8 ms·

The real question is why the insurance companies are pushing the annual exams very hard, not just in consumer ads, but using lots of incentives for primary care

The real question is why the insurance companies are pushing the annual exams very hard, not just in consumer ads, but using lots of incentives for primary care physicians. One would assume they would not want to pay for unnecessary tests for healthy people. So either their own research shows they save money with annual checkups in spite of what the article says, or more sinisterly, they do want to spend money to be able to justify higher premiums, because in several states they are required to spend around 80% of the premiums, and this is one easily plannable way. Does anyone know? Perhaps someone working for an insurance company?

InvaderFizz 3y ago
Wild speculation is a combination of one insurance company offering it and it becoming a relatively low cost competitive bullet point on one hand. On the other hand, insurers probably have better actuarial data because of annual checkups and can better align their profit margins with fees. Thus reducing their own reinsurance fees.
- londons_explore 3y ago
  > insurers probably have better actuarial data Imagine you are an insurer and advise free annual checkups. Some of your patients don't bother. Those patients have a higher mortality. You conclude the annual checkup is good. But you might be deceiving yourself - the kind of people to ignore health advice about getting an annual checkup might also be the kind of people to ignore the health advice on the back of a cigarette packet...
  - nradov 3y ago
    Major medical insurers are not naive about this stuff. They employ expert actuaries and data scientists who understand statistics and causality.
    - londons_explore 3y ago
      Sure, they understand the problem... But is there anything they can do about it? I'm not aware of insurance companies being too keen on getting into medical experiments like 'people with a birthday on a Thursday don't get the free annual checkup'.
lostlogin 3y ago
There was a case here in New Zealand where the "not for profit" insurance company "Southern Cross" was owned by a group of doctors. You can see how something that might not be in the insurance company's best interest could be in owners best interest, particularly if they own the hospital too.
omegadeep10 3y ago
I work at at a large health insurance company, though not involved in decision-making around annual exams or rate-setting so take that as you will. A lot the decision-making we do is around trying to improve the health outcomes for large populations of members at scale. When dealing with millions of members, interventions that require lots of effort and time are hard to scale up. If the data shows members with annual checkups have better health outcomes on average than members without annual checkups, that is something that's relatively cheap and easy to do with potentially significant impact. There are other benefits to annual checkups as well - catching an expensive condition early can be the difference between a $100,000 episode of care vs. a $10,000 episode of care. To be honest internally I've noticed the tide is shifting on annual checkups. Physician time is limited and every slot is valuable. I believe we're currently exploring virtual care options as a better alternative.
- throwaway29812 3y ago
  Your industry exists only by taking in more in premiums than you give out in care, correct?
- whitemary 3y ago
  [flagged]
  - haldujai 3y ago
    The groups driving "improving health outcomes" are not (just or even mostly) insurance companies but rather physician societies and government agencies like the USPSTF. We can also look to other national agencies from countries with publicly funded systems (Canada, UK, France, Australia) which share the same mission statement of "improving health outcomes" and have very similar screening recommendations as the US does. The statement is a bit of PR speak, but it's not made to sell more products. People working in healthcare generally do care about improving health outcomes.
    - whitemary 3y ago
      > People working in healthcare generally do care about improving health outcomes. If you knew the first thing about capitalism, you would know that what one "cares about" has only the most contingent relation to the end product of their labor. In other words, what the workers care about is effectively meaningless because the workers are not in charge; the profit is.
dividefuel 3y ago
I feel it's a kickback to the companies that provide care. If I bring up any health issues I'd like to discuss at my annual exam, it's billed as a doctor visit because it's no longer "preventative" care. For the visit to be free, I have to stay silent. It also gives providers an opportunity to recommend and order expensive tests or procedures that the patient might otherwise not have pursued.
- CuriousCosmic 3y ago
  > If I bring up any health issues I'd like to discuss at my annual exam, it's billed as a doctor visit because it's no longer "preventative" care. For the visit to be free, I have to stay silent. It also gives providers an opportunity to recommend and order expensive tests or procedures that the patient might otherwise not have pursued. They tried to bill me for that in the past at practices I was a patient of. There's a fine line between preventative care and E/M. You can generally walk the "preventative care" line by presenting your concerns as an observed change to be documented rather than a problem to be solved. If they do charge you, call the office to appeal the billing and they generally drop it as long as you can push the point that you weren't seeking a specific treatment but rather were just informing the doctor of a change in your health or conditions since the last visit.
  - peteradio 3y ago
    Oh yea just call and talk to someone its easy and its not like you are going to be put through the ringer talking to 10 different people over several weeks inexplicably over several continents.
    - CuriousCosmic 3y ago
      I've not found that to be an issue with smaller practices. Most of the times small practices just have one person other than the doctor who deals with billing. Sure they often outsource past that but if you can get either the doc or that person, they'll often just change the codes because even if they can technically bill you, it's probably not worth the time or effort for them. But yeah at big practices good luck. They are a living nightmare to deal with and I feel for anyone who can't get access to a smaller (ideally solo) practice.
billy_bitchtits 3y ago
Because they get paid more when people are diagnosed with conditions. https://www.nytimes.com/2022/10/08/upshot/medicare-advantage-fraud-allegations.html https://www.nytimes.com/2022/10/08/upshot/medicare-advantage...
anothernewdude 3y ago
Insurance companies don't care if you're healthy - they just want to save money. Sure, they could prefer healthy customers, or they could select for lower risk populations. The latter is easier. So instruction following and hoop jumping are the sorts of test that won't improve health incomes, but will select for good customers.
- nradov 3y ago
  That's simply not how the medical insurance business works. Since the Affordable Care Act, insurers have almost no ability to pick and choose their customers. And since profit margins are capped there is like little incentive to "save" money by reducing medical expenses.
  - hattmall 3y ago
    That's not true because they can pick and choose where and what to offer based on geographic areas through the ACA plans. But even more selectively they can offer group plans to employers that incentivize maintaining a healthy workforce. Most unhealthy people don't work good jobs that provide insurance.
  - anothernewdude 3y ago
    Your country is the bizarre case.
- sigstoat 3y ago
  > Sure, they could prefer healthy customers, or they could select for lower risk populations. The latter is easier. how are insurance companies (in the US) supposed to achieve this, when it is generally acquired through an employer?
bombcar 3y ago
I suspect that part of it is that some huge percentage of Americans are obese, and obesity-related health complications are a driving cost center. If even 10% of those who get an annual checkup succeed in losing weight when the doctor recommends they do so, it's a win.
firesteelrain 3y ago
My work offers free annual check ups and it’s mostly DIY. Prick of a finger, punch in weight, height and blood pressure into web app. Eventually once the results on the blood return, you get feedback on cholesterol etc. I get $500 from it and it is psychological to an extent - it helps encourage healthier habits
maxerickson 3y ago
Around here the insurance companies created a billing code that is just for annual checkups, with discussion of ongoing care turning it into a different type of visit (that isn't necessarily free).
cma 3y ago
Under the ACA, insurance companies have a profit cap as a percentage of expenditures, so they need to drive expenses to increase total profit (but still have to be competitive price-wise so it isn't unlimited).

