After The Blocked Aetna-Humana Merger…

This is a message for clinical colleagues, office managers, and PDA’s working teammates. Insurers can only scale so much to drive efficiency and profits.  Saying it again…“Going forward, both industry consolidation and the changes relating to the Affordable Healthcare Act, will not be a panacea for growing insurer profit margins.” Eight years of a dramatic federal redo of the healthcare insurance model is perhaps in the rearview mirror. And, the view of the road before us is somewhat unclear. Still, leading insurance executives must continue to look for other ways to increase returns.  Achieving return on investment is inescapable.

This message underscores that IPAs must perform the credentialing, verification, and contracting support functions with a higher level of efficiency. Also, communication with the carriers and providers must be constantly improved and reviewed for quality control. PDA and our peer group need to improve our performance ASAP. This means the IPA has to be engaged with the membership while continuing to serve as an administrative resource. We must aggressively assert the rights for the independent providers. And, we have to determine new avenues of provider income enhancement.

We are going to grow closer in synergy with the carriers and partial self-funded plans. Our physician members will be called on to assist in enhancing the carrier and business-owner relationships. Our primary care group has an important role in interacting with businesses, law firms, engineering firms, etc. Throughout this year, we will work to effectively communicate to professionals and patients the added value of independent providers who care about performance and value. This has exciting, practical potential.

This retooling of the essentials means an increased emphasis on vertical integration with the preferred carriers and business community—that is, supporting more involvement by payers at the provider and patient level to more effectively manage risk. We are headed into the risk-reward area of providing service. We are actively evaluating third-party ACO systems to jump start risk-reward contracting.

The size of a provider group is not the key in value-added service. It is how good are we in managing performance metrics, intergroup financial equity, and patient satisfaction.

More to come….

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