The New Year is about to begin, and I’m now closely connected with people who are shifting to a new provider network because their health plan sponsor changed insurers.
On the one hand, the new coverage seems to be great, platinum-level coverage.
The plan switchers are healthy. All they usually need is need checkups, and an occasional dose of reassurance about a nagging cough.
The fact that the new plan has a shorter provider directory should not be that big of a deal, because the physicians in the new directory appear to be world-class physicians.
But, on the other hand, the plan switchers are still facing what to them seems like a nightmare.
In theory, there’s nothing so terrible about asking healthy people to shift from one world-class primary care doctor to make the U.S. health care system more efficient.
In reality, a network shift highlights other weaknesses in the U.S. health care system.
One issue is that, even though care coordination is a popular buzzword, provider directories do nothing to support enrollees who want well-coordinated care.
My plan-switcher friends have been getting an older kind of de facto care coordination by using what amounts to a group medical practice shopping mall affiliated with a local hospital. The group practices are legally separate enough to satisfy insurer anti-self-referral rules but close enough that patients can walk from one office to the other and get any extra procedures needed during the same visit. The mall setup eliminates the need for the patient to go on a scavenger hunt for an in-network facility that can handle a simple cholesterol test or mammogram.