Progressive plan sponsors are either half pregnant flower lovers with a passion for tulips or cliff dwellers not afraid of sharks.
By Bill Rusteberg
There is a growing trend among progressive brokers, consultants and third party administrators pushing alternate payment methods for medical care givers. All share two things in common – (1) They understand PPO’s are cost drivers providing the guarantee of overpaying for healthcare and (2) Their wavering cult mentality essentially remains strong but vulnerable.
Most are late entrants to the Reference Based Pricing arena. Their cult like mindset has delayed and made it difficult for them to break away from 45 years of managed care addiction. But they’ve escaped the compound.
Now what?
“Let’s wean members off their expensive managed care addiction. Let’s start with narrow networks of providers who have agreed to accept less, and maybe even initiate a limited Reference Based Pricing strategy targeting four or five surgical procedures through providers agreeing to charge less. But, at the end of the day, it’s essential we remain proverbial dope dealers in order to maintain member addiction in a controlled manner consistent with HR protocols. The alternative would trigger a horrendous and disruptive meltdown including screaming and yelling associated, with managed care withdrawal. Besides, HR is out of ear plugs.”
This is the methadone method of solving health care financing.
There is no such thing as being half pregnant. A half pregnant approach to solving health care only extends and aggravates withdrawal symptoms, taking longer than necessary to achieve the end goals of lower costs, better benefits and higher wages.
There is no question that moving away from egregious managed care contracts no one can see but through which most health care costs are based is fundamental to solving health care financing in this country. To continue the status quo amounts to blindly gifting co-mingled funds through third party intermediaries to be distributed to parties known and unknown without any accountability whatsoever.
Overcoming any addiction is difficult but Managed Care addition is by far the hardest.
Tip-Toeing-Through-The-Tulips (the Methadone Method) only makes change more difficult. There is no such thing as being half pregnant, half addicted.
A philosophy based on individual responsibility, prudent economic practices without much concern for “social” issues is characteristic of cliff dwellers. They understand “Jumping Off The Cliff” into shark infested waters produces desired results quickly. They don’t believe in wasting time.
The initial shock is harsh but momentary (Survival rate is 100%).
They get to where they need to go faster. The healing process averages 4 – 6 months, well in advance of their next renewal cycle.
Feared sharks morph into spooked gold fish. Heretofore feral Health Care Hogs are caged and tamed, reserved to be subjects of field trips for future generations of children to see and marvel at things that once were.
If its true plan sponsors are either half pregnant flower lovers with a passion for tulips or cliff dwellers not afraid of sharks which one are you?
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