InvaderFizz 3y ago

Wild speculation is a combination of one insurance company offering it and it becoming a relatively low cost competitive bullet point on one hand. On the other hand, insurers probably have better actuarial data because of annual checkups and can better align their profit margins with fees. Thus reducing their own reinsurance fees.

londons_explore 3y ago
> insurers probably have better actuarial data Imagine you are an insurer and advise free annual checkups. Some of your patients don't bother. Those patients have a higher mortality. You conclude the annual checkup is good. But you might be deceiving yourself - the kind of people to ignore health advice about getting an annual checkup might also be the kind of people to ignore the health advice on the back of a cigarette packet...
- nradov 3y ago
  Major medical insurers are not naive about this stuff. They employ expert actuaries and data scientists who understand statistics and causality.
  - londons_explore 3y ago
    Sure, they understand the problem... But is there anything they can do about it? I'm not aware of insurance companies being too keen on getting into medical experiments like 'people with a birthday on a Thursday don't get the free annual checkup'.

lostlogin 3y ago

There was a case here in New Zealand where the "not for profit" insurance company "Southern Cross" was owned by a group of doctors. You can see how something that might not be in the insurance company's best interest could be in owners best interest, particularly if they own the hospital too.

omegadeep10 3y ago

I work at at a large health insurance company, though not involved in decision-making around annual exams or rate-setting so take that as you will. A lot the decision-making we do is around trying to improve the health outcomes for large populations of members at scale. When dealing with millions of members, interventions that require lots of effort and time are hard to scale up. If the data shows members with annual checkups have better health outcomes on average than members without annual checkups, that is something that's relatively cheap and easy to do with potentially significant impact. There are other benefits to annual checkups as well - catching an expensive condition early can be the difference between a $100,000 episode of care vs. a $10,000 episode of care. To be honest internally I've noticed the tide is shifting on annual checkups. Physician time is limited and every slot is valuable. I believe we're currently exploring virtual care options as a better alternative.

