Special Posting: MODERN HEALTHCARE Comment Letter

The November 6 issue of Modern Healthcare featured an opinion piece entitled What’s behind America’s epic fail on diabetes care in which Editor Emeritus Merrill Goozner describes recent efforts around public awareness, prevention and treatment efforts, none of which seem to be having a significant impact.  He also asks a question that prompted me to submit an idea that could potentially result in real improvement for this and other prevention-oriented issues.

I’m please that Modern Healthcare published my piece.  Here it is:

In Merrill Goozner’s article What’s behind America’s epic fail on diabetes care (November 6) he astutely asks, “In our fragmented insurance system where people are constantly changing plans or aging into Medicare, why spend money today when the benefits will accrue to some other payer down the road?”  He’s exactly right under the current system.  

However, here’s an idea.  We know that some preventive care is truly cost-effective if you look over a multi-year horizon.  Although I’m not normally a fan of increased regulation, requiring all insurance companies to cover those preventive services that are known to be not only clinically effective, but also cost-effective over time would eliminate the impact of insurance churn.  If Insurance Company A pays for truly cost-effective preventive care for Patient 1 who subsequently moves to Insurance Company B, it is just as likely that Patient 2 might switch from Company B to Company A, thereby balancing the economic scales.  At that point, it becomes a market share issue, introducing another element of competition where those insurance companies that achieve the highest level of patient care and satisfaction come out ahead through enrollee retention.  

Of course, paying for additional preventive services would result in short-term cost increases for the overall system, but the benefits should balance out if only those preventive services that are cost-effective over the long term are covered.