cloudy
Tuesday September 25th, 2018 1:17AM

Insurers get into care, but is it good for your health?

By The Associated Press
Related Articles
  Contact Editor

In the not-too-distant future, your health insurance, your prescription drugs and some of your treatment may come from the same company.

Insurers are dropping billions of dollars on acquisitions and expansions in order to get more involved in customer health. They say this push can help cut costs and improve care, in part by keeping the sickest patients healthy and out of expensive hospitals.

That's a huge potential benefit for employers and other customers stressed by rising costs. But is this good for your health?

That question worries some health care insiders who wonder if the patient's best interest — and not profits — will remain the focus as insurers dive deeper into care.

"The fights about price and cost are only going to get worse. Now you've got more integrated and powerful private insurers ... coming up with the answer," said medical ethicist Arthur Caplan.

The insurer Cigna said Thursday it will spend $52 billion to buy Express Scripts, which administers prescription benefits for about 80 million people.

Late last year, CVS Health also announced a roughly $69 billion deal to buy another insurer, Aetna. Those companies plan to convert drugstores into health care hotspots that people can turn to for a variety of needs in between doctor visits.

Other insurance companies, including Humana and UnitedHealth Group, also are making deals to expand their role in managing or providing care

The concept isn't new. Many people already have coverage through health maintenance organizations, or HMOs, where insurers either employ doctors or contract with them to manage care.

But major insurers are buying into the idea because the usual ways they control costs — by negotiating rates with hospitals or cutting their own expenses — have a limited impact, said Standard & Poor's analyst Deep Banerjee. He added that delving into care is the most efficient way for insurers to manage costs.

If insurers don't find a better way to control costs, Amazon might. The online giant announced earlier this year that it will collaborate with billionaire Warren Buffett and JPMorgan Chase to create a company aimed at giving employees high-quality, affordable care. The companies have yet to announce details.

Insurers and other nontraditional care providers like CVS say they aren't trying to replace doctors or randomly shave expenses.

They say the goal is to supplement the care a patient already receives or provide affordable options for people who don't have doctors. Big acquisitions also help them gather more information about customers, which can improve care, for instance, by helping doctors figure out which medicine might work best for a patient.

They also say that cutting costs and improving care are not mutually exclusive goals.

Humana gives wireless scales to about 2,000 patients with congestive heart failure — a sliver of the insurer's total enrollment — and has nurses monitor their weight remotely. A sudden gain can be a sign of looming trouble for these patients, so a nurse may check in to see if they need to adjust their prescription or see a doctor.

"If we can intercede before a heart attack, we not only obviously help the individual, but we prevent an ER visit and downstream cost of that," CEO Bruce Broussard said earlier this year at a health care conference.

UnitedHealth Group runs the nation's largest insurer, but its separate Optum business also operates more than 1,100 doctor offices, urgent care and surgery centers.

Optum leaders say their urgent centers can handle 90 percent of the care patients would receive in an emergency room at a fraction of the cost, thanks to lower overhead and fewer staff. Their surgery centers can perform outpatient procedures, which don't involve an overnight stay, for about half of what a hospital charges and still deliver high quality care, they say.

"It's about more care in the right setting," Optum executive Andrew Hayek said, adding that his company works with more than 80 different health plans, not just UnitedHealth customers.

Insurers say the expansions will lead to more personalized, affordable health care. Whether the average patient sees lighter insurance or pharmacy bills remains to be seen.

Health care consultant Bob Laszewski expects insurers to be focused first on making sure their stockholders get a return from these big deals

"When you spend $50 billion of shareholder money, it's clear the accountability is going to be with the shareholder not with the patient," the former insurance executive said.

Lawmakers and doctors have long been concerned about corporate influences on medical care. Most states have laws or standards that prevent a business or employer from interfering with a doctor's medical judgment, health care attorney Kim Harvey Looney said. But these standards don't prevent an insurer from denying coverage if a treatment is deemed experimental or excluded under a plan.

That worries Caplan, an ethicist with New York University's School of Medicine. He wonders how hard doctors will fight for patients if it means clashing with their own employers.

"It's a little easier to be an advocate for the patient when you don't work for the corporation that is controlling the reimbursement decision," he said.

