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Money is top priority of for-profit health plans

The Buffalo News' revealing look at UnitedHealth Group on Oct. 22 raises some serious concerns about this company and what Western New Yorkers might expect when it enters the local market.

UnitedHealth's ongoing stock-options scandal and federal ethics probe that led to the recent resignation of the company's CEO, among others, have been well documented, overshadowing to a large degree its blistering battles and lawsuits with physicians and hospitals throughout the United States. From New York to Denver and many points in between, UnitedHealth is involved in contentious negotiations with providers, negatively impacting millions of its members.

As a physician and health care executive, I understand the importance of working collaboratively with our physician and provider partners, and aligning hospital and physician reimbursements with quality of care measures.

Health care is a public good, not just an industry, to be governed by the same economic principles that govern pure business. Value in health care can only be assessed by weighing cost and quality together. Quality health coverage not only improves care, it saves lives.

UnitedHealth's record in this regard, as measured by the National Committee for Quality Assurance (NCQA), is as revealing as is its animosity toward physicians and hospitals. According to last year's ranking of the country's best health plans by NCQA and US News & World Report, UnitedHealth's highest-rated plan was UnitedHealth New England at 77. UnitedHealth New York was even lower at 125. In contrast, Independent Health was ranked the 7th best health plan in the country.

What makes UnitedHealth's rankings particularly unsettling is the fact they are based on such important criteria as access to care, member satisfaction, disease prevention and treatment.

The NCQA findings are consistent with numerous studies that demonstrate the quality of care provided through nonprofit health plans such as Independent Health is far superior to that provided through for-profit or investor-owned health plans such as UnitedHealth. Consider this finding from a study reported in the Journal of the American Medical Association in 1999. Based on the differences in mammography screenings, it reported that "if all 23.7 million American women between ages 50 and 69 were enrolled in investor-owned, rather than nonprofit plans, an estimated 5,925 additional breast cancer deaths would be expected." Make no mistake, the first priority of for-profit plans is shareholder wealth.

If you look at the nation's best health plans as judged by an unbiased third party such as NCQA, it becomes apparent that plans such as Independent Health have set the benchmarks for outstanding quality; collaboration; improved patient outcomes; low administrative costs; accessible, responsible local leadership; and improving the health of our communities.

Michael Cropp, M.D., is president and CEO of Independent Health.

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