Insurance carriers are looking for ways to save money!  I know I am shocked as I am sure you are.  All the available health plans out there be they a high deductible health plan, a senior health plan, or even plans that have low health insurance premiums, have to show a profit or they will not be in business long.

Here is an interesting article from Kaiser Health News.  The story begins with James S. Miller, a 68-year-old retired transit worker and jazz saxophonist who lives in Philadelphia.  Mr. Miller suffers from congestive heart failure and every few months he would show up at the ER very short of breath and with swollen legs that are the symptoms of his disease.

The hospital stays were expensive, both for Medicare and Mr. Miller.  Last September Miller enrolled in a private senior health plan called Bravo Health.  After some research I was able to figure out the connection so I could explain it to you.  Bravo Health is a Medicare Advantage plan.  They take the place of Medicare as the payor for the medical expenses of their members.  Keeping the members healthy and out of the hospital makes them more profitable. In August of 2010 Bravo Health was acquired by a company called Health Spring for $545M. Health Spring operates “Health Centers” called Living Well.  According to their web site “Led by Health Spring, Living Well and local physicians have partnered in designing a revolutionary, personalized healthcare experience and center.”  What they are saying is that the Insurance Carrier, Health Spring, merged with a clinic called Living Well and employed the doctors who worked there.  Moving forward, Bravo (now owned by Health Spring) has a clinic in Philadelphia called Bravo Health Advance Care Center on Lehigh Avenue.  It’s a pleasant place with flat screen TV’s, 10-minute waits- and medical care.  The medical care is provided by doctors the insurance company employs just like the doctors at the Living Well center.  The patients are seen by the doctors for no charge.

Why would an insurance carrier want to own and operate a clinic and employee the staff?  Let’s go back to the story from Kaiser Health News.  In order to stay profitable the Medicare Advantage plans must hold down costs, especially hospital spending.  Jason Feuerman, a senior executive for HealthSpring, said “We don’t have the revenue lever that commercial plans have to keep up with soaring costs. They can just raise their premiums.”

Kaiser goes on to report “Humana, the fifth largest sponsor of Medicare plans in the Philadelphia area, operates six urgent care clinics near the city as a result of its December acquisition of Concentra, a Texas-based urgent care chain.”  Paul Kusserow, Humana’s chief strategy officer said “We wanted to give people alternatives to the emergency rooms.”

Health plans for individuals are also trying to limit emergency room visits by their members.  Most now charge a facility fee in addition to the deductible if you go to the ER and are not admitted or have surgery.  They are also offering a co-pay for urgent care centers.  In Florida Blue Cross and Blue Shield has partnered with Walgreens and Floridians can now be seen at one of Walgreens’ health centers called “Take Care”.