Skip to main content

Wellpoint Buys CareMore Health Group and Why You Should Care

LA Times: "Cerritos healthcare provider CareMore Health Group is being acquired by health insurance giant WellPoint Inc. for about $800 million as part of an effort to bolster the insurer's profile in senior care as baby boomers age."

Like with the Humana-Concentra deal, insurers have a vision for value-driven health care that's quite different from most hospitals' 'let's avoid it until Medicare sweetens the pot' posture.
"The deal, announced Wednesday, will give WellPoint a boost as it competes for a piece of the fast-growing elderly care market, said Ana Gupte, an analyst with New York research firm Sanford C. Bernstein.

"They've purchased a company that has a strong record of managing chronic disease and clinics that specialize in caring for seniors," Gupte said."
Hospitals are in full-blown dither mode about ACOs.  Should we or shouldn't we?  Now? Next year? Never?  Ever?  Some caution is probably appropriate at this point.  Still, it bears watching as insurers' own diversification plans become clearer and they move closer to becoming full-blown competitors.

Insurers are looking at a range of options:
  • Selling IT services to ACOs.  (I.e. They're our vendor.)
  • Contracting to run ACO's back-end operations - underwriting, claims, plan administration, etc. (I.e. they're our partner.)
  • Becoming their own full-blown ACO-like organization.  (I.e. they're our competitor.)
Example: With Concentra, Humana now has clinics in 40 states and 1,000 employed primary care docs clustered in geographies where Humana has a large presence. They could easily morph into something resembling an ACO, using existing hospital and specialist contracts for a ready-made, low-cost network.

Is it possible that hospitals and physicians are in for a replay of 1990's style, bottom-of-the-food-chain managed care environment?  A time when insurers drove contracted rates and utilization as low as possible, keeping the risk and the savings for themselves? They've certainly broken out to an early lead, with deep capital pockets and superior information gathering and analysis skills.

AND their information systems offer an end-to-end, 'across the continuum' view of health spending and utilization, not just the doctor and hospital silos we're used to working with.

If there's value to be gained, be assured that insurers will find a way to reserve most of it for themselves!  So dither away!

Comments

Popular posts from this blog

Michael Porter On Health Care Reform

Michael Porter, writing in the New England Journal of Medicine, proposes "A Strategy For Health Care Reform - Toward A Value-Based System." His proposals are fundamental, lucid and right-on, meaning they're sure to be opposed by some parties to the debate, the so-called "Yes, but..." crowd. Most important, in my opinion, is this: "... electronic medical records will enable value improvement, but only if they support integrated care and outcome measurement. Simply automating current delivery practices will be a hugely expensive exercise in futility. Among our highest near-term priorities is to finalize and then continuously update health information technology (HIT) standards that include precise data definitions (for diagnoses and treatments, for example), an architecture for aggregating data for each patient over time and across providers, and protocols for seamless communication among systems. "Finally, consumers must become much mor...

gapingvoid cartoon #378

Buy your own, here.

"An Affordable Fix For Modernizing Medical Records"

...from the Veterans Health Administration and Midland (TX) Memorial Hospital. I know enough about my own strengths and weaknesses to know that I'm no IT expert. But I am acutely interested in examples of people and teams thinking differently to solve long-standing, intractable problems and, for better or worse, there are lots of those to be found in the IT realm. Yesterday, it was a story about a team adding iPhone portability to MEDITECH functionality, delivering to harried physicians better access to clinical data and more productive hours in every work day. (Wow. Apple in the boardroom AND the physician lounge. Has to be an IT traditionalist's worst nightmare. But I digress...) Today, the Wall Street Journal features a story about Midland (TX) Memorial Hospital finding an affordable, open-source alternative to proprietary EMR systems : "In the push to digitize America's hospitals, Midland Memorial faced an all-too-common dilemma: a crying need for information ...