While no one was looking, nine big insurers grabbed 76.7% of privately-insured patients!
Consolidation of major health insurance companies in recent years is a trend which reinforced the market clout of the nation’s two largest lab companies at the expense of local laboratories and pathology groups. However, few pathologists and clinical lab managers know precisely how much market power is currently concentrated into the hands of only a few health insurance companies.
Dark Daily now unveils a remarkable analysis. At this moment, just nine companies control 76.7% of all privately-insured individuals in the United States! Moreover, the three biggest of these health insurance firms—UnitedHealth Group, WellPoint, and Aetna—collectively cover 85.6 million of the185 million Americans enrolled in private health plans. That’s 48.3% of the total U.S. market.
As shown in the table below, when the other six companies are added—Humana, HealthCare Service Corp., Cigna Group, Kaiser, Highmark and Health Net—the nine biggest health insurers cumulatively insure 141.9 million of the 185.1 million Americans with private health insurance—or 76.7% of the total.
Employers increasingly see wellness programs as effective ways to reduce the money they spend on health benefits. Health insurers are responding to these employer needs by launching wellness programs aimed at better prevention and disease management.
Such wellness programs often have two dimensions. First, most wellness programs encourage beneficiaries to utilize healthcare in a proactive mode. Beneficiaries are encouraged to receive regular medical check ups, along with preventive tests or screenings consistent with “best practice” protocols by age, gender and health status. This creates an opportunity for medical laboratories to develop services that can add value to the wellness programs offered by employers and health insurers. The second dimension involves efforts to improve lifestyles. Smoking cessation support, encouraging more exercise, and helping people lose weight are examples.
Over at Wellpoint, the nation’s largest health insurer, its regional subsidiary plans rolled out a wellness program called “360o Health.” This program bundles health and wellness programs together for employers. It includes Web-based health support and nurse counseling via phone. Online tools remind members when they’re due for routine tests and checkups or provide tips, such as recommendations on how to obtain less expensive medication options.
Wellpoint, which has 34 million members nationwide, also launched an assessment tool to gauge the program’s success. Its Member Health Index measures success of the WellPoint program in 20 clinical areas, including prevention, screening, care management and patient safety.
WellPoint, which tied its employee bonus structure to patient participation, reports it quickly realized a two-for-one return on its investment in the program, including a 10% reduction in hospital stays, according to a report by Modern Healthcare.
A recent survey of 350 employers by PriceWaterhouseCoopers indicated that just 15% of employees currently participate in wellness programs. Employers surveyed were most interested in programs that help employees lose weight, eat healthy, and reduce stress. They say their employees would be more likely to participate if offered incentives like premium reductions or gift cards.
Over at UnitedHealth Group, its OptumHealth subsidiary launched a project that compiles and analyses medical, pharmacy, behavioral health and laboratory data from claims, employer data and other sources. The goal is to use this information to identify the wellness needs of individual members based on health status. The company says its E-Synch Platform allows staff to take a personal approach to wellness, tailoring services to meet individual needs, and health goals.
Clinical lab managers and pathologists should recognize the market shift taking place as more employers and health plans jump on the wellness trend. This is a definite shift in clinical priorities and will require a different type of service support and test menu for laboratories and pathology groups. Patients in wellness programs need appropriate laboratory tests for screening different diseases and for predicting the patient’s likelihood to develop a chronic disease. This is a different emphasis for lab testing than, say, the 1980s, when most patients went to the doctor only after they felt sick.
On December 1, UnitedHealth Group (NYSE:UNH) unveiled its www.myoptumhealth.com solution. This is an upgraded web-based service that allows consumers to create and manage their own digital health record (DHR).
It’s widely accepted that conversion of medical records to digital format could improve medical outcomes and reduce healthcare costs dramatically. One unexpected development on that road to the universal electronic medical record (EMR) has been the well-financed efforts of companies like Google (NASDAQ:GOOG) and Microsoft (NASDAQ:MSFT) to offer digital personal health records (PHRs) to consumers via sophisticated Web sites. Now comes the major health insurer, UnitedHealth, with its DHR offering for consumers.
Like Google Health and Microsoft’s HealthVault, UnitedHealth’s myoptumhealth is free to consumers and allows them to create and manage their own digital health solution. However, unlike those two competitors, which have lined up affiliated services for its users, myoptumhealth is organized to offer consumers services provided by various UnitedHealth business entities.
Google Health and Microsoft’s HealthVault are partnering with medical providers to offer patients the ability to upload their records from provider files, and provide a host of online medical services, such as Allscripts ePrescribe, a free, Web-based prescription solution for physicians. The sites also provide consultation with medical experts; link patients with providers and related services, like TrialX, which matches patients with clinical trials; and provide a database of information on health topics.
HealthVault, which was launched in 2007, has more than 100 participating provider partners, including leaders in health information technology, such as Kaiser Permanente. Launched earlier this year, Google Health’s partner list is not yet as extensive but growing quickly, and includes medical technology leader, the Cleveland Clinic; national pharmacy chains CVS, Walgreens and Longs Drugs; and laboratory testing giant Quest Diagnostics Incorporated (NYSE:DGX).
It is still too early to gauge whether medical laboratories and imaging providers will be willing to partner with these Web-based DHR services. Because of the importance of lab test data for any patient’s health record, Google Health, HealthVault, and myoptumhealth recognize the need to have clinical laboratories and imaging providers upload test results to patients’ digital health records and digitally sign them as evidence of authenticity. Access to lab results increases the value of DHRs to patients, enabling them to leverage the data in healthcare applications, ask their medical providers informed questions, and monitor their own health status by comparing lab tests over time.
While only time will tell, a positive indicator of consumer support is increased interest in online health information. Visits to health Websites rose 21% last year-more than four times the rate of total U.S, Internet population, according to comScore, a Reston, Virginia-based firm that measures digital usage.
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