Another medical ethicist, Dr. Matt DeCamp of Johns Hopkins University, said he doesn't see an inherent conflict of interest when insurers provide care.

Whether one surfaces depends on how the deals are structured. DeCamp would want to know how involved the patient's regular doctor is with insurer programs that manage care and whether participation is linked to the cost of coverage. That could make it hard for patients to say no.

Ultimately, insurers can earn customer trust simply by keeping them healthy for a reasonable price, said health economist Paul Keckley. But that will be a struggle for an industry in which the average patient already has little faith, he said.

"You trust your nurses most, your doctors and pharmacists next, hospitals some, and insurers none," he said.

___

Follow Tom Murphy at https://twitter.com/thpmurphy

  • Associated Categories: U.S. News, Associated Press (AP), AP National News, AP Online National News, Top U.S. News short headlines, Top General short headlines, AP Health, AP Business, AP Business - Industries, AP Business - Financial Services, AP Business - Health Care, AP Business - Personal Finance
© Copyright 2018 AccessWDUN.com
All rights reserved. This material may not be published, broadcast, rewritten, or redistributed without permission.
Insurers get into care, but is it good for your health?
As costs spiral and traditional boundaries blur in health care, insurers are taking more control over monitoring customer health and delivering care
2:45PM ( 4 minutes ago )
California bullet train costs soar to $77B; opening delayed
The projected cost of California's bullet train between San Francisco and Los Angeles has jumped to $77 billion and the opening date has been pushed back four years to 2033
2:42PM ( 7 minutes ago )
Aid delivered to Syria's Ghouta amid renewed violence
An aid convoy has crossed into the embattled rebel-held suburbs of Damascus delivering desperately needed aid despite heavy fighting that broke out "extremely close" to the convoy and renewed airstrikes by the Syrian government
2:38PM ( 10 minutes ago )
Associated Press (AP)
US: Trump decision to meet Kim leader validates his approach
The White House says the U.S. push to isolate North Korea compelled the reclusive nation to reach out for presidential-level talks
2:26PM ( 23 minutes ago )
UK military chemical experts aid police in spy poison probe
British troops trained in chemical warfare are on the streets of the city of Salisbury to help a police investigation into the nerve-agent poisoning of a former Russian spy and his daughter
2:10PM ( 38 minutes ago )
'Pharma Bro' tearfully apologizes, then sentenced to prison
'Pharma Bro' Martin Shkreli sentenced to 7 years in prison
2:09PM ( 40 minutes ago )
AP National News
The Latest: 'Pharma Bro' says he made mistakes, apologizes
Federal prosecutors say "Pharma Bro" Martin Shkreli should be sentenced to 15 years, not because he is "the most hated man in America," but because he's a criminal convicted of serious fraud
12:38PM ( 2 hours ago )
The Latest: Prosecutor: 'Pharma Bro' deserves 15 years
Federal prosecutors say "Pharma Bro" Martin Shkreli should be sentenced to 15 years, not because he is "the most hated man in America," but because he's a criminal convicted of serious fraud
12:25PM ( 2 hours ago )
Watchdog group wants federal probe into porn actress payment
A nonprofit watchdog group has asked the Justice Department and the Office of Government Ethics to investigate whether a secret payment to an adult film actress violated federal law because Donald Trump did not list it on his financial disclosure forms
11:49AM ( 3 hours ago )
Top U.S. News short headlines
AP finds the NRA gave $7 million to hundreds of schools
AP finds the National Rifle Association has given more than $7 million in grants to hundreds of U.S. schools in recent years
11:36AM ( 3 hours ago )
The Latest: Lawyer: Shkreli outspokenness shouldn't hurt him
'Pharma Bro' Martin Shkreli faces sentencing on securities fraud conviction
11:36AM ( 3 hours ago )
Does Cohn's exit mark end of Trump's Goldman era?
With top economic adviser Gary Cohn heading for the exit, Trump's collection of advisers from the Wall Street giant has further dwindled.
11:10AM ( 3 hours ago )
Top General short headlines
Trump Org says it donated $151,470 in profits to US Treasury
A Trump Organization executive says the company has donated $151,470 in foreign government profits at its hotels and similar businesses last year to US Treasury
2:09PM ( 39 minutes ago )
Money's not the problem as lawmakers tackle spending bill
