Hospitals are collecting consumer purchases…beware drinkers, over eaters, and the lazy…you have been warned!

 

 

You are on notice...BIG BROTHER IS WATCHING...and you will pay! But ah....if you are over using the system because of self destructive behavior (i.e. drug, drink, too much food...)  you should have to pay more! Just saying!

 

Hospitals Spy on Your Purchases to Spot Bad Habits

By Shannon Pettypiece and Jordan Robertson Jun 26, 2014 12:01 AM ET

You may soon get a call from your doctor if you’ve let your gym membership lapse, made a habit of picking up candy bars at the check-out counter or begin shopping at plus-sized stores.

That’s because some hospitals are starting to use detailed consumer data to create profiles on current and potential patients to identify those most likely to get sick, so the hospitals can intervene before they do.

Information compiled by data brokers from public records and credit card transactions can reveal where a person shops, the food they buy, and whether they smoke. The largest hospital chain in the Carolinas is plugging data for 2 million people into algorithms designed to identify high-risk patients, while Pennsylvania’s biggest system uses household and demographic data. Patients and their advocates, meanwhile, say they’re concerned that big data’s expansion into medical care will hurt the doctor-patient relationship and threaten privacy.

“It is one thing to have a number I can call if I have a problem or question, it is another thing to get unsolicited phone calls. I don’t like that,” said Jorjanne Murry, an accountant in Charlotte, North Carolina, who has Type 1 diabetes. “I think it is intrusive.”

Acxiom Corp. (ACXM) and LexisNexis are two of the largest data brokers who collect such information on individuals. They say their data are supposed to be used only for marketing, not for medical purposes or to be included in medical records.

While both sell to health insurers, they said it’s to help those companies offer better services to members.

Bigger Picture

Much of the information on consumer spending may seem irrelevant for a hospital or doctor, but it can provide a bigger picture beyond the brief glimpse that doctors get during an office visit or through lab results, said Michael Dulin, director of research and evidence-based medicine at Carolinas HealthCare System.

Carolinas HealthCare System operates the largest group of medical centers in North Carolina and South Carolina, with more than 900 care centers, including hospitals, nursing homes, doctors’ offices and surgical centers. The health system is placing its data, which include purchases a patient has made using a credit card or store loyalty card, into predictive models that give a risk score to patients.

Within the next two years, Dulin plans for that score to be regularly passed to doctors and nurses who can reach out to high-risk patients to suggest interventions before patients fall ill.

Buying Cigarettes

For a patient with asthma, the hospital would be able to score how likely they are to arrive at the emergency room by looking at whether they’ve refilled their asthma medication at the pharmacy, been buying cigarettes at the grocery store and live in an area with a high pollen count, Dulin said.

The system may also score the probability of someone having a heart attack by considering factors such as the type of foods they buy and if they have a gym membership, he said.

“What we are looking to find are people before they end up in trouble,” said Dulin, who is also a practicing physician. “The idea is to use big data and predictive models to think about population health and drill down to the individual levels to find someone running into trouble that we can reach out to and try to help out.”

While the hospital can share a patient’s risk assessment with their doctor, they aren’t allowed to disclose details of the data, such as specific transactions by an individual, under the hospital’s contract with its data provider. Dulin declined to name the data provider.

Greater Detail

If the early steps are successful, though, Dulin said he would like to renegotiate to get the data provider to share more specific details on patient spending with doctors.

“The data is already used to market to people to get them to do things that might not always be in the best interest of the consumer, we are looking to apply this for something good,” Dulin said.

While all information would be bound by doctor-patient confidentiality, he said he’s aware some people may be uncomfortable with data going to doctors and hospitals. For these people, the system is considering an opt-out mechanism that will keep their data private, Dulin said.

‘Feels Creepy’

“You have to have a relationship, it just can’t be a phone call from someone saying ‘do this’ or it just feels creepy,” he said. “The data itself doesn’t tell you the story of the person, you have to use it to find a way to connect with that person.”

