A Shift in the Healthcare Dollar Pie

By my second lecture, I have taught my students about the healthcare dollar pie and its 3 pieces:

Piece 1 for the patient or consumer
Piece 2 for the service/medical provider
Piece 3 for the insurer/payor

I always tell them how the size of the pieces shift over time reflecting the cycles within healthcare delivery. Most of my students were not even born when patients got a big piece of the pie – that is, when patients received the services they needed for the amount of time that they needed them, all without pre-authorization! Many students can barely remember when the piece for the medical provider was big- when doctors were “rich” and therapists could become financially successful. My students do learn about the big piece of the pie that the insurers are eating, how well their stocks are doing, how much their CEOs are making, and how big their pended/denied departments are. And just in time for this fall’s lecture, the pie is shifting again, and in the wrong direction.

Yesterday, I received a letter from my insurance company (BCBS), informing me, as is required by law, that they are seeking a 17% increase in the premium for the new policy I got in January 2015. This both shocked and bothered me on many levels. Year one and the insurers are already taking “affordable” out of the Affordable Health Care Act. More disturbing is that this insurance company has systematically been lowering the fees paid to private practitioners –lowering the fee, eliminating CPT codes and time/ modality based payment in favor for flat fee methodology and bundling. While they systematic deny therapists a rate increase, even one based on cost of living and instead are lowering fees or canceling contracts, they claim they need a 17% increase in part because of the rising costs of medical care, a new pool of customers, and new providers.

I am beginning to no longer see the 3 pieces of the healthcare dollar pie. Instead, slowly it is becoming one pie solely for the insurers and payors, with 2 crumbs, one for providers and the other for patients.

Comments are closed.