Money's not really the holdup in talks on a huge $1.3 trillion catchall spending bill that's making its way through Capitol Hill
1:32PM ( 1 hour ago )
The Latest: US official ties tariff relief to NATO payments
U.S. allies seeking to avoid the steel and aluminum tariffs approved by President Donald Trump might be asked to step up their financial commitments to NATO.
1:26PM ( 1 hour ago )
AP Business
Venezuela-linked trust sues foreign oil traders for bribes
A lawsuit has been filed in Florida against Glencore, Lukoil and other international energy firms for their alleged role funneling bribes to corrupt Venezuelan officials in exchange for rigged oil purchase contracts involving state-run PDVSA
10:38AM ( 4 hours ago )
Global stocks hold firm despite US tariff confirmation
Global stock markets held their own Friday after President Donald Trump announced new tariffs on steel and aluminum imports
7:43AM ( 7 hours ago )
Central banker: China can be 'bolder' about market opening
The head of China's central bank says the country can be 'bolder' about opening its financial markets following steps to strengthen financial regulation and encourage use of its currency abroad
2:28AM ( 12 hours ago )
AP Business - Industries
European Central Bank: Trump tariff move 'dangerous'
Europe's top monetary official denounced U.S. President Donald Trump's proposal to put tariffs on steel and aluminum imports as a "dangerous" unilateral move
12:44PM ( 1 day ago )
European Central Bank: Trump tariff move "dangerous"
Europe's top monetary official denounced U.S. President Donald Trump's proposal to put tariffs on steel and aluminum imports as a "dangerous" unilateral move
11:08AM ( 1 day ago )
US stocks edge higher; Express Scripts jumps on deal news
Gains for technology companies and retailers are sending US stock indexes modestly higher in morning trading.
10:32AM ( 1 day ago )
AP Business - Financial Services
Watchdog report: Failed VA leadership put patients at risk
Veterans Affairs Secretary David Shulkin is pledging wide-scale changes at the VA after a blistering internal investigation found "failed leadership at multiple levels" at the agency
4:35PM ( 1 day ago )
Can ride-hailing companies cure medical transportation woes?
Lyft and Uber are expanding rides to the doctor with the bill going to care providers or insurers
4:38PM ( 3 days ago )
Uber starts offering rides to the doctor
Uber is driving deeper into health care by offering to take patients in every U.S. market where it operates to their next medical appointment
5:23PM ( 1 week ago )
AP Business - Health Care
Stock market lifts US household wealth to $98.7 trillion
Soaring stock market lifts US household wealth to $98.7 trillion, a record high
12:55PM ( 1 day ago )
The most and least affordable places to buy a home
Everyone wants to know how much house they can afford, and the answer depends on where they live
10:26AM ( 1 day ago )
Washington's housing discrimination bill heads to governor
A measure approved by legislators in Washington state bars landlords from turning away tenants who rely on Social Security income, veterans benefits and federally funded Section 8 vouchers that help low-income people pay rent.
8:25PM ( 2 days ago )
AP Business - Personal Finance
Aid delivered to Syria's Ghouta amid renewed violence
An aid convoy has crossed into the embattled rebel-held suburbs of Damascus delivering desperately needed aid despite heavy fighting that broke out "extremely close" to the convoy and renewed airstrikes by the Syrian government
2:38PM ( 11 minutes ago )
The Latest: UN chief 'encouraged' by word of US-Korea talks
The U.N. says Secretary-General Antonio Guterres is "encouraged" by the announcement of an upcoming U.S.-North Korea summit and "commends the leadership and vision of all concerned."
2:34PM ( 15 minutes ago )
Florida's governor expected to sign school safety bill
Florida Gov. Rick Scott is expected to meet Friday with families of the 17 people killed in a school shooting and sign a $400 million school safety bill with new gun controls opposed by the NRA and a plan to arm staff that teachers don't want
2:32PM ( 17 minutes ago )
ACLU accuses US of broadly separating immigrant families
The American Civil Liberties Union has filed a class-action lawsuit accusing the U.S. government of broadly separating immigrant families seeking asylum
2:27PM ( 22 minutes ago )
US: Trump decision to meet Kim leader validates his approach
The White House says the U.S. push to isolate North Korea compelled the reclusive nation to reach out for presidential-level talks
2:26PM ( 23 minutes ago )