Murry, the diabetes patient from Charlotte, said she already gets calls from her health insurer to try to discuss her daily habits. She usually ignores them, she said. She doesn’t see what her doctors can learn from her spending practices that they can’t find out from her quarterly visits.

“Most of these things you can find out just by looking at the patient and seeing if they are overweight or asking them if they exercise and discussing that with them,” Murry said. “I think it is a waste of time.”

While the patients may gain from the strategy, hospitals also have a growing financial stake in knowing more about the people they care for.

Under the Patient Protection and Affordable Care Act, known as Obamacare, hospital pay is becoming increasingly linked to quality metrics rather than the traditional fee-for-service model where hospitals were paid based on their numbers of tests or procedures.

Hospital Fines

As a result, the U.S. has begun levying fines against hospitals that have too many patients readmitted within a month, and rewarding hospitals that do well on a benchmark of clinical outcomes and patient surveys.

University of Pittsburgh Medical Center, which operates more than 20 hospitals in Pennsylvania and a health insurance plan, is using demographic and household information to try to improve patients’ health. It says it doesn’t have spending details or information from credit card transactions on individuals.

The UPMC Insurance Services Division, the health system’s insurance provider, has acquired demographic and household data, such as whether someone owns a car and how many people live in their home, on more than 2 million of its members to make predictions about which individuals are most likely to use the emergency room or an urgent care center, said Pamela Peele, the system’s chief analytics officer.

Emergency Rooms

Studies show that people with no children in the home who make less than $50,000 a year are more likely to use the emergency room, rather than a private doctor, Peele said.

UPMC wants to make sure those patients have access to a primary care physician or nurse practitioner they can contact before heading to the ER, Peele said. UPMC may also be interested in patients who don’t own a car, which could indicate they’ll have trouble getting routine, preventable care, she said.

Being able to predict which patients are likely to get sick or end up at the emergency room has become particularly valuable for hospitals that also insure their patients, a new phenomenon that’s growing in popularity. UPMC, which offers this option, would be able to save money by keeping patients out of the emergency room.

Obamacare prevents insurers from denying coverage because of pre-existing conditions or charging patients more based on their health status, meaning the data can’t be used to raise rates or drop policies.

New Model

“The traditional rating and underwriting has gone away with health-care reform,” said Robert Booz, an analyst at the technology research and consulting firm Gartner Inc. (IT) “What they are trying to do is proactive care management where we know you are a patient at risk for diabetes so even before the symptoms show up we are going to try to intervene.”

Hospitals and insurers need to be mindful about crossing the “creepiness line” on how much to pry into their patients’ lives with big data, he said. It could also interfere with the doctor-patient relationship.

The strategy “is very paternalistic toward individuals, inclined to see human beings as simply the sum of data points about them,” Irina Raicu, director of the Internet ethics program at the Markkula Center for Applied Ethics at Santa Clara University, said in a telephone interview.

Hospital's lose Hospital’s cutting work force…How much, and will effect me? Get admitted into the hospital, and find out!

So Obamacare is lowering reimbursements from Medicare. Americans are not signing up for Obamacare. Obamacare is reimbursing on the same scale as Medicaid (in some instances ½ of what Medicare pays). Private insurances are lowering reimbursements because Medicare is. Americans are losing their health insurance from work. Private insurances are not writing policies to individuals. On and on and on and on…..So what could go wrong? Read on and find out!

In Obamacare Buildup, Hospitals Face a Self-Inflicted Wound

By John Tozzi July 18, 2013

From BloombergBusinessweek

Liberty Hospital near Kansas City, Mo., has eliminated 120 jobs this year, closed its wound-care clinic, and stopped offering free rides to poor and elderly patients. The Cleveland Clinic is searching for ways to cut $250 million from its $6 billion budget in the next 16 months. It’s already closed expensive maternity wards in half the hospitals it operates. In northern New York, Adirondack Health may shutter its emergency room in Lake Placid and a dialysis center in Tupper Lake. All of these hospitals and scores of others nationwide are squeezing services to make up for unexpected budget shortfalls—the result of a deal they made with the federal government that they’re now having second thoughts about.

