Wendell, thanks for what you do as always. You may have highlighted this in other recent articles, but this is missing another huge reason insurers buy up primary care. It's a way around the MLR requirement in their insurance business. United does this with Optum all the time. They pass a large portion of the risk and capitation to their fully owned medical group and that entity can make unlimited profits. They can run a 50% MLR in some cases.
Why do experts applaud Kaiser Permanente, Geissinger and other integrated care management companies that take capitated risk but melt down when others try to integrate?
Where is the kickback? CVS/Aetna employed doc refers (or doesnt) to desired specialist? Unless primary care doc gets a bonus for actions such as those, or you consider savings to MCO, how does that constitute a kickback? There are specialists who receive Mcare now who spend a half day a week in PCP's office seeing DM or geriatric problems ("referrals"). No difference.
Kaiser Permanente has been doing exactly this for 80 years. They now serve 12 million people. Why no hue & cry before?
Nice piece, Wendell.
Wendell, thanks for what you do as always. You may have highlighted this in other recent articles, but this is missing another huge reason insurers buy up primary care. It's a way around the MLR requirement in their insurance business. United does this with Optum all the time. They pass a large portion of the risk and capitation to their fully owned medical group and that entity can make unlimited profits. They can run a 50% MLR in some cases.
Why do experts applaud Kaiser Permanente, Geissinger and other integrated care management companies that take capitated risk but melt down when others try to integrate?
Whats a PBM? SHOULDNT have to google it.
You're going to need a lot of Nurse Practitioners...
Where is the kickback? CVS/Aetna employed doc refers (or doesnt) to desired specialist? Unless primary care doc gets a bonus for actions such as those, or you consider savings to MCO, how does that constitute a kickback? There are specialists who receive Mcare now who spend a half day a week in PCP's office seeing DM or geriatric problems ("referrals"). No difference.