The program presented by Rachelle Neuwirth at LIMBA this morning was about an approach to healthcare delivery that is considerably different than we have come to expect. The fee for services method of medical care is being replaced by a concept that can be called Wellness Maintenance.

The system we know is predicated on large insuring units creating multiple configurations of policies that in the final analyses make understanding the product difficult if not incomprehensible. When payments are made they are made on the basis of the amount of procedures delivered and the complexities of those procedures. This is a system the incentivizes maximum care with little regard for effectiveness.

The Affordable Care Act (Obamacare) mandates that there be several levels of insurance that you can buy. The choices may be Platinum Gold, Silver, etc., but the coverage within those descriptions is all the same, whether the issuer is ABC Company or XYZ Company. By creating levels of insurance that are consistent from one company to another forces the issuers to compete on price. The system is designed to lower premiums.

Narrow networks of coverage such as CareConnect, which was also the sponsor, are emerging. The so called narrow networks are more responsive than the giants and even get into doctor referrals. They are developing medical databases that help each physician that treats a patient with information that is essential to good care. Eventually Integrated Medical Records will be the standard.

By having a thorough understanding of the patients under care allows the insurance company to act more quickly to the questions of eligible procedures. We were told that the denial for care rate in health insurance business is a whopping 18%. In the smaller networks it is much lower. CareConnect boasts a 2% denial rate by comparison.

Under this concept of wellness maintenance it is conceivable that an Rx could read; take a 10 minute walk twice daily instead of a pill. Advice on lifestyle changes such as smoking we have been doing for years, but there are other behaviors as well that should be addressed. Such as; how long should we sit at a computer screen before getting up to get a drink of water.

The presentation was thought provoking and there were many questions at the end.

Ernie Fazio