When the Obama administration was selling the benefits of the Affordable Care Act in 2010, the hospital industry agreed to accept a $155 billion decrease in Medicare payments over a decade. The administration assured hospital executives that patients newly covered under the health-care law would make up for much of the loss. Because of the ongoing squabbles between President Obama and Republicans in Congress over the U.S. budget, that hasn’t happened.

The automatic federal spending cuts known as sequestration have sliced an additional 2 percent from Medicare reimbursement payments to hospitals this year. Beginning next year, many hospitals will also collect less money from Medicaid, the federal program that provides coverage for the poor, than they’d been promised when they signed on to the Affordable Care Act. The law required all states to expand their Medicaid programs to cover uninsured citizens who make too little to buy plans under Obamacare. But the Supreme Court ruled last year that states could opt out. Nearly half have chosen to do so, as Republican governors or GOP-led state legislatures have opposed the increased Medicaid spending. That means 6 million poor Americans who would’ve been eligible for health coverage won’t get it; many of them will continue to walk into emergency rooms unable to pay for services that hospitals by law have to provide. “We are hugely affected by what’s happening in Washington,” Adirondack Chief Executive Officer Chandler Ralph says. “It’s a hiccup there, and it’s a tsunami here.”

For-profit health systems whose patients are largely covered by private insurance may be equipped to absorb the losses. Rural and inner-city hospitals that run on thin margins and treat large populations of patients on Medicare, Medicaid, or without any insurance are suffering. “The trade-off that the hospital industry made was, we’ll take lower payments going forward in exchange for more people being insured,” says Patrick McGuire, chief financial officer of St. John Providence Health System in the Detroit area, which eliminated 160 positions in May. “It’s not quite working out the way we thought it was going to.”

Missouri’s decision not to expand Medicaid is bad news for Ozarks Medical Center, which serves a largely poor, rural part of the state near the Arkansas border. Beginning on Oct. 1, the 114-bed nonprofit hospital will lose $630,000 a year in federal payments it now gets for treating low-income patients. Expanded coverage under Medicaid was supposed to make up for that, but Missouri’s Republican legislature blocked it. The federal sequester is taking another $660,000 from Ozarks’ budget, says CEO David Zechman. He and 64 other managers took a 5 percent pay cut at the end of June, and the hospital laid off 32 workers. A dozen open positions won’t be filled. “We haven’t cut any services yet. That’s not to say we won’t in the future,” Zechman says.

The industry is lobbying to get some government money back. A bill by Georgia Democratic Representative John Lewis would delay Obamacare cuts to the extra Medicare and Medicaid payments that Ozarks and other hospitals receive for treating the poor. Another measure, introduced in June by Democratic Representative Bruce Braley of Iowa, would reinstate some funds for rural hospitals, such as Adirondack Health, that were allowed to expire in the fiscal cliff standoff in December.

U.S. hospitals have lost jobs in two of the last six months, according to the Bureau of Labor Statistics, a point hospital lobbyist’s stress in their rounds on Capitol Hill. They aren’t hopeful of persuading lawmakers to put money back into the federal budget when all of Washington is arguing over how to take more out. Rick Pollack, executive vice president of the American Hospital Association, says hospitals that treat the poor and elderly are instead focused on preventing deeper cuts in the deficit showdown coming this fall. The goal for now, he says, is “making sure that there is no more harm done.”

