The Milliman Review was commissioned by the Republic of Ireland’s Department of Health and Children and said that state owned t Vhi Healthcare should become a US style healthcare utilisation manager. Effectively what this means is that Vhi Healthcare would change from an organisation that currently funds the healthcare needs of customers to one that actually determines what level of care and the type of treatment that customers would receive. So, rather than the consultant in a hospital determining the care pathway for patients, Vhi Healthcare would enter into new agreements with consultants and hospitals and its customers whereby the care pathways would ultimately be determined by Vhi Healthcare.
Becoming a US style healthcare utilisation company would require Vhi Healthcare to invest in and set up significant pre-authorisation processes, concurrent review processes and post care review processes. Pre-authorisation would require the consultant treating the customer to obtain Vhi Healthcare’s sign-off on the proposed care pathway and in the event that Vhi Healthcare did not sign-off, the customer’s healthcare costs would not be reimbursed. Concurrent reviews would involve Vhi Healthcare staff continuously monitoring the health status of patients to determine whether they should still be treated and post-care reviews would involve Vhi Healthcare examining whether the patient should have received the treatment.
Vhi Healthcare rejects the Milliman Review, as it doubts that savings could be made and would require a very significant upfront investment.
Jimmy Tolan of Vhi Healthcare says, “Vhi Healthcare faces very significant healthcare funding challenges over the next ten years as our customer base continues to age. We anticipate that we will have to deliver significantly more care in critical healthcare areas such as cancer, cardiac, orthopaedic and managing chronic conditions.”
Rival health insurer Aviva is calling for the government to sell Vhi Healthcare immediately so that taxpayers are not hit with another huge bailout bill. Jim Dowdall of Aviva says,” The cost of getting the Vhi to a solvent level so that it can be sold will put a huge burden on the taxpayer. With every month, VHI's solvency levels are deteriorating."
Although last May the Irish government said it would be selling VHI, it could be another two or three years before the insurer is sold.