Insurer clinic competition 'very worrisome for hospitals'

Clinics run by UnitedHealth Group, Blue Cross and Blue Shield, and CVS Health have hospitals worried that patients may be steered away from their doors, according to The Wall Street Journal.

There's a growing fear that large health insurers will take control of the delivery and payment of healthcare by guiding their members to providers they own. The trend especially threatens physician groups and hospitals that have acquired practices to gain more control over where patients are referred.

A few of the insurer-led primary care initiatives hospitals are worried about are:

  • UnitedHealthcare's new plan in Los Angeles that is built around Optum physicians
  • Aetna's decision to drop copayments for members who use CVS' MinuteClinics  
  • BCBS of Texas' new plan to offer free primary care visits at clinics it opened with a partner in Houston and Dallas

In these situations, a major concern for hospitals is insurers' ability to hold revenue inside their own businesses rather than pay it to outside providers.

"It's very worrisome for hospitals," healthcare consultant Chas Roades told WSJ. "Suddenly, the plan you're relying on for payment is also competing with you at the front end of the delivery system."

More articles on healthcare finance:
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U of Vermont Health Network blames operating loss on Epic install
Highest-earning nonprofit hospitals give less charity care than lower-earning ones, study finds

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