Obamacare lowers reimbursements to Hospital! Hospital close because of ObamaCare Reimbursements

Hospitals were promised reimbursements for uninsured patients. Well…The uninsured are still uninsured. 75% of ObamaCare enrollments are Americans that had lost their health insurance because of ObamaCare. Here is the thing….Obamacare reimburses for SHIT! Hospitals cannot stay open with these low, low, low reimbursements. There you go…!

In Obamacare Buildup, Hospitals Face a Self-Inflicted Wound

By John Tozzi July 18, 2013 in BloombergBusinessweek

Liberty Hospital near Kansas City, Mo., has eliminated 120 jobs this year, closed its wound-care clinic, and stopped offering free rides to poor and elderly patients. The Cleveland Clinic is searching for ways to cut $250 million from its $6 billion budget in the next 16 months. It’s already closed expensive maternity wards in half the hospitals it operates. In northern New York, Adirondack Health may shutter its emergency room in Lake Placid and a dialysis center in Tupper Lake. All of these hospitals and scores of others nationwide are squeezing services to make up for unexpected budget shortfalls—the result of a deal they made with the federal government that they’re now having second thoughts about.

When the Obama administration was selling the benefits of the Affordable Care Act in 2010, the hospital industry agreed to accept a $155 billion decrease in Medicare payments over a decade. The administration assured hospital executives that patients newly covered under the health-care law would make up for much of the loss. Because of the ongoing squabbles between President Obama and Republicans in Congress over the U.S. budget, that hasn’t happened.

The automatic federal spending cuts known as sequestration have sliced an additional 2 percent from Medicare reimbursement payments to hospitals this year. Beginning next year, many hospitals will also collect less money from Medicaid, the federal program that provides coverage for the poor, than they’d been promised when they signed on to the Affordable Care Act. The law required all states to expand their Medicaid programs to cover uninsured citizens who make too little to buy plans under Obamacare. But the Supreme Court ruled last year that states could opt out. Nearly half have chosen to do so, as Republican governors or GOP-led state legislatures have opposed the increased Medicaid spending. That means 6 million poor Americans who would’ve been eligible for health coverage won’t get it; many of them will continue to walk into emergency rooms unable to pay for services that hospitals by law have to provide. “We are hugely affected by what’s happening in Washington,” Adirondack Chief Executive Officer Chandler Ralph says. “It’s a hiccup there, and it’s a tsunami here.”

For-profit health systems whose patients are largely covered by private insurance may be equipped to absorb the losses. Rural and inner-city hospitals that run on thin margins and treat large populations of patients on Medicare, Medicaid, or without any insurance are suffering. “The trade-off that the hospital industry made was, we’ll take lower payments going forward in exchange for more people being insured,” says Patrick McGuire, chief financial officer of St. John Providence Health System in the Detroit area, which eliminated 160 positions in May. “It’s not quite working out the way we thought it was going to.”

Missouri’s decision not to expand Medicaid is bad news for Ozarks Medical Center, which serves a largely poor, rural part of the state near the Arkansas border. Beginning on Oct. 1, the 114-bed nonprofit hospital will lose $630,000 a year in federal payments it now gets for treating low-income patients. Expanded coverage under Medicaid was supposed to make up for that, but Missouri’s Republican legislature blocked it. The federal sequester is taking another $660,000 from Ozarks’ budget, says CEO David Zechman. He and 64 other managers took a 5 percent pay cut at the end of June, and the hospital laid off 32 workers. A dozen open positions won’t be filled. “We haven’t cut any services yet. That’s not to say we won’t in the future,” Zechman says.

The industry is lobbying to get some government money back. A bill by Georgia Democratic Representative John Lewis would delay Obamacare cuts to the extra Medicare and Medicaid payments that Ozarks and other hospitals receive for treating the poor. Another measure, introduced in June by Democratic Representative Bruce Braley of Iowa, would reinstate some funds for rural hospitals, such as Adirondack Health, that were allowed to expire in the fiscal cliff standoff in December.

