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Businesses Need Reasons To Stay in Coverage Game

MANAGED CARE July 2010. © MediMedia USA
Editor's Memo

Businesses Need Reasons To Stay in Coverage Game

John Marcille
MANAGED CARE July 2010. ©MediMedia USA

John Marcille

Employers stand by the exit signs in the back as echoes ring through the great hall of public discourse about the Patient Protection and Affordable Care Act. Everybody wants to know: What will be the effects of implementation? Meanwhile, the businesses that sponsor most of the coverage in the country jiggle their keys and check their watches. They’ve got a pretty good idea.

As our cover story points out, reform makes it inviting for companies to get out of the health insurance game for good. Thomas Reinke, the author, shows that as the costs of reform for health plans mount, the establishment of exchanges will make it much easier — and inviting — for employers to head for the hills.

As we were putting this issue to bed, a survey was saying that 91 percent of doctors “reported believing that physicians order more tests and procedures than needed to protect themselves from malpractice suits.” According to the survey, in the Archives of Internal Medicine, an overwhelming number of generalists (91 percent), specialists (89 percent), and surgeons (93 percent) hold that view. Tests and procedures are ordered whether they’re needed or not. As much as $60 billion might be lost due to defensive medicine, the study says.

Paul Fronstin, PhD, a senior researcher and director of the health research and education program at the Employee Benefit Research Institute, says that these days the employer asks the health plan: What innovative ways can you come up with to keep my costs under control?

Insurers address this in many ways. Yet, as the study about defensive medicine indicates, they do not now, nor ever will, control every aspect of medical coverage. That’s another thing employers know.

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Pharmaceutical Pricing and Contracting Conference Philadelphia, PA September 22–23, 2014
Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014