“David and Goliath (1599) oil painting by Caravaggio.
Herewith the story of Evergreen Health Cooperative, created under the federal Affordable Care Act to offer “patient-centered” care and cut healthcare-market costs. (We keep being slightly amused by term ”patient-centered” care. Isn’t that the population that healthcare was always suppose to be centered on? Well, maybe not….Follow the money?)
Evergreen has two parts: a nonprofit insurance company with a traditional network of doctors and a health system that directly employs providers.
“We’re the first new commercial insurer in 20 years in Maryland as far as we know,” Peter Beilenson, M.D., a former Baltimore health commissioner, told The Baltimore Sun. “It’s not easy to have a successful startup in a state that basically has a monopoly,” citing CareFirst BlueCross BlueShield, Maryland’s dominant insurer.
Evergreen is one of 24 such co-ops in America, officially called Consumer Operated and Oriented Plans, and, as The Sun noted, ”many of them face similar behemoths.”
And the ACA doesn’t let these co-ops do traditional marketing. Further, government rules make it hard to sign up large employers that could bring in many paying customers at once.
”That fierce competition {from big insurers} is the biggest hurdle to the co-ops’ success …. But there are a host of other potential stumbling blocks, including name recognition and funding, and the co-ops are responding by boosting their industry knowledge, aggressively marketing their services and cutting premium prices to lure customers, ” reports The Sun.
Evergreen looks to small businesses that it could attract on its own and enroll in groups. ”So far, about 1,000 small businesses employing {a total of} about 12,000 people have switched to the co-op.”
Research ”shows those insurers that follow the {co-op} model could save around 20 percent on hospitalizations alone, one of their biggest costs.”
We wonder how some of these co-ops might be integrated with Federally Qualified Health Centers.
“Improvements in all aspects of discharge summary quality are necessary to enable the discharge summary to serve as an effective transitional care tool,” the authors wrote.
“If you discharge a patient from the hospital and the physician that is now going to be following them is not given a discharge summary that is accurate and complete, then [the doctor is] going to screw things up,” Steven Wolfson, M.D., a New Haven cardiologist uninvolved in either study told the New Haven Register. These transitions are particularly dangerous for patients, he said, because “[i]t’s like crossing an international boundary … largely because the information flow is critical and it’s often very poor.”