Health Insurance Company Buys Doctor Practice... A Fable
ฝัง
- เผยแพร่เมื่อ 3 ก.พ. 2024
- The Fable of "The Multi-Specialty Physician Practice and the Insurance Carrier."
In this fable, physician practice sells to a vertically integrated insurance carrier.
This physician practice used a vendor--called Vendor A--to perform a particular service for certain patients. Vendor A charged $300 per patient per day.
Everyone was happy. The patients were happy. The physicians were happy. Vendor A was happy.
BUT... the vertically integrated insurance carrier also owned a vendor--called Vendor I--that performed the same service as Vendor A, except Vendor I charged $800 per patient per day.
After buying the physician practice, the insurance carrier replaced Vendor A with Vendor I to increase their overall revenue... all while increasing healthcare cost.
BUT, There is MORE...
The insurance carrier had negotiated an Earnout with the physician practice whereby the practice was to receive future payments from the carrier based on future profits of the practice.
However by installing Vendor I, the insurance carrier diminished the profitability of the practice and therefore, decreased the earnout payments that they needed to pay.
The insurance company won DOUBLE.
THE END
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What would happen if all Americans insisted that 'insurers' reimbursed patients after the fact for direct-pay care provision?
Sounds like a good idea.
Optum bought the Everett Clinic and the Polyclinic in Seattle WA.
Thank you for the video. An insurance carrier in my area has purchased 30 practices and I was wondering how they were able to do so. Appreciate the information.
Thank you for watching and for your comment.
I feel like businesses today are more interested in using clever legal strategies to siphon money out of a complex system than to actually produce anything of value.
Agreed.
Another great video Eric!! -- unfortunately, I think this is only going to happen more and more going forward
Agreed. Thank you for watching.
I thought that earn outs are supposed to be a win win. Is it really worth it for the insurance carrier to start on the wrong foot with its new practice and disincentivize any revenue growth initiatives by sticking sticks in their spokes?
Thank you for sharing your thoughts.
Do you have a video on ACO Reach vs MSSP? I think that would be helpfull... thanks!
Not sure if it’s just me but sound quality in most recent videos aren’t good. Great vid though
Thank you for letting me know.
I wish it was a fable, but it is true! I am currently experiencing this exact issue. : (
#Yup. Thank you for watching.
Could you explain what exactly does the vendor do in this situation? Thanks
Hospital at Home / Remote Patient Monitoring.
This sounds more like a Grimms' Fairy Tale than an Aesop Fable. Unbelievable how messed up the American health care system is.
Agreed. Thank you for watching.
What 😢
Quite a Tale.
And the shareholders, at the expense of everyone else, lived happily ever after - the end 🥲🥲
Yup… Thank you for watching.