The timing is right for coalition ventures

Options may be limited if you don’t act now

More change is coming to the health care delivery arena, and unless physicians take a proactive stance, it may not be for the better.

"Faced with a 20% rate increase for insurance, some large employer coalitions in the Midwest are at the point of wanting to have the government come in and do something," says William J. DeMarco, MA, CMC, president of DeMarco & Associates, a Rockford, IL, health care consulting firm.

"If physicians don’t step up to the plate and take the lead in bringing care back to the community, their options may be limited down the road. If we don’t have some real success stories in the next five years, we may see mass regulations and a single-payer system," he warns.

Lawmakers in a number of states are starting to discuss setting up a single-payer system as a way to control spiraling health care costs and stem complaints about HMOs, he adds. "If we don’t have a market-based solution, we are open to the potential of having a government-based solution in three to five years."

A government administered single-payer system is likely to be more restrictive than many HMOs and will probably mean stronger price controls for physician services, DeMarco says. "State legislation on patient protection, Medicaid choice, and other health care issues are very strict on oversight and control."

If one or two states go to a single-payer system, their experiences could trigger a move toward a national type of single-payer system, he points out.

If the idea of a single-payer system arises in your state, you’ll be in a better position if you already have a direct contracting program up and running, DeMarco says. "The state doesn’t want to ruin anything that’s working. The state wants to take care of people who are unhappy with their health care plans."