Current Weather
The Spy FM

When The Doctor Works For The Insurance Company

Filed by KOSU News in Business.
December 21, 2012

Some insurance companies are taking a page out of their own history books: running their own doctors’ offices and clinics. Though the strategy previously had mixed results, insurers think that by providing primary care for patients, they might reduce costly diseases and hospital stays in the long run.

Dr. Michael Byrne spent eight years working for a Brooklyn hospital and he saw firsthand why the United States spends more on healthcare than any other country in the world.

“I would regularly see patients who were admitted to the hospital, I took care of, who got better and we’d discharge with plan of care,” he said. “And they’d come back either to the E.R. sick or to the floor. It’s a common occurrence.”

Roughly 25 percent of patients hospitalized in Brooklyn were back in the hospital within a month, according to Byrne. They wouldn’t fill their prescriptions or take their medications; they’d miss appointments for follow-up tests or consultations with specialists.

But Byrne recently started working for CareMore, a company that’s figured out a way to cut readmission rates for its Medicare patients to about half the national average. Since being acquired last summer by WellPoint, one of the largest health insurance companies in the country, CareMore is expanding across the country – adding 13 new clinics to their existing 30 by the end of the year.

If Medicare patients choose to have a WellPoint affiliate administer their benefits, they can use their clinics for free, in addition to seeing their regular primary care physician. Additionally, the clinic staff does many things that most physicians don’t offer. For example, they’ll come to patients’ homes and install a scale that automatically sends their weight to the clinic. They’ll design a workout that patients can do in the clinic gym, which is specially designed for seniors. They’ll even cut patient toenails in an effort to avoid foot infections.

The idea of joining insurers and medical providers was the original concept behind Health Maintenance Organizations, or H.M.O.s, says Anthony Schlaff, a professor of public health and community medicine at Tufts University.

Schlaff says this strategy can work – Kaiser Permanente, for example, has been using this model for decades and is generally well rated with its customers. But H.M.O.s became unpopular in the 1990s because people thought they tried to cut costs by limiting care.

Schlaff said consumers should be keep that concern as insurers again experiment with similar models.

“Where it doesn’t work is where there aren’t protections against skimping on care,” he said. “If the insurer and the provider are one and the same organization, then how does the public know that the company isn’t staying in business by collecting money and then not giving the care it should be giving?”

CareMore patient David Benavides says his diabetes has been much better controlled since he signed up for the plan about five years ago. He visits the clinic often for check-ups and blood work.

“Actually, I go once a month,” he said. “And I feel better and better, like I got the power to do what I want to do.” [Copyright 2012 National Public Radio]

Leave a Reply

5AM to 9AM Morning Edition

Morning Edition

For more than two decades, NPR's Morning Edition has prepared listeners for the day ahead with two hours of up-to-the-minute news, background analysis, commentary, and coverage of arts and sports.

Listen Live Now!

9AM to 10AM The Takeaway

The Takeaway

A fresh alternative in morning news, "The Takeaway" provides a breadth and depth of world, national and regional news coverage that is unprecedented in public media.

View the program guide!

10AM to 11PM On Point

On Point

On Point unites distinct and provocative voices with passionate discussion as it confronts the stories that are at the center of what is important in the world today. Leaving no perspective unchallenged, On Point digs past the surface and into the core of a subject, exposing each of its real world implications.

View the program guide!

Upcoming Events in your area (Submit your event today!)

Streaming audio and podcasts

Stream KOSU on your smartphone

Phone Streaming

SmartPhone listening options on this page are intended for many iPhones, Blackberries, etc. with low-cost software applications available to listen to our full-time web streams, both News on KOSU-1 and Classical on KOSU-2.

Learn more about our complete range of streaming services

We're perfecting the patient experience - Stillwater Medical Center