The Health Care System in 2018: Combat Zones to Watch

By PAUL KECKLEY Entering the home stretch on 2017, the stage is set for some classic duels next year: they’re about money and control and they’re playing out already across the industry. Here’s the five combat zones to watch: Hospitals vs. insurers: This is the quintessential struggle between two conflicting roles in our system. Hospitals see themselves as the protector for a community’s delivery system, bearing risks for clinical programs, technologies and facilities that require capital to remain competitive. Insurers see themselves as the referee for health costs, calling balls and strikes on the necessity and cost-effectiveness of improvements providers deem essential. Each sees the other as complicit in healthcare waste and guard jealously their leverage: hospitals enjoy community support and physician relationships and insurers controls premiums. Around the country, the combat zones involve stand-offs involving reimbursement negotiations and narrow networks (i.e. Mission Health (Asheville NC) and Blue Cross of NC), coverage determinations by insurers that impair hospitals (i.e. Anthem’s decision to deny coverage for unnecessary emergency room use) and others. Integrated Systems of Health vs. the Federal Government: The federal government’s scrutiny of the ATT-Time Warner combination is being touted as a case study in vertical integration. And before the end of the year, CVS’ takeover of Aetna is anticipated—horizontal integration. The sectarian borders i...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Uncategorized Paul Keckley Source Type: blogs