2.
A few things to know right off the bat:
Group Health Co-operative is not, technically, a co-op. It is instead a consumer-governed non-profit corporation (a distinction with important tax differences), and a large one at that. It currently covers about 600,000 members, and last year took in $2.7 billion in revenue while paying its president and chief executive officer, Scott Armstrong, a $1.2 million salary. Its main competitors are familiar private insurance names—Regence Blue Shield and Premera Blue Cross—and its rates have risen over the years just like those of any other health insurer.
Meaning it’s not a small, average-citizen-controlled health care co-operative of the kind that Maria Cantwell and other Senate leaders seem to be suggesting would appear all over the country through passage of the co-op compromise. It’s also not jaw-droppingly unique (and certainly not as unique as it used to be). “To the average person or the average enrollee there’s not a lot of difference between Group Health and the average health plan,” said Stephanie Marquis, spokesperson for the Washington Insurance Commissioner’s office. She added, in reference to the co-op compromise proposal: “When I first heard it, and I thought of a co-operative, I have to be honest, my mind did not go first to Group Health.”
Certainly Group Health does have some attributes worth noting in the health care reform discussion. It runs its own facilities; employs salaried doctors (rather than contracting mainly with “preferred providers,” as other insurers do); and has been a leader in web-based medicine, electronic medical records, and the effort to promote contact with primary care physicians (rather than the see-a-specialist model that has helped drive up costs around the nation). Its quality of care is well-regarded, and the number of complaints about it to the Insurance Commissioner’s office is far lower than the number for its competitors.
Diana Birkett, director of federal relations and policy for Group Health, said these are the attributes that naturally bring Group Health attention. “We’re being looked to as a model because we’re an integrated organization,” Birkett explained. “We’re not just an insurer. We’re not just a member-governed organization. We’re not just a provider. We’re all of those things.”
Notice what she didn’t say: that Group Health is a small co-op of the kind that some in the Senate seem to want to create in communities all over the country. That’s because, as far as can be determined from the still-sketchy details of the co-op compromise, it’s not.
Previous part here, final part later today.
The “salaried doctors” over “preferred providers” part is interesting. Ever since reading that article about McAllen, Texas, I’ve become intrigued with how doctors make their money… That was one of the most interesting parts of the article — how do you create a patient-care culture vs. a money-driven culture.
I’m feeling like I need to find a doctor in Eugene now that I’ve been here almost 6 months, and I’d really like to know how the doctors in the major medical groups are paid. I know that in Chicago, my husband and I both had what I perceived to be unnecessary tests recommended by our GP (who was a member of one of the big medical groups), and I have a strong suspicion that there was a financial incentive from the medical group for her to do so…
It used to be a co-op. Think that changed around 2000 or 2001. Was during the dot com years.
“…not as unique as it used to be.”
Something is either unique or it isn’t. There are no degrees of uniqueness.
if you divided the country up into GHC sized co-op health plans there would be something like 600 co-op insurers. Trying to nationalize units much smaller than that seems crazy since the point of insurance should be economies of scale; is that *really* what the “co-op option” purveyors want?
I like GHC too. I’ve had no problems with them, and get excellent cover at a reasonable price. I do, however, understand that it might not be the ideal option for many people though I can’t say I’m sure I understand WHY.
I mean this article starts out implying that GHC is bad, because rates have increased, AND rates have increased at other HMOs. Isn’t that logical? If rates go up, isn’t there a reason for it? I’m betting there is, and I’m also betting it’s not “too make tons more cash.”
It’s not small enough? But the size allows for a variety of options and not being shoehorned into a less than ideal choice/surgery/doctor/whatever the fuck.
I guess, now, I need someone to explain to me why the smaller co-op is a better option, because it seems much more limited to me. A regional cooperative, like GHC, seems more manageable and more able to manage major health catastrophes.
Someone tell me why I’m wrong, ’cause I’m just not getting it.
My dad has been a GHC member since 1995, is medically complex, and I atrribute him still being alive to the highly-coordinated primary and specialty care he has received. Disclaimer here – I’ve worked for Group Health 2000-2002 and 2006-present, and compared to other healthcare entities, I find our work environment to be one that is team-based and patient-centered. And while HMOs have been villified (I won’t dance around sematics about whether GHC is truly a co-op vs. an HMO) – Group Health gets it – that yes, cost-effectiveness makes resources available for where they’re truly needed – but that skimping on care only leads to worsening (and more expensive) patient outcomes down the road. There is an emphasis on preventative care with the goal of keeping people out of the hospital.
In related threads I’ve read about some feeling rushed by their harried providers or that there has been little time during a visit. To address those concerns Group Health is rolling out the Medical Home Model (very successfully piloted at Factoria GHC and being expanded to other locations), which will allow patients to have more time and care from their providers.
I don’t know if the ‘co-op’ aspect of Group Health should serve as a model for US healthcare, but rather, the coordination of care is what should be modelled.
BTW, I am not from Marketing – I am a clinic worker.
PS And yes, I think Mr Armstrong could make less than what he does, though so far he has been an effective head of GHC, IMO.
PPS My husband, son, and I have had various health issues and love our care here.
Group Health does some things well – primary and preventative care most of all. They’re also pretty good about steering patients towards lower-cost treatments like generic prescriptions.
I’ve been with GHC for at least 15 years now and I’m only 31. I started out on my mom’s health plan as a kid and stuck with them after I graduated from college and started working myself. In all the years I’ve been with them I can honestly say I’ve only had a couple of complaints.