Comment by mjn

Kaiser is one example where incentives align, because they're an integrated HMO, running both the insurance and the care side of things. It's kind of like an opt-in single-payer organization. Their model is that they charge you X/month for care, and then everything is billed internally, with Kaiser clinics treating Kaiser plan members. So if they can bring costs down, that helps them; since nobody external is reimbursing for services, there is no advantage to billing expensive tests.