Being Beloved

According to the story in Modern Healthcare, Blue Shield of California has formed a new company called “Altais”, the spelling of which my spellcheck keeps trying to change. Perhaps that is because it sounds like a terrible disease, as in “I have a bad case of Altais.”

Or maybe Blue Shield sees treating bad breath as a natural extension of being a health plan and Altais will be competing against Altoids. I know dealing with Blue Shield always left a bad taste in my mouth. Anything is possible when your spellcheck runs amuck.

In fact, Altais is Blue Shield’s latest attempt to stay relevant in a changing healthcare environment. Altais will offer management services to the ever decreasing number of physicians in California who have not joined with hospitals to form clinically and economically integrated healthcare delivery systems. The fox is trying to get into the hen house by pretending to be a good guy. Not going to work. The chickens have been to medical school and they are too smart to fall for that ploy.

Blue Shield of California is not the only health plan trying to escape being a commodity. United Healthcare is among the health plans now actually trying to acquire physician practices in a forlorn attempt to avoid not being relevant. That will be an expensive mistake when they learn that physician practices don’t behave the same way a spreadsheet full of actuarial statistics does. It’s the hubris of the ignorant.

It is not fun being in a boring business and that is what the health plan business is. Stand alone health plans (as opposed to hospital and physician owned health plans) really cannot be easily distinguished from one another. The role of any kind of insurance is to manage and hedge risk. Risk management is not the same thing as delivering a service or product. You don’t see auto insurance companies building cars.

Real people—not the “lives” as health plans refer to their members—do not particularly care what health plan they have as long as they have access to their preferred physicians and hospitals. After all, no one goes to Blue Shield’s or United Healthcare’s headquarters with an illness on a Sunday night. Or for that matter, try calling their customer service department for a phone consult.

It is not just health plans who envy the central role of physicians and hospitals in healthcare. The same week the Modern Healthcare article appeared, the New York Times published an op-ed by one of its former writers who bemoaned the fact that hospitals are “beloved”. Being “beloved” is apparently a bad thing in some quarters.

From her point of view, hospitals should be lumped with health plans and pharmaceutical companies as villains. Pundits love finding villains. It’s a living. This was also one of the points of a book she wrote a few years ago which after a brief period of hype disappeared from view. Her present frustration no doubt stems from that experience and perhaps from not being beloved.

Those darn hospitals and doctors really get in the way of the schemers who know better. The public just does not know how bad they are. Here is a message to the schemers of all types: the public does know who, when they have a healthcare need, they can rely upon.

Health plans are trying to weasel their way into physician practices in order to escape being a commodity. Pundits like the one who wrote the op-ed also know the sting of not being relevant. The fact that hospitals and physicians are the target of such actors is a compliment to how relevant healthcare providers are to the public.

Not being relevant is no fun. Being beloved is nice, though, and it is earned as a result of meeting real needs of real people.