U.S. hospitals have lost jobs in two of the last six months, according to the Bureau of Labor Statistics, a point hospital lobbyists stress in their rounds on Capitol Hill. They aren’t hopeful of persuading lawmakers to put money back into the federal budget when all of Washington is arguing over how to take more out. Rick Pollack, executive vice president of the American Hospital Association, says hospitals that treat the poor and elderly are instead focused on preventing deeper cuts in the deficit showdown coming this fall. The goal for now, he says, is “making sure that there is no more harm done.”

Obamacare killing patients 10 at a time! No Hope with ObamaCare!

Obamacare snatches patients’ healthcare coverage, and leaves patients without doctors, medicine, and hope. That’s right I said it…NO Hope with Obamacare!

Brain Patient: ObamaCare makes it hard to find doctors, meds

By Lorena Mongelli and Carl Campanile

April 17, 2014

NY Post

After four brain operations, Margaret Figueroa thought she was prepared for anything — until she ran into ObamaCare.

“I’m frustrated with the system. I feel like I paid but I’m not getting what I paid for,” said Figueroa, 49, who broke down in tears while explaining her bureaucratic nightmare.

“It’s scary because this is America. I didn’t expect to go through this.”

Figueroa — who has a neurological disorder — said she enrolled in a new EmblemHealth insurance program in February as required under the Affordable Care Act. And that’s when her problems began.

After paying her premium, she received a temporary ID card. But when she went to order medication, the pharmacists said her name wasn’t in the system. And she said her doctors were not included in her new medical plan.

“They just don’t have enough doctors. Two of them are full to capacity, and the others aren’t even in my radius. There are some who don’t even speak English,” the Arden Heights resident said during a press conference with Staten Island Rep. Michael Grimm.

“Now I have to find a whole new set of doctors. The doctors I had were familiar with my condition. I’ve had my neurologist for years. You want to stay with someone who’s been in your brain and knows what’s going on.”

Not having a regular doctor has put her in a Catch-22: A patient can’t get medication without a prescription from a doctor.

Figueroa takes five different medications a day, including 60 milligrams of morphine.

“I’ve been sick. I’ve had chills, a lot of vomiting. The pain is unbearable. I’ve had insomnia. I lost 23 pounds,” she said. “Who’s going to write the scrips if I don’t have a primary-care doctor? They’ve been giving us the runaround.”

Out of desperation, she called Grimm’s office for help on March 24. She now is at least getting some of her medications.

Grimm, who voted against ObamaCare, was furious.

“This is now becoming very common,” he said. Of Figueroa, he said, “This isn’t like someone who needs an aspirin here, this is her life.”

EmblemHealth declined requests for comment.

 

Obamacare - Sign up and lose your favorite, trusted, and best physician. Oh, and...where is my $2,500

A New York woman suffering from a neurological disease that has required four brain surgeries has been dropped by all of her doctors and denied medications due to her Obamacare plan.

By Wynton Hall  16 April 2014  Breitbart

"I've been vomiting. I lost 22 pounds. The pain is unbearable," said Margaret Figueroa, 49, on Wednesday.  "My medication helps me function during the day."

Figueroa suffers from a disease known as Arnold Chiari Malformation and Syringomyelia. Even though the Obamacare plan she purchased assured her that she was covered, her insurance card was denied when she went to fill her prescriptions. Then she learned that none of her doctors accept her Obamacare plan. Figueroa says she cannot find a doctor who accepts her Obamacare plan; indeed, there are only six doctors in all of Staten Island who take her plan, none of whom she's been able to get appointments with.

Figueroa's congressman, Rep. Michael Grimm (R-NY), intervened to help her obtain some of her vital prescriptions. Grimm says he's already received calls from at least a dozen Staten Island residents facing the same problem with Obamacare's "narrow networks" – extreme restrictions to doctor and hospital access imposed by Obamacare.

