July 21--On the surface, the Affordable Care Act looks like a bonanza for health-insurance companies. Its requirement for most Americans to carry health insurance should bring in millions of new customers.
Rick Cochran, the new president and chief executive officer of Physicians Health Plan, sees that potential, but he also sees risk that few are mentioning when they praise or bash the national health-care law.
"We're going to bring in all these consumers, and the theory is that premiums they pay will be more than the expenses they bring with them. But what if they're not?" he asked.
Cochran has led PHP for six months, long enough for him to get to know quite a bit about the 40,000 members enrolled in PHP plans. Most are in northeast Indiana. Two thousand have individual policies; the rest are enrolled through group plans offered through their employers.
One thing he's seen that makes him reserve judgment on the ACA -- also widely known as Obamacare, after President Obama -- is how resistant people are to preventative care. That's a crucial point, because supporters of this massive reorganization of the way Americans pay for health say it will help control costs by improving preventative care.
What Cochran sees among PHP members doesn't make him optimistic. Only 12.8 percent of men enrolled take advantage of preventative-care benefits. "Women do better," he notes, but only 48 percent of them use the benefits.
Expense shouldn't deter PHP members from getting check-ups and tests that might catch illnesses sooner. PHP provides 100 percent coverage for a wide range of preventative care, he said. PHP isn't alone in that. Cochran, who had worked for other health insurers for more than 30 years before coming to PHP, said insurers have understood the math for years: Preventative care can save money.
"For at least 15 years, we've all basically said the answer is prevention. We've all created benefit plans that emphasize prevention," he said.
Cochran understands how challenging pushing prevention will be. Though he's been involved in health insurance more than 30 years, he didn't have his first comprehensive check-up until he came to PHP, he said.
That's not to say that preventative care can't be improved. For one thing, ACA aims to tilt payment toward encouraging preventative care. If doctors and their support staffs do more to push preventative care, more patients may get on the bandwagon. An example Cochran offered: Suppose nurses called patients routinely to schedule check-ups and made that scheduling a part of the care routine? That could begin overcoming the tendency, especially among men, to put off doctor visits until something is wrong.
Another idea he offered, one that is gaining popularity in a few places, is scheduling "well days," days when every patient on a doctor's schedule is in for check-ups. "People who are healthy don't have to be in the same waiting room with people who are sick," Cochran said.
This much is certain: When the U.S. Supreme Court upheld most of the ACA last month, Cochran said, it started "people talking about the right things again," namely, prevention. And if its reforms designed to give hospitals and physicians a financial stake in keeping people healthy succeed, it could press health care providers and insurers to become more cooperative and less adversarial.
"Now we're figuring out we'd better like each other a little more and work on a solution," he said.
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