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Four Presents Health Insurers Want Under Their Trees

Les Masterson, for HealthLeaders Media, December 16, 2009

Health insurance leaders will place their stockings over the fireplace on Christmas Eve. They will put out milk and cookies for Santa Claus. All that will be left is the big morning when these executives head downstairs, gaze at the gifts Santa left, and rip open their presents.

But what exactly does a health insurance leader want this year—besides the early gift they received Tuesday? Here are four gifts they would like to see under their Christmas trees:

An olive branch from physicians. Despite some inroads, such as quality contracts, doctor-health insurer relations remain icy at best.

Physicians view insurers as money-grubbing, procedure-declining, patient-interfering companies that provide no benefit. Insurers, meanwhile, think of physicians as procedure-happy, cash-cow doctors who are a major reason health costs are skyrocketing.

If these two sides could only find some common ground and work together, Americans would have better healthcare. Better data exchange between insurers and physicians would lead to better outcomes. Doctors would know when their patients visited the ER or another physician immediately and insurers would get clinical data that could help them catch at-risk patients before they develop a chronic illness. Physicians would get paid and know when claims are denied—and why—immediately.

Progress has been made, but there isn't an olive branch under insurers' Christmas tree this year.

Healthier Americans. This is at the top of health insurers' lists each year, but much like the girl who excitedly puts a pony on her list, this isn't going to happen.

That's not to say that it's not a lofty goal. In fact, imagine the impact on healthcare costs if Americans ate better, smoked less, and exercised more.

Instead, we supersize everything—starting with our food.
As I wrote in August, all the talk about health reform is pointless if Americans don't take better care of themselves. If we continue to gorge ourselves and stay away from the gym, don't expect much to change in healthcare.

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