Insurers Are Getting Into Health Care, But Is It Good for You?

From TIME - March 10, 2018

In the not-too-distant future, your health insurance, your prescription drugs and some of your treatment may come from the same company.

Insurers are dropping billions of dollars on acquisitions and expansions in order to get more involved in customer health. They say this push can help cut costs and improve care, in part by keeping the sickest patients healthy and out of expensive hospitals.

Thats a huge potential benefit for employers and other customers stressed by rising costs. But is this good for your health?

That question worries some health care insiders who wonder if the patients best interestand not profitswill remain the focus as insurers dive deeper into care.

The fights about price and cost are only going to get worse. Now youve got more integrated and powerful private insurerscoming up with the answer, said medical ethicist Arthur Caplan.

The insurer Cigna said Thursday it will spend $52 billion to buy Express Scripts, which administers prescription benefits for about 80 million people.

Late last year, CVS Health also announced a roughly $69 billion deal to buy another insurer, Aetna. Those companies plan to convert drugstores into health care hotspots that people can turn to for a variety of needs in between doctor visits.

Other insurance companies, including Humana and UnitedHealth Group, also are making deals to expand their role in managing or providing care

The concept isnt new. Many people already have coverage through health maintenance organizations, or HMOs, where insurers either employ doctors or contract with them to manage care.

But major insurers are buying into the idea because the usual ways they control costsby negotiating rates with hospitals or cutting their own expenseshave a limited impact, said Standard & Poors analyst Deep Banerjee. He added that delving into care is the most efficient way for insurers to manage costs.

If insurers dont find a better way to control costs, Amazon might. The online giant announced earlier this year that it will collaborate with billionaire Warren Buffett and JPMorgan Chase to create a company aimed at giving employees high-quality, affordable care. The companies have yet to announce details.

Insurers and other nontraditional care providers like CVS say they arent trying to replace doctors or randomly shave expenses.

They say the goal is to supplement the care a patient already receives or provide affordable options for people who dont have doctors. Big acquisitions also help them gather more information about customers, which can improve care, for instance, by helping doctors figure out which medicine might work best for a patient.

They also say that cutting costs and improving care are not mutually exclusive goals.

Humana gives wireless scales to about 2,000 patients with congestive heart failurea sliver of the insurers total enrollmentand has nurses monitor their weight remotely. A sudden gain can be a sign of looming trouble for these patients, so a nurse may check in to see if they need to adjust their prescription or see a doctor.


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