Geisinger boots Coordinated from health plan
He anticipates needing a second knee replacement soon, but he likely needs a new orthopedic surgeon, too, now that Geisinger's health insurance plan is booting
The announcement came quietly in February, in a letter notifying
Dodgson, 62, of
"I get that business is business, but I thought health care was supposed to be a little bit different," he said. "I thought doctors were supposed to determine our treatment and not insurance companies."
Ahead of the move, Geisinger fortified its regional position in musculoskeletal health and acquired
"When making decisions about the composition of our networks, we focus on ensuring that our members will have ready access to care and also consider providers' ability to work with us to improve the quality of a member's health care experience," he said. "Most importantly, our physician network should have the ability to improve health care outcomes."
Coordinated officials, who say it was Geisinger's decision to part ways, pledged to bill around 6,000 affected
"It's probably not sustainable forever," he said. "We're probably going to continue for this calendar year."
Geisinger, a nonprofit health system, made an identical move in December in the
The decision there affected about 5,000 patients. Coordinated officials say that patient groups in the
The separation, which Coordinated officials say caught them off guard in both markets, smacks of another recent competitor standoff involving Geisinger.
In January, for-profit
The quarrel ended what was a symbiotic partnership seemingly centered on training new doctors.
By cutting out other providers, Geisinger is narrowing its network, a strategy that grew popular in the wake of the Affordable Care Act as a way to curb costs. Narrow networks limit what doctors a patient can see, and steer them toward lower cost alternatives.
However, as health systems expand and integrate to hold both the medical care and the insurance plans to pay for it, a narrow network could mean that the money never really leaves, and that's a big incentive, one health care economist said, speaking in general terms about integrated systems.
"It's pretty clear, they'd much rather have things stay inside to capture as much as possible," said
"It's important to remember this is a really big business," he said. "It's pretty simple; you just have to follow the money."
Coordinated, a smaller specialty health system of 1,400 employees including about 100 physicians with a heavy focus on orthopedics, is strengthening its foothold in the northeast, already a battleground market where Geisinger has an established presence. Across its network, Geisinger has more than 30,000 employees.
"From our point of view, this has more to do with the planned growth of CH (
Advocates for integration claim that it provides better care at a lower cost, but that typically doesn't shake out in the big picture, Gaynor said.
"That may be true for certain systems, but on average the evidence does not support that claim," he said, again speaking in general terms about integrated systems.
A 2015
Schmaltz and Nyberg said Coordinated's size gives it a competitive edge, and allows it to be nimble and innovate, which is better for health care.
"If we can provide excellent quality outcomes to patients and a good patient experience, there's going to be room for us," Schmaltz said. "We're worried about the narrow networks, but we're not afraid to compete in that world. We think we can do that effectively if we give people what they want."
Being small, however, is not always an asset when squaring off with a system 20 times larger.
With the inevitable divorce looming, Dodgson said he is bracing for what he expects might be a big switch, including a whole panel of tests and MRIs to get his new doctors up to speed.
"Here's the bottom line," he said. "If they make this change, obviously, I can't afford to go to Scranton Orthopedics because my employer, who I get my health care through, has Geisinger. Basically I have to go back to square one."
Contact the writer: [email protected]; 570-348-9131; @jon_oc on Twitter
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