Industry and HMOs: A Natural Alliance


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CARA researchers have filed 10 patents, and have had more than 20 peer-reviewed papers accepted or published. The broad research expertise represented by this vibrant West Coast scientific community will surely expedite the discovery process for many scientific and technological questions.

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UC Davis is a global community of individuals united to better humanity and our natural world while seeking solutions to some of our most pressing challenges. The university offers undergraduate majors and 96 graduate programs through four colleges and six professional schools. July 25, United States. Healthcare costs are running well ahead of premiums, and plans are looking for ways to reduce the hemorrhaging.

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One successful technique is to increase membership and premium revenue by legally cherry-picking the healthiest -- and lowest cost -- enrollees. The most attractive enrollees are young, healthy adults between ages 21 and They generally have few health problems, rarely see the doctor or need procedures, have low costs for prescription medications, and on average should generate profits for HMOs certainly as compared to pediatric patients and older HMO members. Most young adults are probably already in an HMO. The only way to grow market share in this segment of the population is to cannibalize other managed care plans -- steal their patients by offering something new and attractive, like refractive surgery, at significant discounts.

Refractive surgery has become a way for HMOs to differentiate themselves from other HMOs and bring in the most profitable "bodies. It costs them nothing or essentially nothing other than promotion. HMOs and employers like the idea of adding a high-visibility "perk" without increasing financial exposure, no matter how many patients use the service.

The HMOs would love to have everyone undergo discounted LASIK, and to tell their friends about how they got the procedure at a great price through their health plan. Patients with discretionary income, particularly young adults ages 21 to 40, see it as a way to have a procedure that they might not be able to afford otherwise.

We've definitely seen an increase in the number of alliances formed by HMOs, vision plans, and LASIK centers, which has resulted in a corresponding rush to promote the procedure. And that's driven an increase in surgical volume. But, of course, there's a dark side.

Initially, when only one or two HMOs in town offer the benefit, patients would gravitate toward those plans. Discounts from "usual and customary" were modest and acceptable for most physicians.

Certainly, at that point there was nothing approaching bloodletting. However, as more and more alliances are formed and more HMOs offer the discount benefit, the situation will become increasingly difficult for independent physicians. Once every HMO in town offers a discounted refractive surgery benefit through its vision plan or through a corporate LASIK center, patients could start choosing refractive surgery based not on which HMOs offer access to a discounted benefit but, rather, on which offers the lowest price.

And once that begins, where does it lead? One might be inclined to think that the game is over -- that these alliances have added insult to injury, crippled the marketplace and robbed the independent refractive surgeon of all pricing power.

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In the short term, obviously, plenty of independents are struggling. And not all will survive this current assault.

The corporate laser centers have a competitive edge compared to most independent surgeons in building managed care alliances. I am confident HAP will continue to grow its footprint as the trusted partner in health in our communities. Michael Genord , M.

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For nearly 60 years, HAP has partnered with leading doctors and hospitals, employers and community organizations to enhance the health and well-being of the lives it touches. HAP excels in delivering award-winning preventive services, disease management and wellness programs, as well as personalized customer service.

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Industry and HMOs: A Natural Alliance Industry and HMOs: A Natural Alliance
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Industry and HMOs: A Natural Alliance Industry and HMOs: A Natural Alliance
Industry and HMOs: A Natural Alliance Industry and HMOs: A Natural Alliance
Industry and HMOs: A Natural Alliance Industry and HMOs: A Natural Alliance
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