This post is the seventh in a series on the state of managed care by Kevin Thilborger. Check out the first post here.

Occasionally, we can recognize that we live in extraordinary and interesting times, and the current healthcare system is demonstrating qualities we have not seen in our lifetime. These extraordinary times should cause us to consider whether extraordinary changes are required to make this system work better.

What is the cause of these extraordinary times?

First, the primary cause is the complete dominance of the healthcare system by health plans, particularly United and Humana for Medicare Advantage, and United plus Elevance plus the independent Blues for commercial. The system is dominated by these financial players, and the consequences for the healthcare system — and every one of us — are significant.

Second, there are no easy fixes.  These extraordinary times are the result of years of dysfunction, and a system of laws and regulations at the federal and state levels that consolidate more and more power and money with a precious few — the health plans. Yet “no easy fixes” does not mean there are no fixes, and it certainly doesn’t mean we should throw up our hands.

Third, we need a healthcare system designed for patients, not health insurance companies. In the same way, hospitals and health systems need to design their own organizations around patients, not physicians (or payors for that matter). None of this is easy, but it should be a long-term strategy and focus. In many ways, this is what most organizations mean by “patient experience,” yet system redesign — not just helping consumers better navigate a flawed system designed for the needs and wants of physicians and others — is often required.    

Unlock Health is here to help providers set managed care strategy and negotiate contracts in the complex world of payor-provider relations. Our full-service managed care consulting group helps providers set their managed care strategy, negotiate contracts, and handle all the contract modeling, analytics, and contract performance. And when negotiations are difficult or contentious, we pioneered the use of strategic marketing communication campaigns to protect providers’ brands and create pressure on payors for fair and reasonable settlements of contract negotiations. Email Kevin Thilborger, our chief managed care and revenue strategy officer, at  [email protected].