This limited or tiered network benefit package lets the health plan hold the insurance license and perform its traditional insurer functions while the hospital system acts as the leading in-network provider. The plan gains market share, while the provider makes more money. Sounds like a win-win.
Aside from the Affordable Care Act, it’s the biggest event in health care, says the savvy consultant. “…[I]f the hospital has enough market power, the parties come to an agreement but from the plan’s perspective it is certainly not a happy agreement.”
Ever hear of incidentalomas? That’s the word coined by radiologists for overtesting leading to overtreatment, one of the topics touched on in the book, Cracking Health Costs: How To Cut Your Company’s Health Costs and Provide Employees Better Care, by Tom Emerick and Al Lewis. Here’s an excerpt.
Amy C. Edmondson, PhD
Collaboration is the name of the game these days, but even when lower-level providers speak up, will physicians really listen?
Despite their attraction, these cost-control programs don’t always deliver
For centuries, the problem in medicine was too little information. Now there’s too much, and doctors need help coping.
Mike Pellini, MD
With limited peer-reviewed literature, health plans take an evaluative approach to tumor profile testing
At issue is how much large provider systems can charge for services after they’ve acquired physician practices
Robert Royce, PhD
The country’s catastrophic economic situation shrinks coverage, closes hospitals, and cuts physicians’ salaries — and that might be just the beginning
The insurer hopes to give businesses of between 50 and 400 employees more flexibility under defined contribution
This new treatment for nephritic cystinosis costs a quarter million annually, whereas the original formulation comes in at $8,000