"Even though the insurance company cashed your check, it doesn't mean it (the policy) has been implemented," said Grimm at a Wednesday press conference with Figueroa. "That's the problem – that the back end of Obamacare hasn't been fully built. You can go on the front end of an application and look at a list of plans, but what they don't tell you is that many of those plans don't have doctors yet."

Figueroa is not alone.

As Breitbart News reported in January, the Washington Post warned that "Obamacare's narrow networks are going to make people furious – but they might control costs." Breitbart News contributor Scot Vorse learned the hard way about Obamacare's narrow networks when the nearest dentist who accepted the mandatory dental plan he was required to purchase for his children was over 100 miles away.

Obamacare's narrow networks have also shut out access to top cancer centers. The Associated Press says just 4 of 19 nationally recognized comprehensive cancer centers offer Obamacare access through all insurance plans in their state Obamacare exchanges, and a McKinsey and Co. study revealed 38% of all Obamacare plans only allow patients to pick from just 30% of the largest 20 hospitals in their areas.

Experts say the narrow network horror stories will only grow as more and more Obamacare customers attempt to use their Obamacare insurance only to realize its harsh realities.

Obamacare remains deeply unpopular nationally. The latest USA Today/Pew Research poll finds that just 37% of Americans now support Obamacare.

Obamacare sinks more Americans into the ranks of the uninsured!

So here is how the math works on Obamacare; I give you $3.00, and you give me $2.00. Now I am short $1.00, but you tell what a good guy you are because you helped me gain $2.00.

So scratch your head because the above analogy makes no sense. That’s okay! Obamacare makes no sense, so like the Obamacare administration and the HHS I can say (and write) whatever I please. That’s how it’s done now!

 Sorry state of affairs! Oh yeah….This your healthcare system!

Ten states where Obamacare wipes out existing health care plans

7:35 PM 09/28/2013

Sarah Hurtubise

President Barack Obama famously promised, “If you like your health care plan, you can keep your health care plan.” He later got even more specific.

“If you are among the hundreds of millions of Americans who already have health insurance through your job, or Medicare, or Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have,” Obama said.

But as Obamacare’s rollout approaches, we have learned this is not true. Here are the ten states where consumers may like their health care plans, but they won’t be able to keep them.

1) California: 58,000 will lose their plans under Obamacare. The first bomb dropped in California with a mass exodus from the most populated state’s Obamacare exchange. Aetna, the country’s third largest insurer, left first in July and was closely followed by UnitedHealth. Anthem Blue Cross pulled out of California’s Obamacare exchange for small businesses as well.

Fifty-four percent of Californians expect to lose their coverage, according to an August poll.

2) Missouri: Patients of the state’s largest hospital system — which spans 13 hospitals including the St. Louis Children’s Hospital — will not be covered by the largest insurer on Obamacare exchanges, Anthem BlueCross BlueShield. Anthem covers 79,000 patients in Missouri who may seek subsidies on Obamacare exchanges, but won’t be able to see any doctors in the BJC HealthCare system.

3) Connecticut: Aetna, the third largest insurer in the nation, won’t offer insurance on the Obamacare exchange in its own home state, where it was founded in 1850. The reason? “We believe the modification to the rates filed by Aetna will not allow us to collect enough premiums to cover the cost of the plans and meet the service expectations of our customers,” said Aetna spokesman Susan Millerick.

4) Maryland: 13,000 individuals covered by Aetna and its recently-purchased Coventry Health Care won’t be able to keep their insurance plans if they want Obamacare subsidies on the exchanges. Aetna and Coventry canceled plans to offer insurance in the exchange when state officials wouldn’t allow them to charge premiums high enough to cover costs.

5) South Carolina: 28,000 people were insured by Medical Mutual of Ohio, SC’s second-largest insurance company, until it decided to leave the state entirely in July due to Obamacare’s “vast and quite complex” new regulations. Company spokesman Ed Byers said Medical Mutual’s patients would be switched over to United Healthcare plans instead.

