Group Health Care – Facing Up To The Challenge

The biggest challenge facing group health care in the last few years has been the dramatic escalation in prices, due mainly to the increasing cost both of prescription drugs and of medical care. This has forced every health insurance agency Pittsburgh to increase premiums, and this in turn has meant that many companies have had to cut down on their employee medical benefits. Some regions, like Pittsburgh PA, appear to be in the forefront of the fightback against these trends, by bringing in measures to achieve the best possible health outcomes combined with maximum value for money.

One not-for-profit organization leading these efforts is the Pittsburgh Regional Health themselves Initiative (PRHI). Although there are similar groups across the nation, the PRHI is unique in incorporating businesses and personnel from outside of the health care field, which enables it to bring in innovations from other areas of industry. One of these is the health home model of care, whereby the whole of a patient’s care from start to finish is coordinated by a designated physician. This has already been achieved at some of the city’s health centers.

This model of coordinated care is increasingly being seen as the way forward, and is being taken up by at least two of the largest health care insurers in the region. One of these, Highmark, has set up a large scale health home pilot project incorporating about 150 providers of primary care, encouraging the providers to look at agencies outside themselves to increase coordination of patient care. The results are so encouraging that it is considering expanding the number, even before the completion of the pilot. Meanwhile Pittsburgh’s other major insurer, UPMC Health Plan, has set up its own health home program, which tracks recently discharged patients to ensure they are receiving the follow up care they require. The company report spectacular improvements in health outcomes as a result.

Pennsylvania is also in the lead in encouraging other means of reducing group health insurance costs. Healthy spouses are being encouraged to insure themselves individually, as it has been shown this can be done more cheaply than under a family care plan. Pennsylvania has also pioneered the Children’s Health Insurance Program, offering free or low cost coverage of children to parents living in the state.

Every health insurance agency in Pittsburgh is only too aware of the problem to employers posed by the remorseless rise in health care costs. It is becoming increasingly clear to these agencies that coordination of patient care has a major part to play in bringing about greater efficiency, and combining this with improved outcomes for patients. Provision of group health care can be daunting in the current climate, but this region is in the lead in utilizing the power of innovation to make the provision both more affordable, and more effective.

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