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On the Third Hand: Location, Location, Location

By Allison Bell

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Researchers at Washington University in St. Louis have done a study that seems to be about the quality of medical care but could also be about the future of health insurance agents and brokers in a world of big health insurance exchanges, or Web-based insurance supermarkets.

The researchers wanted to see whether actively coordinating patient care would improve the quality of care.

The researchers hired fine people in a call center in California to manage patients’ care, and — nothing happened. Nothing really changed. The patients didn’t get any better. Costs increased 12%.

Then the researchers tried, for the heck of it, to use local coordinators, in St. Louis, and, voila! That worked. The local coordinators reduced hospitalizations 12% and reduced total monthly spending by $217 per enrollee, offsetting the $151 monthly care management fee. 

“The results underscore findings from the overall Medicare Coordinated Care Demonstration that suggest that programs with more in-person contacts were more likely than others to build trusting relationships with patients and providers, improve patient adherence to care plans, and address additional needs and barriers that entirely telephonic contacts had been unable to identify,” the researchers say in an abstract of the paper, which appeared in Health Affairs, a health care finance and delivery academic journal.

Maybe the study says something about the exchanges, whether the exchanges materialize because of the Patient Protection and Affordable Care Act of 2010 (PPACA) or because cost-cutting efforts started in the wake of some Supreme Court or congressional action that makes PPACA go poof.

What are traditional, live human-type insurance agents and brokers but local health insurance delivery coordinators, as opposed to faceless bureaucrats or COBOL-based rules engines located thousands of miles away from the insureds?

Rules engines are great for simple, clean transactions. Who really wants to go back to the days when you have to talk to a live human to buy an airplane ticket? The travel agents and ticket agents certainly don’t want to have to talk to you, and get you to re-spell your first name for the umpteenth time.

But there’s nothing like talking to a live human when a situation is confusing, or something has gone wrong, or when someone has to thump you on your thick skull and explain, for example, that voluntarily staying a mile away from the National Association of Health Underwriters meeting hotel in Las Vegas, in June, to save a little money, is idiotic, because, in June, Las Vegas is hot. No way would a computer operating with current technology be able to tell you how stupid trying to walk a mile to a hotel in Las Vegas, in June, would be.

Similarly, a computer, or a call-center worker operating off a script, might tell you that you’re obese, but it, or he, or she, probably would not tell you that you look like your daughter’s grandmother, and it, or he, or she, probably would not be so crazy as to recommend some disreputable fad diet that violates all standard wellness program rules but might actually work for you, in particular, just because it somehow matches with your personality/body type/astrological sign.

It might not be clear what future live humans have in health coverage distribution, but it seems as if this is still a matter to be decided, not a done deal. 

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