Fri Apr 27, 2012, 02:12 AM
eridani (51,896 posts)
Wellpoint eliminates plans with a higher than average number of sick people
The Wall Street Journal
WellPoint's Profit, Membership Shrinks
WellPoint Inc. reported a 7.6% decline in first-quarter earnings and a decrease in members, but the health insurer also gave indications that the problems affecting its Northern California business are easing.
While health insurers, in general, have benefited from the sluggish pace of patient visits to operating rooms and doctors' offices, WellPoint's gains have been muted by unexpectedly high costs for seniors in Northern California, where the company picked up thousands of members with expensive health issues.
The company has said it has fixed the problem by walking away from the difficult market, which is part of some planned membership losses for the new year aimed at boosting profit margins.
Comment by Don McCanne of PNJP: What is a private commercial insurer to do when when one or more of their plans has thousands of members with expensive health issues? Walk away, of course. That's exactly what WellPoint did with its expensive plan membership in Northern California.
What else can you expect from a private, for-profit health insurer? It is first and foremost a business, which must never allow its role of patient service to interfere with its profit mission.
Insurers providing Medicare Advantage plans are prohibited from exercising favorable selection - cherry picking, cream skimming, or whatever - but what do you call it when they dump an entire plan population of sicker than average patients? That's worse than cherry picking individuals because that involves an entire plan population.
The plans have figured out how to cheat on the Medicare adjustments for adverse selection when their patients are actually healthier and less expensive than average. They just haven't figured out how to cheat when their patients are less healthy. They certainly don't want to make them look healthier which would then adjust downward their payment rates. No, walking away from their sicker populations seems to be their only answer.
And what is the Obama administration doing about this? Not only do they let them walk away from high-cost populations, they also are rewarding these overpaid plans with extra "quality award" money - a phony guise since these awards are going to almost all plans regardless of how mediocre their quality scoring. This is really a money allocation scheme designed to enable plans to offer extra benefits in order to entice patients away from the traditional Medicare program. Numerous releases from HHS have bragged about the increased enrollment in these private Medicare Advantage plans. Why are they promoting and awarding such a despicable industry?
President Eisenhower warned us about the military-industrial complex. Arnold Relman warned us about the medical-industrial complex. But what about the government-private insurer industry complex. That one is killing us... literally.
My comment: "But what do you call it when they dump an entire plan population of sicker than average patients?" Lemon dropping.
4 replies, 1526 views
Wellpoint eliminates plans with a higher than average number of sick people (Original post)
|Saving Hawaii||Apr 2012||#1|
|kenny blankenship||Apr 2012||#3|
Response to eridani (Original post)
Fri Apr 27, 2012, 02:34 AM
Saving Hawaii (441 posts)
1. Your comment...
'My comment: "But what do you call it when they dump an entire plan population of sicker than average patients?" Lemon dropping."
I like to call it Lehman crashing. Almost the same. Maybe if we term it that way some of these f***ers will give a hoot.
Response to eridani (Original post)
Fri Apr 27, 2012, 02:46 AM
kenny blankenship (15,689 posts)
3. Health care would be a pretty sweet business if it weren't for all the sick people,
am I right? They can get pretty damn GROSS.
But here's the thing Insurance Companies figured out : you can just refuse to pay for fucking tests or delay 'em until they stagger off and die. That way you get to keep all their money and get rid of the unsightly sick people in one fell swoop.
That my friends is called free market Innovation, and it separates our Uniquely American system from all those Euro-Socialist models with their public hospitals stacked high with patients, lying with their noses stuck up each other's bungholes.