Most of the approximately 150 primary care physicians contracting with MPP also work with HMOs, says Edwards. If circumstances prove right for direct contracting, he says, his company is poised to take over much of the administrative work currently handled by HMOs. Plus, more of the premium dollar will go to patient care. When our company takes full risk, many of those we associate with believe that the insurance companies are keeping too much of the premium for what they do. Parker Eales is president of Business Health Care Solutions, which organizes providers into groups that contract with employers.
Direct contracting is what comes next in health care.
Not so, responds Mark Tierney, M.H.A., the chairman of Network Management, a Minneapolis-based benefits outsourcing and consulting company. You have to have the kind of serious purchasing leverage that is available only to a few employers. You must also have an intensely focused administrative intermediary before you can even consider a move toward direct purchasing, because the systems used to pay doctors and hospitals are far too complex for any individual employer to take on. Tierney states his position as if it were a law of physics no less immutable than the laws of light and gravity. Purchasing health care from the provider is not like buying paper for your copier, where the colors, the sizes, and the amounts are standardized.