Posted by fachad on July 15, 2002, at 12:23:51
In reply to Insurance, Profitability, Utilization, Profiling, posted by fachad on July 15, 2002, at 11:08:36
Here's a little sarcastic version of the story from the perspective of the insurance company...
Anyone who takes psych meds needs to add "High Utilization" to their list of diagnosis.
High Utilization is that horrible condition where someone actually uses their health insurance, and gets benefits. In severe cases, the benefits they claim exceed the premiums they've paid, resulting in losses at the bottom line.
There are several approaches to treatment.
The best treatment is prevention. Try not to insure high utilizers if at all possible. You can discourage them by setting their premiums ridiculously high.
If you find yourself insuring high utilizers, there are still a few things you can do to protect your bottom line.
Try to exclude their conditions from coverage.
Put a cap on their coverage.
Put a "gatekeeper" in place to keep them from getting quick access to expensive treatments. If you can stall long enough, they may die or switch insurance companies - either way your bottom line is protected.
Exclude high cost medications from coverage and demand they use low cost generic meds instead. A one-time open heart surgery can cost less than a lifetime supply of daily expensive meds.
And keep your eyes open for high utilizers. Do your "Utilization Review" homework and regularly update the data in your "Group Profiles". Don't let sick people ruin the profitability of your health insurance business!
poster:fachad
thread:112416
URL: http://www.dr-bob.org/babble/20020709/msgs/112427.html