throwaway29812 3y ago
Your industry exists only by taking in more in premiums than you give out in care, correct?
whitemary 3y ago
[flagged]
- haldujai 3y ago
  The groups driving "improving health outcomes" are not (just or even mostly) insurance companies but rather physician societies and government agencies like the USPSTF. We can also look to other national agencies from countries with publicly funded systems (Canada, UK, France, Australia) which share the same mission statement of "improving health outcomes" and have very similar screening recommendations as the US does. The statement is a bit of PR speak, but it's not made to sell more products. People working in healthcare generally do care about improving health outcomes.
  - whitemary 3y ago
    > People working in healthcare generally do care about improving health outcomes. If you knew the first thing about capitalism, you would know that what one "cares about" has only the most contingent relation to the end product of their labor. In other words, what the workers care about is effectively meaningless because the workers are not in charge; the profit is.

dividefuel 3y ago

I feel it's a kickback to the companies that provide care. If I bring up any health issues I'd like to discuss at my annual exam, it's billed as a doctor visit because it's no longer "preventative" care. For the visit to be free, I have to stay silent. It also gives providers an opportunity to recommend and order expensive tests or procedures that the patient might otherwise not have pursued.

CuriousCosmic 3y ago
> If I bring up any health issues I'd like to discuss at my annual exam, it's billed as a doctor visit because it's no longer "preventative" care. For the visit to be free, I have to stay silent. It also gives providers an opportunity to recommend and order expensive tests or procedures that the patient might otherwise not have pursued. They tried to bill me for that in the past at practices I was a patient of. There's a fine line between preventative care and E/M. You can generally walk the "preventative care" line by presenting your concerns as an observed change to be documented rather than a problem to be solved. If they do charge you, call the office to appeal the billing and they generally drop it as long as you can push the point that you weren't seeking a specific treatment but rather were just informing the doctor of a change in your health or conditions since the last visit.
- peteradio 3y ago
  Oh yea just call and talk to someone its easy and its not like you are going to be put through the ringer talking to 10 different people over several weeks inexplicably over several continents.
  - CuriousCosmic 3y ago
    I've not found that to be an issue with smaller practices. Most of the times small practices just have one person other than the doctor who deals with billing. Sure they often outsource past that but if you can get either the doc or that person, they'll often just change the codes because even if they can technically bill you, it's probably not worth the time or effort for them. But yeah at big practices good luck. They are a living nightmare to deal with and I feel for anyone who can't get access to a smaller (ideally solo) practice.

billy_bitchtits 3y ago

Because they get paid more when people are diagnosed with conditions. https://www.nytimes.com/2022/10/08/upshot/medicare-advantage-fraud-allegations.html https://www.nytimes.com/2022/10/08/upshot/medicare-advantage...

anothernewdude 3y ago

Insurance companies don't care if you're healthy - they just want to save money. Sure, they could prefer healthy customers, or they could select for lower risk populations. The latter is easier. So instruction following and hoop jumping are the sorts of test that won't improve health incomes, but will select for good customers.

nradov 3y ago
That's simply not how the medical insurance business works. Since the Affordable Care Act, insurers have almost no ability to pick and choose their customers. And since profit margins are capped there is like little incentive to "save" money by reducing medical expenses.
- hattmall 3y ago
  That's not true because they can pick and choose where and what to offer based on geographic areas through the ACA plans. But even more selectively they can offer group plans to employers that incentivize maintaining a healthy workforce. Most unhealthy people don't work good jobs that provide insurance.
- anothernewdude 3y ago
  Your country is the bizarre case.
sigstoat 3y ago
> Sure, they could prefer healthy customers, or they could select for lower risk populations. The latter is easier. how are insurance companies (in the US) supposed to achieve this, when it is generally acquired through an employer?

bombcar 3y ago

I suspect that part of it is that some huge percentage of Americans are obese, and obesity-related health complications are a driving cost center. If even 10% of those who get an annual checkup succeed in losing weight when the doctor recommends they do so, it's a win.

firesteelrain 3y ago

My work offers free annual check ups and it’s mostly DIY. Prick of a finger, punch in weight, height and blood pressure into web app. Eventually once the results on the blood return, you get feedback on cholesterol etc. I get $500 from it and it is psychological to an extent - it helps encourage healthier habits

maxerickson 3y ago

Around here the insurance companies created a billing code that is just for annual checkups, with discussion of ongoing care turning it into a different type of visit (that isn't necessarily free).

cma 3y ago

Under the ACA, insurance companies have a profit cap as a percentage of expenditures, so they need to drive expenses to increase total profit (but still have to be competitive price-wise so it isn't unlimited).