Insurers – the quiet revolution

On the face of it little has changed in health care insurance. An antagonistic game continues to play out between insurers and providers with the former disputing prices and the latter grumbling about tariff cuts. Value health has yet to deliver. Insurers are sceptical of its complexity and providers who seek to demonstrate quality tell us that insurers are not interested in paying extra or even recognising them. Consumers continue to have no clear idea of quality.

Under the surface, though there is a lot of change taking place.

Insurers are increasingly working with operators to push work into outpatient and ambulatory settings. Take Sana, the big German hospital operator. It is negotiating special rates for ambulatory work which are higher than the very low tariffs normally offered by German insurers but far lower than the fat inpatient rates that German hospitals are so reluctant to relinquish. Insurers are offered access to a national ambulatory platform.

Meanwhile, we are seeing the growth of disease-specific treatment paths with insurers willing to pay for diabetes, epilepsy, prostate and a host of others. There are big pilot projects in these areas in the Netherlands and to a lesser extent the UK and Nordic region. But will these succeed?  After all, we have had 20 years of chronic diseases management programmes trialled and then rejected. We are told the answer is yes. An insurer source said: “Patients really want these disease-specific outpatient programmes. So private medical insurers will offer them over the next 3-5 years.”

So we can say that:

– Under the bonnet, there is a lot of quiet change taking place. Don’t take fiery, antagonistic rhetoric at face value.
– Payors and providers are gradually integrating healthcare. This can happen without shared ownership.
– The jury is out on value health. Particularly when it comes to highly complex multi-morbidities, comparable outcome measurements are still nigh impossible.

We would welcome your thoughts on this story. Email your views to Max Hotopf or call 0207 183 3779.