No. of Recommendations: 19
https://hbr.org/cover-story/2019/03/how-employers-are-fixing...

Much is at stake: Various actors in the health care ecosystem, some large insurers and providers among them, benefit from an arrangement that layers on administrative costs and rewards volume, not value. Yet business as usual is unsustainable for those absorbing the costs and experiencing the uneven quality of care. Pioneering employers and providers are in a position to upend the status quo and change expectations about what affordable, quality care can and should be. What follows is an account of our experience with one important effort, among several being tried, to find a better way.

Walmart and other innovative companies, including Lowe’s, McKesson, GE, and Boeing, are disrupting how employers pay for care by taking insurers out of the equation and contracting directly with leading health systems.

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Eliminate the 20% insurer's skim, reduce costs. It's just arithmetic.

intercst
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No. of Recommendations: 9
Yes, Boeing Walmart and etc., who have paid for the politicians who created the mess, now exit the mess and throw smaller employers and people to the ravening skimming wolves.

Gosh I wish I felt confident enough about the future to short the "healthcare" mafia.


david fb
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No. of Recommendations: 2
Every business is run for profit. The difference between insurers and others is that the insurer's profit is actually regulated and limited. (15% in CA IIRC.)

Having said that, structurally, putting insurers between doctors and patients is clearly adding a layer of overhead, so anything to reduce that is good - as long as the savings are passed to doctors (higher reimbursements) or patients (lower premia) or both. Medicare does that, but it is not self-sustaining at present.

I like the Kaiser model which eliminates the conflict of interest among patients vs insurance vs doctors and pharmacies. I'd love to see what the ABCs are up to. Amazon, Berkshire (Hathaway) and (JPM) Chase have formed the Haven healthcare venture. Knowing Berkshire's reputation I'd trust them more than WalMart.

And socialism has nothing to do with it. I have lived in a socialist country. The economy simply goes underground. Case in point - a patient comes in for a surgery. The government pays the doctor a pittance, so he demands payment under the table from the patient. If the patient can't come up with the money, they die. As simple as that. Do not want a repeat of that in US, thank you very much.

There is a market rate for all life-saving procedures and somebody has to pay for that in some way. I am not suggesting that a patient is an informed consumer free to choose - those who say that are full of it too. Just that a well-regulated, open, fair and transparent pricing will solve a lot of woes. The tab can be picked up in different ways based on the needs and the means of the patients. But the tab always exists, you can't wish it away by saying "free healthcare."
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No. of Recommendations: 3
knightof3 analyzes,


And socialism has nothing to do with it. I have lived in a socialist country. The economy simply goes underground. Case in point - a patient comes in for a surgery. The government pays the doctor a pittance, so he demands payment under the table from the patient. If the patient can't come up with the money, they die.

</snip>


Which socialist country was that? I've spent enough time in Europe to know that's not happening in places like the UK, France, and Germany -- maybe Bulgaria?

intercst
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No. of Recommendations: 4
Thanks for the article links, sounds like good news to me. Large companies have self-insured for years. The difference now is that healthcare costs have gotten so high, and healthcare is so important for an aging workforce, that companies are more actively managing their self-insurance.

The performance metrics are different. A for-profit insurance company tracks sales and profit. A self-insurance unit in a large company doesn't have a P&L, instead performance measures are employee satisfaction and overall costs. If you want to improve something, measure it.
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No. of Recommendations: 14
knighttof3 writes,

I like the Kaiser model which eliminates the conflict of interest among patients vs insurance vs doctors and pharmacies. I'd love to see what the ABCs are up to. Amazon, Berkshire (Hathaway) and (JPM) Chase have formed the Haven healthcare venture. Knowing Berkshire's reputation I'd trust them more than WalMart.

</snip>


You need to keep Kaiser on a short leash just like any other medical provider. You'll see just as much collusion and price gouging with Kaiser as any place else. I've been using Kaiser for the past 2 years.

My Kaiser doctor kept referring me to the Kaiser Pharmacy for my prescriptions. I kept telling them I'm not using Kaiser's Pharmacy since their prices are double to quadruple the cost of filling the same prescriptions at Costco or Walmart.

After about 6 weeks of continuing resistance, I sent them a letter saying I'd file a complaint with the State Medical Board and Insurance Commissioner if they didn't give me a written prescription I could take to any pharmacy I like. It's against the law in Washington State to require a patient to use a captive pharmacy (at higher cost) as a condition of receiving care.

The situation was quickly resolved once I threatened the complaint to the authorities. God knows how many less informed patients are being shafted by these cretins.

intercst
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No. of Recommendations: 3
...rewards volume, not value...

And how do you determine value?

Doctor X/hospital Z only has 1% of there patients readmitted/bounce back after discharge, so they must be good. Meanwhile, Doctor A/Hospital C has a 10% bounce back rate, they must be horrible. But the first pair are treating highly motivated competitive athletes while the second pair is treating indigent, schizophrenic, alcoholics. Until you come up with an equitable way to compare apples and oranges, ratings are meaningless.

FWIW, my group has to report on 5 measures for each patient we have contact with to Medicare/Medicaid so the government can keep track if we are doing are job properly. Do these measures have any bearing on patient outcome? No. They are merely numbers that can be easily recorded, downloaded, and parsed to determine if we should be "punished" for reaching a success rate of 98% instead of 99.9%.

JLC
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