Under pressure to squeeze out costs, some of the U.S.’s biggest health insurers are quietly erecting more hurdles for patients seeking medical care.
The companies are in many cases reaching back to the 1990s and boosting the use of techniques that antagonized patients and doctors alike.
Today’s approaches are tweaked, but may feel familiar to many: Insurers are rolling out plans with more restricted choices of doctors and hospitals, and weighing new requirements for referrals before patients can see specialists.
UnitedHealth Group Inc., UNH +0.36%Cigna Corp. CI +0.87% and others are increasingly requiring doctors to get prior authorization before patients can get certain care such as spinal surgeries.
Earlier versions of these practices were closely identified with the managed-care era of the 90s. They later receded in many parts of the country, as employers switched away from restrictive health-maintenance organizations, and insurers backed off some limits.
Health insurers say today’s versions of 1990s strategies are very different, and use new technology to focus closely on improving care as well as reining in expenses.
UnitedHealth, for one, said it is using prior authorization “surgically” to counter “extreme variations in quality and cost.” But doctors aren’t sure how much things have changed.
“There seems to be a return we’re hearing about to some of the old practices that have been very frustrating to physicians,” said Jeremy A. Lazarus, president of the American Medical Association.
In its 2012 analysis of medical billing claims, the AMA saw a 23% increase in the share that included an insurer pre-authorization review, to 4.7%. For certain types of procedures, the percentage is far higher, according to athenahealth Inc., which provides electronic health records. Still, the company said, only 4.9% of all the prior authorization requests it processed were denied in 2011.
Erica Swegler, a family physician in Keller, Texas, said the growing number of prior authorizations she has to secure for treatments such as high-tech imaging scans “costs me a tremendous amount of time.” The approvals typically take 48 to 72 hours, and sometimes longer if she needs to have a phone conversation with an insurer, she said. “It’s a huge headache.”
Insurers are responding to pressure from employers to tamp down costs and address evidence of disparities in quality. In recent years, employers have shifted a growing share of the expense of coverage onto workers, and companies are betting employees will accept trade-offs they rejected 15 years ago in order to prevent premiums from jumping even faster.
“This is back to the future,” said Eric Grossman, a senior partner at Mercer, a consulting unit of Marsh & McLennan Cos. Employers are interested in “rigorous, aggressive medical management,” including prior authorization, as well as limited networks of health-care providers, he said. Some insurers have promised savings of 3% to 5% from narrow-network plans, he said, and reductions of more than 10% if other restrictions are added, including even fewer choices of medical providers, strong pre-authorization, and requirements for patients to get a referral to access specialty care.
via Remember Managed Care? It’s Quietly Coming Back – WSJ.com.