 46 states found that in 96 percent of the metropolitan statistical areas (MSAs), a single health insurer holds at least a 30 percent share of the commercial market.
A 2008 Government Accounting Office (GAO) survey found that the median market share at the state level of the largest small group carrier had risen to 47%. The same GAO survey also concluded that in 34 of the 39 states surveyed, the five largest carriers had a combined market share that was 75% or more, and in 23 of these states, the combined market share for the five largest carriers represented more than 90%. This reduction of competing health plans has raised concerns among both physicians and patients because competition drives innovation and the efficiency that can result when there is not a lack of competition within the healthcare marketplace.
Source: “Healthcare Organizations” [Management Strategies, Tools, Techniques and Case Studies]. In-Process from: (c) Productivity Press 2012
http://www.crcpress.com/product/isbn/9781439879900
Ann Miller RN MHA
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