Friday, March 23, 2007

Its not necessary to change. Survival is not mandatory

Edward Deming famous quote comes to mind as I read this mornings Industry Radar about employers pushing health insurers to either run or integrate with the on-site health centers they are either running or planning. hello Health Insurers--the choice is integrate or die. At what point will many of the large managed care carriers realize their large self-funded clients will be walking for vendors capable of fully integrating their services with the strategic direction their efforts to manage health & productivity are taking? Read on

Employers Push Health Plans to Integrate On-Site Health Centers With Care Management

Reprinted from the March 19, 2007, issue of MANAGED CARE WEEK, the industry's leading source of business, financial and regulatory news of health plans, PPOs, and POS plans.

Although worksite health centers are an old idea, integrating with them may become the newest service to be offered by health insurers. Large self-funded employers are pushing the managed care organizations (MCOs) that administer their health plans to integrate these centers into their medical, disease and wellness management programs — or even to manage the centers themselves. And at least one operator of workplace health centers says it is partnering with health insurers to offer fully integrated health benefit programs to employers.

Some employers provided on-site health centers a few decades ago, but in the more recent past these facilities primarily were used for occupational health care or discrete services like flu shots. Today, however, companies are returning to the concept of making medical care accessible at the job site, in an effort to close gaps in care and lower health expenses over the long term. In fact, 23% of large companies have opened on-site health centers at some locations, according to a recent survey of 573 large employers released last month by Watson Wyatt Worldwide and the National Business Group on Health.

Full text at

So 23% of large employers have now opened and on-site health center and look at the response from CIGNA & Aetna.

Health insurers interviewed for this article say they are reviewing ways to integrate workplace health centers into overall benefit plans. CIGNA Corp. spokesperson Amy Turkington says that company is "actively evaluating and discussing with employers the topics of how these facilities can be direct employees to available programs, such as disease management or health coaching services, to help them reduce health risks or better manage a chronic condition."

Similarly, "Aetna is currently evaluating with our customers the opportunity to integrate our benefits design and medical management activities with the on-site clinics and programs we are seeing proliferate among larger employers," says Brad Fluegel, the insurer's vice president of enterprise strategy. "We are engaged in identifying the best opportunities to realize these types of outcomes in partnership with our customers.

Now that's really nimble huh? It gets better. Lets consider some of the speculation about why major insurer's are not integrating.

For now, however, employers typically set up an on-site health center, and then ask their insurer to work on integrating that provider with other health management activities, according to John Asencio, senior vice president and health practice leader at Sibson Consulting, the strategic human resources consulting division of The Segal Co. Although some employers ask insurers to directly manage work site health centers, Asencio says, in his experience the insurers have declined the offer. He speculates that insurers "are negotiating with providers to bring volume," and on-site centers divert that volume to other channels.

I do not know Mr Asencio but I would suggest that the reason insurers are declining to integrate is probably not rooted in any great concern that the on site clinics will divert volume from providers in their networks. These managed care organizations are after all revered by physicians everywhere and known for acting exclusively in their best interest right? Is that not what evidence based medicine is really all about? Just call me jaded but I spent enough time in the belly of the beast to think an alternative reason for the lack of integration has everything to do with the not invented here syndrome. Remember health insurers--survival is not mandatory. Its only 23% of large self-funded employers who have invested in strategic on site clinics.

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