Risk Pools

Financing Healthcare

My pick of healthcare systems would be none. Why?

All the choices are dated. Rather than looking at a model in it’s entirety, we need to look deeper to what aspects are working and why.

What we know is that healthcare financing affects timely access and all systems no matter how they are currently financed have access issues whether it’s waitlists, the cost of care or patient’s who prioritize savings over timely care.

We also know that untimely care typically results in more expensive care. So the question should be not which system is best but rather do we shift the financing to emphasize more timely care that keeps people healthy.

The questions that everyone should be asking now are:

1/ Which companies should be at risk for keeping people healthy?

2/ Which companies should be at risk for delivering high quality care?

3/ What role should the government play to make healthcare affordable?

As an industry, we can’t answer those questions. We need to know:

1/ Who do people trust as a partner for their journey through life?

2/ How much involvement are they willing to tolerate before the solution becomes too invasive and creepy?

3/ How can we build trust?

Risk Pools

Risk pools are a powerful tool but they have been incorrectly within the healthcare system.

Risk Pools are a way for insurers to share the medical responsibility and financial risk with healthcare providers for managing a defined patient population. It rarely goes well.

Providers have a few big issues:

1. Insurers have premiums and investment vehicles to absorb risk pool loses. The risk pool is a limited amount of money with no means to increase the available funds. Providers end up rationing care.

2. Managing the risk pool is about predicting future medical events. The technology and methods providers use are getting better but still pretty limited.

3. The conversation between doctors and patients is changing. Patients are more informed of experimental therapies. Telling a patient NO when there is even a remote shot of something working would be tough for someone who is invested in the relationship.

Given that many insurers are becoming provider organization offering health coaching and preventative care, risk pools would be better used between the government and insurers as a way to incentivize them to keep people healthy.

The government is also better positioned to improve access by providing the Stop Loss insurance for patients with genetic issues.