Healthcare Data Worth its Weight in Gold

For all the badmouthing of health insurers, one thing they deserve credit for is their ongoing attempts to lower medical expenditures.

Yes, it's in their best fiscal interest to pay fewer and less-expensive claims. But I wouldn't call it greed run amok. After all, about 60% of health plans nationwide with at least 100,000 medical enrollees are not-for-profit, according to the Alliance for Advancing Nonprofit Healthcare.

With exceptions—using a coverage loophole to reject a cancer treatment claim, perhaps—it's more of a preservation of interests. The problem is that these interests often don't jibe with those of healthcare providers, or the general public.

Over the years, health plans have tried a number of medical expense-lowering tactics, such as heavy-handed preauthorization and utilization guidelines, which theoretically are an effective way to ensure physicians aren't driving up the bill by administering unnecessary procedures. Amid severe pressure from physicians, and a realization that these efforts weren't doing the trick, insurers have moved on to more progressive strategies, including incentives for caregivers that improve quality and lower costs.

They're also getting the public more involved with their healthcare via wellness programs and, I hate to say it, higher out-of-pocket costs, which are forcing patients to ask, "Do I really need to see my doc for a sore throat?"