As American Health Care Changes, New Partnerships Emerge

The trend of insurance companies venturing beyond traditional ways of doing business to have more direct contact with individuals is widespread: About 200 partnerships between insurers and large health groups have been created in the last five years, according to The New York Times.

UnitedHealth Group acquired a chain of outpatient surgery centers earlier this year. Cleveland Clinic joined forces with an insurance start-up, Oscar Health, to offer health plans to individuals in Ohio. Aetna, one of the nation’s largest health insurers, has partnerships with large health systems that include hospitals and doctors’ groups in Northern California and Virginia and is in talks to combine with CVS Health, which manages pharmacy benefits.

While the companies promote the convenience of these partnerships to employers and consumers, they could also put customers at a disadvantage by limiting their choices. People may not be able to see doctors outside the organization’s own medical group, and patients worry that their doctor will not order an expensive test to save money for their partners – the insurer and the health organization.

On the other hand, partnerships between insurers and hospital groups allow entities to better communicate about patient care and management, rather than simply haggle over cost or choice of treatment. Tangible benefits for consumers include lower drug costs and access to a doctor at a nearby clinic. When Banner Health, a large group in Phoenix, partnered with Aetna to offer a joint health plan, it added 35 retail clinics where people could receive care after-hours or closer to their homes.

Given the uncertainty over the Affordable Care Act and the potentially limited appeal of the core insurance business, it is likely that these combinations will continue to proliferate; it’s too soon to tell whether they will succeed in delivering on promises to consumers.

Source: The New York Times, November 26, 2017.