“The employer is thrilled because the cost doesn’t go up, and the primary care doctor is incentivized to keep the cost down,” he continued. “If the doctors really understand the nature of the business, there are a lot of ways to deliver healthcare services that create a better financial model for the doctors.”
Preventing the Anthem/Cigna merger makes it possible for primary care doctors to think more creatively about working with insurance companies, says Schultz.
“Because no merger occurs, it creates the opportunity for more insurance companies in each market,” he explains. “If I’m a primary care doctor, I want to find every way I can to be involved in the care of the patient, to get between the employer and the patient. The primary care doctors are in the driver’s seat.”
Further reading: Top tips for physicians to deal with uncertainty
With so many consumers paying high out-of-pocket costs because of rising deductibles, he continues, the health insurance companies that win will do so by reducing overall costs while increasing access to care. For example, it costs less to send a patient home with a private duty nurse than to keep that patient in the hospital several days longer to recuperate after surgery.
“If I were your doctor and I told you that your mother could go home a day early from the hospital and have a nurse go with her, wouldn’t that be better?” Schultz says. “She’s scared sitting in the hospital, and she’s in danger of infection. And it’s cheaper to have a nurse go home with her. That would save on cost and be better for the patient. Isn’t that what we want? It’s intuitive, it’s practical and it helps everybody.”
Anthem announced on February 9 that it would appeal the U.S. District Court’s decision, requesting an expedited hearing. A date for the hearing has not yet been set.