One of the strongest, long-lasting unifying themes in the health care provider brotherhood is how much everyone distrusts insurers. It's in our DNA, as in Do Not Acquiesce. Well, without putting up a good fight first, anyway.
And then there are the stories. Every health care executive has multiple tales to tell about negotiations with insurers over the course of his or her career as health care marches on through history with managed care, tiered providers and more.
And then there are the physicians. Wake one up in the middle of the night and he would instantly recount endless individual examples of how interactions with insurance companies affected what he perceived as detrimental to patient care, and, to put it politely, made decisions that did not reside within the boundaries of common sense.
You want to see true physician/hospital alignment? Just start telling war stories about payers. Everyone will happily vent for hours — maybe with just, how to say it, slightly different points of view.
And then there are employers and consumers — each with different demands and expectations, as in lower costs, more benefits. They all have stories to tell as well. It's the stories told by beneficiaries over the decades that landed the insurance industry near the bottom of consumer trust polls.
Of course, the insurers have stories to tell as well. As one former insurance executive who switched sides (and received insulting phone calls from "colleagues") blogged: "Literally, no one can throw a rock in this glass house." Some have opined that the quickest way to understand the insurance industry is to become a self-insured entity.
Others have noted the irony that those in the best position to help and educate others about managing population health are the least trusted to do so and would arouse the suspicion — if not the ire — of everyone in the health care chain.
One notable exception to the current status quo is the medical home concept, which in some cases seems to be a mutual touch-point for insurers, physicians and hospitals to try something new and build upon the skills of each.
For example, a CIGNA and Dartmouth-Hitchcock medical home pilot has "the goal of improving the quality, affordability and patient satisfaction with care through collaboration and aligned incentives." Three years out, all seems to be on track. You can read the complete description and many others at the Patient-centered Primary Care Collaborative website.
Of course, that's not all insurers are doing. Some are buying physician practices. And Pittsburgh insurer Highmark Inc. is acquiring West Penn Allegheny Health System.
So, like Columbus at high sea, we don't know exactly where the New World is or what it looks like, but, by golly, we're going. Just remember that voyage was made by an armada. Everyone else is coming, too.