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"Fucking HMO bastard pieces of shit," she exclaims, to spontaneous applause in cinemas across the land.
Mary Brainerd is the CEO of HealthPartners, a not-for-profit HMO.
But according to the National Committee for Quality Assurance (NCQA), an independent accreditation agency, the average HMO does better than traditional fee-for-service medicine on several counts.Take, for example, the benefits of reducing needless operations.
UnitedHealth, the biggest insurer by revenue, is rolling out pay-for-performance contracts for hospitals, as well as testing its own medical homes and ACOs.Bob Atlas of Avalere Health, a consultancy, offers a curt sketch of the ACO model: "HMO wannabe".
Dr Dolittle has a chance of making millions of dollars and getting a new car every other year if he agrees to join CalNet, a giant HMO.
Worse for Aetna, the premiums of over half of its policies for next year have already been fixed, so the firm is locked into underpriced deals for quite some time.Aetna is not the first HMO to experience such post-merger malaise.
United Healthcare, the country's largest HMO, suffered similar glitches after buying MetraHealth in 1995.It is noteworthy that the fastest-growing HMO, at roughly 35% per year, is Oxford Health Plans of Norwalk, Connecticut, which has made no large acquisitions (though it does buy tiny firms to save it from having to apply for operating licences in states it wants to enter).
The programme was such a success that it grew into what is now the second largest non-profit HMO, with 9m members.Kaiser's ideas took a long time to catch on.
But medical expenses in America are still far higher than they are anywhere else, and the only proven way to lower them is to get a big HMO to throttle discounts out of hospitals and doctors, to ban unnecessary tests and operations and bully its members into taking free vaccinations.Aetna's troubles will not alter this.
Most HMO foes argue that managed care, by allowing managers to second-guess or overrule the verdicts of medical professionals, puts lives at risk.
The cost savings to patients are considerable, but they must use only the HMO doctors and facilities.
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