AHIP Responds To Wall Street Journal: Medical Management Improves Health, Reduces Costs

by David Merritt

August 28, 2017

“Insurers Are Still Denying Treatments for Pre-Existing Conditions” (Opinion, Aug. 22, 2017) connects two unrelated, hot-button issues in a way that is both incorrect and overlooks how health plans improve the value of care.

Every single American should have quality, affordable coverage – whether or not they have a pre-existing condition.  Insurers across the country have made that point clearly and consistently throughout the current debate over health care.  Protections for pre-existing conditions coupled with incentives for people to get and stay covered is the best way to ensure access and affordability for everyone.

We need to also ensure access to the most efficient, effective and high-quality care.  Health plans’ medical management practices do just that – and they work.  Here are the facts.

First, private plans approve more than 98 percent of all claims, according to a study by the American Medical Association.

Second, just like doctors use scientific evidence to determine the safest, most effective treatments, health plans rely on data and evidence to understand what tools, treatments, and technologies best improve patient health.  Health plans partner with doctors and nurses to identify alternative approaches that have better results, better outcomes, and better efficiencies.  If different conclusions are reached, patients are protected through an open and honest review.

The opinion writer seems to suggest that universal access to every single service, every possible treatment, and every prescription drug on the market is the best approach – whether or not they actually work. This will not make people healthier – and will undoubtedly raise costs.  Patients and taxpayers alike deserve to see more value for every dollar they spend. Health plans are there to ensure better outcomes and affordability for everyone – no matter their health status.

David Merritt is AHIP’s EVP of Public Affairs.