Health insurance companies are aggressively expanding to adjacent markets and services, a strategy that has led insurers to make venture investments in companies that provide or enable health care services.
The lady doth protest too much. For your defensive friend, here is an example of this practice whereby the insurance companies are using funds taken out of the physician reimbursement payment to monetize third party companies that charge a percentage to process EFT's. So, in essence, in order to get paid, physicians are strongarmed into paying 2-7% of their reimbursement for services already rendered to a 3rd party processor for the EFT payment. Once these companies are big enough to sell for profit, the Insurance companies do just that. Physicians are directly monetizing these companies under duress.
The solution is to make this entirely transparent by law and then to systematically peel back these unnecessary pieces in the complex healthcare supply chain. (Clearinghouses, PBM's, MIPS, EHR add ons, PMP, just to name a few). Elon Musk has far outpaced NASA in building rockets by simplifying and eliminating parts, not adding them. I think we can all agree that big government, government incentives like ACO formation etc., coupled with private equity without proper oversight, and enormous "non-profit" institutions have created a rocket (to use the Musk analogy) that is so heavy and prone to failure, not only will it never get to mars, it is dangerous, even if it does happen to get off the ground.
This is a really nuanced piece. I had never considered how health insurer innovation arms impact on quality could be dwarfed by just adjusting comp for BH providers. What CMS did with the introduction of PCM billing, for example, enables the kind of continuous care delivery needed by the most vulnerable and often most costly members. What is the like of that from large MA plans?
Venture capitalism -- in this case, gambling/manipulating/betting on peoples' healthcare -- is a cancer on America. We The People have become mere conduits through which money flows in one direction -- toward the few, at the expense and health of the many.
Excellent piece, and very relevant to the kidney space. I'd be curious how much of the specialty and tech-enabled care investments fit this strategy. There are several payers (a few mentioned in the piece) who have participated in recent rounds and have contracts with many (if not most) of the players in the space. I'd love to see more transparency and accountability in these situations, and the common-sense recommendations seem like a great place to start.
Hi Tim - Thank you for the comment. There are several kidney companies in this analysis (Strive, Somatus, Cricket, Monogram) which account for a disproportionate share (on the high end) of investment capital. I agree on needing more transparency and accountability! Happy to discuss further.
The healthcare "insurance " companies are masquerading in the field of providing care to a population.
They are and always have been a financial industry with one sole purpose.....making $$$$$. NOT Assisting in providing quality coverage
The lady doth protest too much. For your defensive friend, here is an example of this practice whereby the insurance companies are using funds taken out of the physician reimbursement payment to monetize third party companies that charge a percentage to process EFT's. So, in essence, in order to get paid, physicians are strongarmed into paying 2-7% of their reimbursement for services already rendered to a 3rd party processor for the EFT payment. Once these companies are big enough to sell for profit, the Insurance companies do just that. Physicians are directly monetizing these companies under duress.
The solution is to make this entirely transparent by law and then to systematically peel back these unnecessary pieces in the complex healthcare supply chain. (Clearinghouses, PBM's, MIPS, EHR add ons, PMP, just to name a few). Elon Musk has far outpaced NASA in building rockets by simplifying and eliminating parts, not adding them. I think we can all agree that big government, government incentives like ACO formation etc., coupled with private equity without proper oversight, and enormous "non-profit" institutions have created a rocket (to use the Musk analogy) that is so heavy and prone to failure, not only will it never get to mars, it is dangerous, even if it does happen to get off the ground.
This is a really nuanced piece. I had never considered how health insurer innovation arms impact on quality could be dwarfed by just adjusting comp for BH providers. What CMS did with the introduction of PCM billing, for example, enables the kind of continuous care delivery needed by the most vulnerable and often most costly members. What is the like of that from large MA plans?
Venture capitalism -- in this case, gambling/manipulating/betting on peoples' healthcare -- is a cancer on America. We The People have become mere conduits through which money flows in one direction -- toward the few, at the expense and health of the many.
Excellent piece, and very relevant to the kidney space. I'd be curious how much of the specialty and tech-enabled care investments fit this strategy. There are several payers (a few mentioned in the piece) who have participated in recent rounds and have contracts with many (if not most) of the players in the space. I'd love to see more transparency and accountability in these situations, and the common-sense recommendations seem like a great place to start.
Hi Tim - Thank you for the comment. There are several kidney companies in this analysis (Strive, Somatus, Cricket, Monogram) which account for a disproportionate share (on the high end) of investment capital. I agree on needing more transparency and accountability! Happy to discuss further.