Insurer-owned practices: A problem ... or the solution?


An insurer-owned clinic says it's saving money and providing effective patient care, despite concerns that the model could cause a conflict of interest, according to The Des Moines Register.

Critics are quick to point out that when an insurer is both the payer and the provider, it could be tempted to skimp on treatment in order to cut costs. 

But leaders at CareMore clinic, which is owned by Amerigroup, refuted that critique in interviews with the paper. They said the clinic focuses on caring for patients with chronic health problems that could lead to costly hospitalizations or those who otherwise might not visit a clinic at all. 

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

Although the trend has been slow to catch on, payer-owned physician practices and clinics are popping up in a few spots around the country as insurers and the industry in general struggle to lower healthcare costs. Another idea--mobile clinics to treat low-income patients who may otherwise have limited access to medical care--has helped divert patients from more costly settings, such as emergency rooms. 

CareMore has provided services to approximately 400 Medicaid patients since opening in April, according to the paper--and local hospital officials say the organization seems genuinely dedicated to helping handle high intakes of Medicaid patients

And Amerigroup’s Medicaid members are free to choose different clinics.

UnitedHealth and Amerihealth Caritas also plan to open insurer-owned provider services in Iowa, The Des Moines Register notes. 

- read The Des Moines Register article

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