Becker's Hospital Review

27 CFO / FINANCE 5 reasons fed-up physicians are dropping their health insurance By Morgan Haefner N o one knows the pitfalls of going with- out health insurance better than the physicians who treat uninsured pa- tients, but some of those very physicians are so frustrated with America's healthcare system that they're abandoning their own insurance coverage, according to a Bloomberg report. Here are five reasons physicians are foregoing health insurance: 1. Brian Falkner, DO, an emergency room physician in New Orleans, is one of 4,000-plus Americans who answered a Bloomberg News survey about living without health insurance. Dr. Falkner, who is 40 years old, has a wife and a 9-year-old child who remained uninsured aer they lost their ACA marketplace plan in 2017. 2. Dr. Falkner said the amount his family is spending on physician appointments and pre- scriptions this year is well below the $1,200 they were paying each month in health insur- ance premiums. 3. For Brad Why, 49, a psychiatric nurse prac- titioner in Delaware, cost wasn't the only rea- son he dropped his family's insurance policy. He told Bloomberg he had "pretty significant disrespect" for health insurers. He said they're "dictating who is getting what, how much they're getting, putting limits on the care that you receive and the medication that can be pre- scribed. I just don't want to pay them anymore." 4. e nurse practitioner also said providers will oen agree on a price with uninsured pa- tients for less than a typical co-pay. He pock- ets the $1,800 he saves each month on premi- ums, for a plan that had a $13,000 deductible. 5. Another ER physician, Nemat Dadfar, DO, in San Antonio, said he understands the risk he is taking on by forgoing insurance. e 39-year-old said he ditched his health plan aer frustrating experiences with billing pa- perwork and reimbursements at work. "I just want to be able to do my job, and do it well, and take care of patients. What I've found is that the system is designed to prevent you from doing it," he told Bloomberg. n UnitedHealth CEO: 150M members will be in value- based care arrangements by 2025 By Morgan Haefner U nitedHealth Group expects to provide 150 mil- lion members health insurance through val- ue-based arrangements by 2025, the compa- ny's CEO David Wichmann said May 31 at Bernstein's 34th Annual Strategic Decisions Conference. The 150 million-member benchmark is a massive leap from the 15 million UnitedHealthcare members in value-based care arrangements as of 2017. The health insurer currently has 1,000 value-based care coordination relationships. Value-based efforts con- tributed to a 17 percent reduction in hospitalizations and 10 percent increase in primary care visits for the insurer overall, according to Mr. Wichmann At the conference, Mr. Wichmann also addressed OptumCare's role in value-based care programs. UnitedHealth's physician arm saves more than a third of the average cost of fee-for-service models, accord- ing to the company. OptumCare employs or is affiliated with about 30,000 physicians, outpacing Oakland, Calif.-based Kaiser Permanente by 8,000 physicians. If OptumCare com- pletes its acquisition of Davita Medical Group, the insurer will tack on another 17,000 physicians to its ranks, making it one of the largest physician employ- ers in America. n 5 things to know about Kaiser Permanente's health plan By Morgan Haefner O akland, Calif.-based Kaiser Permanente, which comprises 39 hospitals across the U.S., operates a successful health plan — a venture few providers have found prosperity in. Here are five things to know about the Kaiser Foundation Health Plan. 1. About 12.2 million Americans have insurance coverage through Kaiser. Of that total, nearly 1 million have a Medicaid or CHIP plan, and 8.8 million reside in California. 2. Bernard J. Tyson is the chairman and CEO of Kaiser Founda- tion Health Plan and Hospitals, collectively known as Kaiser Per- manente. 3. Kaiser health plan operates in the District of Columbia and eight states: California, Colorado, Georgia, Hawaii, Virginia, Mary- land, Oregon and Washington. 4. As a system, Kaiser saw operating revenue increase to $72.7 billion in 2017, up 12.5 percent from operating revenue of $64.6 billion in 2016. The system attributed the boost, in part, to its health plan oper- ations. Kaiser saw health plan membership increase by 10.1 percent year over year to 11.8 million members at the end of 2017. About 650,000 of those new members were due to Kaiser's acquisition of Seattle-based Group Health Cooperative in February 2017. 5. In 2018, J.D. Power ranked Kaiser as the No. 1 health plan in six geographical regions across the U.S. based on member satisfac- tion. CMS also gave five Kaiser Medicare plans five-star rankings. CMS ranks Medicare plans on a quality scale of one to five stars, and pays bonuses to plans with high ratings. n

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