This is as true as it gets. And they will continue to put pressure on “efficiencies” which means less face time with a doctor who will essentially “sign off” on a procedure/eval/assessment while the nurses handle the actual administration of the procedure and the support staff handled the logistics.

On paper, it’s not a bad idea (the efficiency model not the corporations buying up local practices). But a model that runs on efficiency equates to a need for high volume. And high volume leads to corners being cut, mistakes being made, and a worse patient experience. But hey, we can brag we’ve got the most “efficient” hospitals in the world!!! We got that going for us….and that’s kinda nice….

sure. but there's also a thing called "creative accounting." that ACA rule also allows for deferments and other "deduction" type loopholes. I think its a good thing, but its not as simple as calculating ACTUAL revenue * .8

There are SO many things broken about our system. what upsets me is that we could fix them but we CHOOSE not to. See above posts about judging who "deserves" quality care.

Just reading the report I linked.

"Independence Health Group, Inc., (Independence) the parent company of Independence Blue Cross, LLC, reported solid financial results for 2020 with total revenue of $21.8 billion, up $2.6 billion or 13.5 percent over 2019"

you could argue the same for profit margins too. If you want to get into depreciation, cash on hand, deferred losses, bad debt, real estate depreciation/appreciaiton. then those numbers Never mean anything at all. you're still getting lost in the numbers and missing my ACTUAL initial point. what you're saying is valid, but I believe your missing the forest for the trees here. good day, good luck. im out.

also, regarding the "average" chart, have you seen a chart showing MEDIAN? this is clearly a situation of restricted range with some folks paying very little and some folks paying the higher end. sure the average may be $400, but that doesn't illustrate the difference between person 1 paying $10/month and person 2 paying $800.

as a business owner, I understand the importance of margins, but that marginal increase translates to them profiting 2.6BILLION dollars more than the previous year. My real point being this was during a pandemic. Sure, during typical years a 2-4% increase is a sign of good, lean management. but it's the same way flood insurance companies make more money during floods....it sure seems counter intuitive, no?

and keep in mind that increase also included the "cost sharing" programs where all copays were waived because they were making so much damn money apparently they felt guilty or were just concerned about blow back. I haven't seen any published figures about what they "waived" but Im willing to bet it'd bump that 2.6B up a bit if they weren't on the hook for it.....

https://news.ibx.com/independence-health-group-reports-2020-financial-results/

maybe im just cynical because I see it from clients perspective and see so many people struggling to access care to sustain a basic quality of life I believe in this country should be an inherent right. I dont believe healthcare should be attached to employment, and I do NOT believe in single-payer solution. (government OPTION.....maybe.)

Most "marketplace" plans take into account income to determine how much insurance plans are subsidized. Each state determines their own scale. In NJ and DE, the scales are significantly inconsistent with one another. These numbers are made up, but just for illustrative purposes, a person making 100k in NJ may qualify for 25% subsidies while that same 100K qualifies for 5% subsidy in DE.

And to your other point about this being class driven, I have no doubt there was that type of mentality in there, sure. BUT it wouldn't have actually happened if it didn't benefit the insurance company. and it wouldn't have been ALLOWED to happen if legislatures had the good of all people in mind.

We have a mentality that in the USA that people who are poor and underserved are deservedly so, and that it is their own fault for being in that position in the first place. I can point to several social perspectives that boil down to that single factor. Its situation vs disposition phenomena at its finest.

obviously I dont know your issue, but there's something odd going on here. The only way a company can legally "drop" a customer mid-year (not during open enrollment ie. end of the benefit year) is bc of not paying the premium. Even then, there's a grace period where if a person catches up on premiums it's as if no lapse in coverage occurred. They also MUST send out letters stating premiums are behind and provide a deadline date.

At my practice we get these letters all the time. like, weekly. Patient A has been coming in and we receive a letter stating "Patient A hasn't paid their premium, if its not paid by Date X claims from (date to date) won't be paid."

Please dont read this as not believing you, what im saying is knowing the regs a little bit gives you some leverage so you aren't surprised as you mentioned. There are also programs to cover kids, even if you have reasonable financial means (CHIP), and it's backdated. So if your kid didn't have coverage starting Feb 1 and he/she I admitted into hospital Feb 15, CHIP will cover the costs 90 days PRIOR to claim. Most hospitals have a social worker that will help with application. Now, its a low-paying plan and they will still try and get you out quickly (hospital soperate in the red with CMS rates and need commercial plans to stay afloat), but you won't be on the hook for monster bills.

https://www.insurekidsnow.gov/coverage/nj/index.html

what year was this? What state was your coverage based??

regulation for this has improved over the past few years. specifically 2010 ACA and 2011 parity law made some huge improvements (pre-existing conditions, mandatory coverage for various services like mental health, catastrophic coverages, etc), its such a shame SOME (not mentioning names to make this political) politicians did their best to tear those laws down. If they just worked to IMPROVE instead of REMOVE we really could have been close to having a system that works.

An existing problem that still exists is that insurance is regulated state by state. I live in NJ and the same plan from Horizon BCBS costing $700/month for a couple (2500 deductible, $20/$50 copays) costs $1500 in Delaware with Highmark BCBS because of the difference in income-driven costs. We all know the best way to keep premiums down is to enlarge the pool of customers. One way the insurances ruin that strategy is to hack us into groups (not allowing cross-state plans).

While I see myself as socially liberal, the Democrats' incompetence has cost us progress as well. However finally allowing CMS to negotiate drug prices for Medicare/Medicaid should be a big improvement for some older and poorer folks.....or maybe Im being naive and the crooked PBM and insurance companies will find a way to sidestep that too....

Sorry, I can go on all day about this shit. drives me crazy.....

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Edit: another rant: another thing people dont realize is their employer HR manager negotiates with insurance brokers for your plan. If you work for a company (especially smaller companies) with older employees op high-utilization folks (read: sicker), it WILL affect the cost of YOUR premiums. Working for a larger, younger company equals lower premiums.

Also a doctor and very familiar with billing. The entire managed care/commercial insurance driven reality focuses so much on efficiency that GPs are forced to adapted. There is a HUGE shortage of young GPs in the USA.

Here’s an example from psychology. Years ago, only psychiatrists conducted therapy and also prescribed medicine. Then psychologists became a credential profession to do just the therapy part (didn’t need to ALSO be a physician for the medicine rx). Then counselors came along and could do the therapy part without having to learn psych testing and evaluations. Now there are psycho-metricians that can administer tests and psychologists only INTERPRET the results. Basically insurances want clinicians to ONLY do the part of their job that requires the highest level of training. Anything under that is done by a lesser credentialed clinician. And it saves insurances tons of money that isn’t passed on to customers.

Did you know that in 2020, during a pandemic, Indep Blue Cross had its highest profit year EVER!?!? Think about THAT one….

In the medical field, we see the addition of Physicians Assistants (to be called Associates starting next week) and NP’s. Unfortunately I see this trend continuing….