An article in the Jan. 6 issue ("A blow to providers," p. 6) implies that Minnesota healthcare providers want "to act like insurers" by assuming financial risk for the care they provide. The article fails to differentiate between two types of financial risk relating to capitated patient groups: potential losses incurred in expected utilization of services and those incurred in unexpected utilization of the system.
Minnesota providers have long been held accountable for expected utilization costs. Financial risk for unexpected costs has always been the province of health plans. In no case, to my knowledge, are providers writing contracts of insurance, determining benefits packages or pooling risk to protect against these unexpected risks, which go to the heart of the insurance contract. Rather, providers in our community have focused on accepting risk only for the expected levels of service they are asked to provide and have left the management of unexpected utilization to the insurer, where it belongs.
If we accept the argument that any risk relating to providing care to a group of patients is the business of insurance, we will lose one of the strongest incentives for innovation in how we provide healthcare services to the communities we serve.
MARK A. SKUBIC
Vice president, government relations
HealthSystem Minnesota, Minneapolis