As far as UHC is concerned, they lost revenue because of poor service and loss of several million accounts. If they don’t learn that arm-twisting physicians and hospitals and creating insurmountable obstacles to effective delivery of healthcare is bad business, they will continue to lose ground, as they should. Just as Geisinger did, we actually lost significant revenue because we decided to use our own efficiency model for chronic disease care for our diabetics for several years. We received a complement as from one of our local insurers for having the best diabetes control with the highest disease burden for only average cost (as compared all similar speciality practices in the local 5-county area and the whole of the neighboring state). But no monetary reward. Obviously, we took a hard look at what we were doing and decided to scale down the program so that we can at least get paid for our efforts.

The fundamental problem of the current “arrangement” of purchase of health coverage is that the financial transaction of buying insurance coverage (between employers & insurance companies) runs a parallel course with the delivery and receipt of care (between physician/hospital & patient). Unless this perverse process is broken down and simplified, we can neither achieve adequate universal coverage nor quality care nor cost savings.

The only logical solution is to break down purchase of care into several components, such as office visits, lab tests/radiology, hospitalisations, etc. and allow individuals and families to purchase such coverage as per inidividual/family needs, with employers being allowed to reimburse for this or individuals being allowed a tax incentive for it. The other component is to allow physicians to directly contract with employers and/or patients for services, getting rid of federal mandates that disallow such contracting at present.