Even doctors are vocal critics of the status quo
of ConsumerAffairsSince the Dec. 4 murder of UnitedHealthcare CEO Brian Thompson, there has been an avalanche of complaints about the health insurance industry. The Wall Street Journal reports that many of the complaints come from doctors.
Doctors say they are spending more time and effort arguing with insurance companies to get them to pay for necessary medical care for their patients.
Its getting worse, Dr. Zulfiqar Ahmed, an internist in Augusta, Ga., told the Journal. This is not only UnitedHealthcare, this is universal in this country.
Health insurance companies counter that their denials keep a lid on spiraling medical costs, limiting unnecessary procedures. But there is no denying that as coverage denials rise, so do health insurance company profits.
Fundamental restructuring
Experts in the industry have been thinking about these issues for a long time. Lindsay Dymowski, CEO at Centennial Pharmacy Services, suggests a fundamental restructuring may be in order.
She says a shift from a fee-for-service model to a value-based care system might help because it would reward outcomes, not volume.
This [current] profitability model makes it difficult for insurers to take long-term financial risks, such as investing heavily in preventive care or innovative models, which yield savings and better outcomes over several years, Dymowski told ConsumerAffairs.
To address this, systemic reforms could focus on encouraging insurers to adopt multi-year care strategies and align incentives with value-based care agreements. This would help shift the focus from short-term profitability to sustainable, patient-centered care.
Short-term focus
Dymowski says insurance companies face a unique challenge in maintaining profitability because their business model is based on insuring individuals for relatively short periods, typically one year at a time.
Unlike other industries that benefit from long-term customer retention and predictable revenue streams, she said health insurers cannot guarantee that a patient will remain with them beyond the insured period.
Webster Golinkin, former CEO at FastMed, says the industry faces additional challenges because of the poor health of its customer base
We have an aging and increasingly sick population, with nearly 75% of our citizens overweight or obese, 60% with at least one chronic condition, more than 100 million individuals with diabetes, and a similar number with heart disease, he said. We urgently need to begin transforming our healthcare system from one that is focused on sick care to one that prioritizes true health care for it to be more effective and sustainable.
Jack Glasker, an executive at Affordable Healthcare Solutions, a New Jersey-based healthcare broker, says the tension between for-profit insurance and access to care prevails. It always will, he says, as long as coverage decisions are made unilaterally by insurance companies.
Photo Credit: Consumer Affairs News Department Images
Posted: 2024-12-13 14:17:06
