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Health Plans: Data Proves that Meddling Works

Jeff Elliott, for HealthLeaders Media, January 5, 2011

So what does this mean? Healthcare providers respond quite differently to incentives in Medicare compared to those in private insurer programs, study authors concluded. "Blue Cross and Blue Shield of Texas has developed several mechanisms to encourage cost-effective care by providers."

Among the tactics used by BCBS that might not be employed by Medicare, according to Franzini, are preauthorizations, provider utilization monitoring, case management efforts and stepped up prevention and wellness programs and incentives. In other words, meddling in provider (and patient) decision-making is effective … at least in some cases.

Chalk one up for health plans and their contentious rules which require physicians to clear procedures and medications before they are delivered.

But before insurers hang their hats on this report, they should realize that by the authors' own admission, the study is so localized, that it renders nearly futile the claim that private health plans do in fact control spending better than Medicare across the board. "McAllen is an extreme outlier in terms of Medicare per capita spending and is not typical," according to Franzini.

But she does admit it's a very intriguing development that is being explored on a wider scale. "This issue of variation in per capita expenditures in privately insured patients relative to Medicare variation deserves further study to see what lessons might be learned."


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1 comments on "Health Plans: Data Proves that Meddling Works"


Chloe (2/3/2011 at 2:55 PM)
Two questions: Is there any differential in these two groups as far as outcomes, readmissions, etc? The other question is,all of this "meddling" takes personnel and infrastructure. It is quite expendive to pay for these "meddlers." The insurance companies keep all of this inhouse, in effect, thay are "paying" themselves rather than paying for health care. So, that being said, one cannot just compare the total dollars paid to providers. So the question remains, hiw do the two groups compare in total dollars spent to deliver health care?