On the Third Hand: Docsourcing

But another interesting theme is that another large health plan customer broke up with Healthways because of "risk-shifting to their provider network."

In other words: the health plan no longer has to worry as much about the condition management risk, because the providers are getting a chance to earn extra cash in exchange for the privilege of handling the condition management risk themselves.

Healthways executives said during the call that one thing they are doing is relying less on care coaches in call centers and more on health management counselors "embedded in the health care delivery system."

On the one hand: When insurers outsource wellness and condition management programs to doctors, it seems as if that's a great way to get a complicated, tedious, potentially controversial hot potato of nagging out of the Big Nasty Health Insurer Cootie Zone and the Bright Shiny St. Marcus Welby, MD, Halo.

On the other hand: Maybe Tom Sawyer actually outsmarted himself a bit and would have gotten something – stronger muscles, a longer attention span, a better character – if he'd whitewashed the picket fence himself. Maybe health insurers would benefit from working harder to hang onto the wellness and condition management piece of health care. Maybe, for example, that kind of activity is a good source of steady fee revenue when regulation is causing problems for health insurance premium revenue.

On the third hand: Until Election Day – and until, really, every last possible health-related court case has made its way through the U.S. Supreme Court a few hundred years from – it seems impossible to know whether it makes sense to whitewash the picket fence yourself, get someone else to do it, or just run for cover and let the picket fence worry about itself.