Moving beyond the PPO

Broken window

A couple of days ago, Heather Caspi published a post in HealthcareDive.com entitled "The mystery of the disappearing PPO plans". We completely agree that the problems she points out are glaring. We do not think, however, there is any mystery in the PPO plans failure.

We are seeing first hand the destructive force of PPO’s - Prefered Provider Organizations - and what happens when they overreach their scope of practice. For the past three decades, PPO’s have been dictating in 80% of the cases what doctors and hospitals will be paid for a particular service. All done under the premise of keeping costs under control while never exposing the true function of a PPO contract - that is, control! Today when we have 80% of the insurance marketplace effectively controlled by three national health insurance companies, PPO’s are about to strangle the free healthcare marketplace in this nation (or, rather, what’s left of it after decades of systematic abuse).

In this case the cause of the decline is not understood. In the case of Cigna pulling all PPO’s from the Florida market for 2016, it was the case of fraud within their network. They say they will be back in 2017 with much more restrictive plans to control fraud and overuse of services. In all cases, the primary problem is the fact that the PPO’s are connected to the insurance companies and not to the consumer directly. Once we state the problem correctly, it becomes readily apparent that the real (in fact, the only) solution is to shift the providers (and power) from the insurance companies to the consumer. Yes! - we do emphasize the fact that the doctor having to work for the insurance company and not the patient is the major flaw in our system. What we need is a system where the doctor and hospitals all work for the patient and their financial reimbursement and public reputation depends on it.

The healthcare industry can accomplish this by providing insurance policies that provide the reimbursed amount to the consumer rather than the provider (a system otherwise known as "reference based pricing") thus creating a transparent and free marketplace where doctors and hospitals would have to compete for customers on quality and price and gradually allow the consumer to accrue benefits via savings and quality. The system of reference based pricing has been working for decades under PPO contracts. The crucial difference we advocate would be that each insurance company should have one price schedule for all the insured and the benefits and savings are consumer directed. Consumers, empowered with the backing of their plans, would be able to pay direclty to providers who offer the best service for their specific needs.

CashDoctor.com is a place where consumers can share today the actual cost of health care and provide personal ratings of various providers and facilities they came in contact with. Never has there been a better time in the history of our nation for a transparent free marketplace in healthcare and a free platform such as CashDoctor.com to power it up. Read today our 8 word solution to healthcare. Usership is FREE via web and mobile app. Visit www.CashDoctor.com or download our app in the app store or google play.

Feedback/Comments

Add a comment

Posting comment as guest.
If you already have an account, please LOGIN.
If not, you may consider creating on. It’s FREE!




Popular new stories

12/21/15
THE FOX GUARDING THE HEN COOP

1/18/16
Health is only what’s easy to measure: the case for mental health tracking

Categories

Editors List

Cash Doctor (Administrator)

Cooper B (Cooper)

George B (George)

Grace B (Grace)

Rob Stehlin (rob_stehlin)

Tags

8 word solution to healthcare access to health care access to information affordable health care afghanistan war ai-enabled healthcare annual cost of medical errors in usa apple healthkit bad healthcare barack obama big data cash doctor app cashdoctor app cashdoctor community cashdoctor mission cashdoctor.com platform cash-only patients college students are hurting consumer empowerment cost increases cost of health care cost reduction cost transparency crowdsourcing healthcare information data mining destroyed lives direct pay physicians direct pay practice direct pay system disruptive technologies dr. oliva blog post florida hospital association future healthcare google knowledge graph health health apps health care health care debate health care deception health care hidden agendas health care reform health insurance health insurance is a right health law health measures health plan healthcare healthcare changes healthcare decision making healthcare factors healthcare impact healthcare insurance healthcare lies healthcare movement healthcare price transparency healthcare reform healthcare solution healthcare system healthcare transparency health-related queries higher deductibles hospital cash discount hurt women hurt young people insurance insurance scam internet self-diagnosis large price increases lost jobs measuring value medical data privacy medical debt medical records privacy medical services price sharing medicare payments mobile apps mobile health search mobile healthcare mobile medicine obama obama administration obama’s health care lies obama’s manipulation obamacare obamacare and babies obamacare and pregnant women obamacare deception obamacare disinformation obamacare lies opposed to obamacare patient empowerment physician extenders ppo prefered provider organizations pregnant women and healthcare president obama prevention price comparison data price transparency privacy breach public agenda national survey public expectations on price information searching for healthcare costs share cost sharing information about medical costs social media impact on healthcare standardization of medical procedures symptom search telemedicine transparency transparent free market solution u.s. health system unmet needs us healthcare 2015 predictions usa today analysis user-friendly healthcare it value-based healthcare value-based points what women think of obamacare white house lies women women hate obamacare world hospital database