6) New York: Aetna pulled out of New York’s exchange in late August in an effort to keep their plans “financially viable,” said Aetna spokeswoman Cynthia Michener.

7) New Jersey: 1.1 million Aetna customers are at risk in New Jersey, where the leading insurer also won’t be a part of the exchange. Just 2,600 patients purchase individual plans with the company, but any looking to take advantage of subsidies on the exchange for unaffordable employer-based insurance won’t be able to do with Aetna.

8) Iowa: Wellmark Blue Cross and Blue Shield, Iowa’s largest health insurer, decided not to offer plans in the Obamacare exchange. It sells 86 percent of Iowa’s individual health insurance plans.

9) Wisconsin: Two of the three largest insurers in the state won’t offer plans on the exchange. United Healthcare and Humana patients will have to get a new health insurer to buy insurance on Obamacare exchanges.

10) Georgia: Just five insurers are participating in Georgia’s Obamacare exchange. Medical Mutual of Ohio left Georgia and Indiana as well as South Carolina, due to Obamacare regulations. Aetna, along with Coventry, also decided against participating in the George health exchange.

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Hospitals plot takeover of Health Insurance Companies...Emanuel Brothers plot takeover of Health

The fact that Dr. Ezekiel Emanuel (Brother of Rahm Emanuel mayor of Chicago) contributed and is quoted in this story means this article is not worth your time reading! Give it quick read anyway, and see how a select few morons (The Emanuel brothers) are running the U.S. Healthcare System. Our system is not broken….but Obamacare and the sycophants involved are in the process of breaking it!

Hospitals Plot the End of Insurance Companies

Rob Garver

The Fiscal Times

March 27, 2014

 The problems with the implementation of the Affordable Care Act may be masking another major change in the way health care is delivered to U.S. consumers, experts believe.

At a conference in Washington on Thursday, health care and business professionals said that there’s an increasing trend in the industry toward cutting insurance companies out of the process entirely, as large, regional hospital systems move into the insurance business.

Dr. Kenneth L. Davis, CEO and  president of Mount Sinai Health System, the largest health care provider in the state of New York, said that starting next year, Mt. Sinai will begin offering its own Medicare Advantage plan. It will look for other opportunities to bring premium payments directly into the hospital system, rather than filtering them through insurance companies.

Davis said he expects organizations similar to his to move in the same direction. “Inevitably the large systems are going to move to take part of the premium dollar,” he said.

For both non-profit systems like Mt. Sinai and for-profit systems, he said, retaining more and more of the health care premiums paid by consumers is essential to providing a full spectrum of care. He said that his system’s St. Luke’s Hospital in New York runs a psychiatric program that loses $14 million per year.

It’s “not sustainable,” he said, so the system needs to cross-subsidize the money-losing services that it nonetheless must continue to provide, with income from more profitable services, such as orthopedic surgery.

The industry, he said, is facing “an entire reformulation of how we pay for services.” The point is not to squeeze more profit out of the system, but to preserve the system’s ability to provide care. “If we don’t put those dollars back into the underpaid discipline, you just end up with underpaid disciplines that can’t be cross-subsidized.”

Dr. Ezekiel Emanuel, chairman of the Department of Medical Ethics and Health Policy at the University of Pennsylvania and one of the architects of the Affordable Care Act, agreed, saying that we’re beginning to see what he called the “Kaiserification” of our health care system.

He was referring to the Kaiser Permanente health care consortium, which combines a health insurance company with subsidiary hospitals and medical practices to create a fully integrated health care delivery system. He noted that large insurer Wellpoint recently completed the acquisition of a health care company in California, apparently with an eye toward replicating the Kaiser model in some form.

Emanuel said we’re witnessing “the end of insurance companies as we know them” and that if they want to survive, they “will have to get into the business of providing care.”

He predicted that in the world of health care, “the wave of the future is integrated delivery systems – integrating insurance with delivery function.”