“Last week’s news story about how Change Healthcare’s cyber attack affected us here in Burke County, thousands of miles away, was an eye opener for some. However, I’ll venture to say most Burke County citizens don’t know what Change Healthcare is and why it’s part of our healthcare system. Excellent question! Let’s explore. “Last week’s news story about how Change Healthcare’s cyber attack affected us here in Burke County, thousands of miles away, was an eye opener for some. However, I’ll venture to say most Burke County citizens don’t know what Change Healthcare is and why it’s part of our healthcare system. Excellent question! Let’s explore.
First, Change Healthcare is a subsidiary of United Health Group (UHG). You may not realize it, but UHG is one of the biggest companies in America. They are usually in the top 10 of the Fortune 100. When UHG attempted to acquire Change Healthcare in 2015 it was known as Emdeon back then. It was concerning enough to the US Department of Justice that it tried to block the purchase. UHG won that suit despite the government’s concerns. You should consider following a healthcare finance expert named Dr. Eric Bricker who produces a daily video blog called “AHealthcareZ”. His video on this subject can be found on YouTube under the name “United Health Group Acquisition of Change Healthcare…Healthcare Data Goldmine”.
So, what is Change Healthcare? It’s referred to as a “switch” and pharmacies and other healthcare providers and intermediaries use the switch to process claims for pretty much all health insurance plans in America. The processing of claims provides a ton of data. Data about patients that most everyone thinks is protected by HIPAA and not known to anyone without express permission. Not so fast. Now that UHG owns Change Healthcare and the processing of claims for almost all providers (even if your health insurance carrier is not United Healthcare), your healthcare privacy is not what you think it is. Data and the analytics that comes out of that data is big business. UHG is cashing in on that millions of times per day.
Why do I say communities like Burke County don’t need big insurance like Blue Cross, United Healthcare, Cigna or Aetna? Because, we have the advantage of community. Not all healthcare needs to be processed as a claim. If your health plan is structured so that local providers (independent doctors, local pharmacies, hospitals, etc.) can directly contract with the health plan, then direct payments can be made from the health plan’s assets to the provider…no traditional claims payment mechanism (processed by a data-hoarding middleman) needs to happen. Essentially, the local provider simply sends an invoice for a previously agreed upon amount. The smart health plans in America are quickly moving to this new and innovative benefit structure.
Another important dynamic is that entire categories of care like primary care are seeing a migration away from fee-for-service (claims processing through a PPO network) and towards an affordable, monthly membership model called direct primary care. The growth of direct primary care is significant. We have direct primary care in Burke County too. Some DPC practices also dispense common generic medicines in-house with no insurance needed. When health plans adopt this payment methodology, no claims processor like Change Healthcare or any other processor is needed; preserving our health data from being attacked by foreign nation state actors as Change Healthcare has admitted in writing since last week. The best part is the payment is pennies on the dollar of what the traditional system is accustomed to charging.
We’ve tried this already in other communities like Ashtabula, OH and we’re actively seeking Burke County employers who want to explore this same concept. If you’re curious about how this has worked out in Ashtabula, OH, search for a video called “Ashtabula School District” under the Patient Rights Advocate’s YouTube channel. This video gives insights into what we refer to as a “community owned health plan”. Not a concept with a household name yet in Burke County, but it’s a growing discussion point that local leaders need to engage in to protect Burke County citizens and local employers from the “too big to fail” healthcare industrial complex and the middleman data hounds that we’ve seen can wreak havoc on our ability to access quality care in our county. In Ashtabula, OH the city, county and school district led the way and now the rest of the business community is finding their way to this simpler, more connected, less costly way to provide healthcare to their workforce. Of course, there are some differences here in Burke County, but we are more alike than we are different.
I have a close colleague, Vinay Patel, who is a pharmacist and owns a NC-based pharmacy benefits manager (PBM) that almost exclusively processes claims for prescription care through local, independent, community pharmacies. I asked him for a quote regarding the situation with Change Healthcare. His response was this, “Healthcare is and always will be local to communities. When employers choose a community owned health plan, those dollars are reinvested in small businesses supporting their well-being; not watching their money siphoned away to Wall Street, robbing from communities the needed funds to thrive.” He’s right. We can change that in Burke County too. All it takes is a willingness to innovate and keep what rightfully belongs to our community.”
Cristy Gupton is a nationally recognized healthcare strategist and expert speaker on subjects related to retooling and redesigning employer-sponsored health plans to better work for their intended stakeholders – the employer and employees.
