The biggest winner in health reform
By Dana Blankenhorn; Aug 20, 2010
The biggest winners out of health reform may come from an industry you never heard of.
Predictive modeling.
The idea has been around for 20 years. Compare the risks of patients, or the costs of clinics, in an effort to lower both. Collect the data, analyze it, then act on the analysis.
Verisk Health is in this business. Much of their work in the past was done with health insurance companies, and chief medical officer Nathan Gunn (right) admitted that in the old fee-for-service era it wasn’t working.
Tiering physicians into high-cost and low-cost networks did not work. Cutting off patients based on risk assessments proved to be political poison.
But capitation, the change from a fee-for-service to a fee-per-patient model, changes everything, he said. Capitation is the health reform the insurance industry wanted, and got, in the bill that passed Congress earlier this year.
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