Unknown Consequences May Ride On Affordable Care Act’s Roll-Out


Our cover story talks about private-label health plans in which Aetna offers large providers stake in the insurance side of the business. Aetna — and other health plans that might try this — hopes that working with the dominant local provider in an area will increase market share in places where they’re either running behind or out of the running.

I suspect this to be one of the early ripples before a tsunami of unforeseen consequences — both good and bad — of the Affordable Care Act.

A private-label health plan offers an alternative formula for competition to providers who do not want to join an accountable care organization (ACO), whether for operational or financial reasons. It comes down to this: Cost-cutting is not a growth strategy for hospitals, but becoming a plan sponsor might be a way to come to terms with the new methods of payment.

And some of our ideas about where to cut costs may be wrong.

A study in the Journal of the American Medical Association last month notes that trying to avoid emergency department care for the costliest Medicare patients by treating them in physicians’ offices instead won’t save as much as some experts had hoped.

Karen Joynt, MD, MPH, the lead author, tells Reuters Health, “It’s a more complicated problem than we thought.” But isn’t it always.

Answers to such vexing dilemmas might be found anywhere, maybe even across the vast Atlantic Ocean. Which brings us to our new department The Wider View. Our man in London (I always wanted to say that), Robert Royce, PhD, will report on how health care fares in the old world. Or doesn’t fare, as the case may be. Now an independent consultant, Robert has had a strong career in health care in the United Kingdom, most recently as director of strategy at Barking, Havering and Redbridge University NHS Trust in greater London.

Career Opportunities

HAP, a subsidiary of Henry Ford Health System, is a nonprofit health plan providing coverage to individuals, companies and organizations. This executive develops strategies to meet membership and revenue targets through products, pricing, market segmentation and advertising.  Aligns business among Business Development, Commercial Sales, Medicare and Public Sector Programs and Product Development. Seeks to enhance and be responsible for business development and expansion through the development of an effective product portfolio, strong interpersonal relationships and service excellence.

Apply via email to jfedder1@hfhs.org or online at http://p.rfer.us/HENRYFORDlXqAJA

Subscribe to Our Newsletters

Monthly table of contents

Be notified as each issue of Managed Care is available online.

Biweekly newsletter

Recent topics have included:

PTCommunity news

New drug approvals, clinical trials, drug management. Three times per week.

UP NEXT

Managed Care
By Peter Wehrwein
Managed Care
By Howard Wolinsky