Insurer-owned clinics help prevent big hospital bills

Health insurers increasingly are opening their own clinics to help save money. The goal is smarter care, not less care. "It's really just trying to make basic routine services a lot more available," says John Gorman, a consultant who works with some plans that are investing in clinics, "so the hospital becomes the provider of last resort."

The strategy is particularly prevalent among private Medicare and Medicaid plans, which receive formula-driven monthly payments from the government. To make money, these plans must hold down costs, especially hospital spending that has risen an average of 7 percent annually from 2000 to 2009, reports Kaiser Health News.

Bravo Health Advance Care Center in Philadelphia, for example, provides flat screen TVs, 10-minute waits and medical care delivered by doctors it employs at no cost to patients. The insurer launched the clinic in January 2010 and has opened two more since. By providing urgent care, working longer hours, welcoming walk-ins and offering treatment such as IV therapy not available at most doctors' offices, the clinic can keep patients from running up big hospital bills.

"We don't have the revenue lever that commercial plans have" to keep up with those soaring costs, said Jason Feuerman, a senior executive for HealthSpring, which recently acquired Bravo. "They can just raise their premiums."

The company estimates hospital stays have declined by about 10 percent among the 20,000 patients living near the clinic. Bravo doesn't do this by withholding care, Feuerman noted. "It is about driving quality, about driving down the need for unnecessary [medical services] being delivered," he said.

Likewise, Humana operates six urgent care clinics near Philadelphia as a result of its December acquisition of Concentra that give people alternatives to emergency rooms. In Louisiana, People's Health, another Advantage plan, bought the Stanocola Clinic in Baton Rouge at the end of March, and hopes to build or buy at least four more clinics over three years. CareOregon, a nonprofit health plan focused on Medicaid, has launched four clinics since last June and will open another next month.

To learn more:
- read the Kaiser Health News article

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