I am beginning to think change might be afoot in the ivory towers of insurers.
With Aetna’s chief running around talking about reform, and United Healthcare committing to improve service, it would seem so. Now Carefirst, one of the few remaining not-for-profit Blues plans, has a new CEO with some strange ideas.
Strange for a CEO of an insurance company that is. Chester ‘Chet’ Burrell took the reigns December 1 and since then has been meeting with the likes of hospital executives and others that formerly have had ‘contentious relations’ with Carefirst in the past. Why? To reassert its role as a ‘policy entity with nonprofit values’. Can such a thing still exist? If we are to believe Mr. Burrell, then apparently it does.
“Yes, it’s an insurance company, but it has a community mission,” Burrell said in a recent interview. “We want to be catalytic for productive changes in the health system.” While much of what he is proposing is modest, such as increasing electronic claim submission adoption to lower costs, some of his other ideas are quite radical including potentially offering grants to help physicians adopt EMRs more affordably.
Burrell also said he is looking to hospitals and affiliated networks of doctors to coordinate care, especially for the most expensive patients, who often have multiple chronic conditions and visit a variety of specialists.
Could it be that physicians will once again be allowed to practice medicine instead of pulling double-duty as clinicians and administrative gate-keepers?
I’ll be keeping my eye on Chet, and all the rest of them.
Categories: Managed Care
The penalty for not buying health insurance in Massachusetts could soon quadruple to $912 a year, the Boston Globe reports.The state is considering increasing the maximum penalty for not buying insurance to persuade those who can afford it, but still haven’t bought coverage, to comply.
What I can’t figure out is what they will do with the fine money. Why not use it to purchase health insurance? If you can force a person to pay a fine, why not convert it to pay the premium and solve the problem going forward?
Categories: Uncategorized
I am so sad to write that Benazir Bhutto has been killed. It is not just Pakistan’s loss - and for all that means, it is tremendous - but also the world’s loss. A courageous, outspoken, fearless yet reasonable, diplomatic and engaged human being was just wiped from the map.
Do I agree with her politics? I don’t know, it isn’t my country, so what can I say about politics local there? But, I can identify with the rhetoric, the passion, and the bravery that necessitated her extraordinary return to Pakistan, and her desire to press for January 8th elections at all costs.
For my colleagues and friends that live in Lahore, I wish for peaceful streets and no violence in that (or any Pakistani) city.
Meanwhile, I’ll be hoping for peace and democracy to prevail over terror - not in a platitudinal way; my people are from Belfast; but in a way that all sides can come to value the merit of diplomacy and dialogue, as such recent foes as McGuinness and Paisley can do now.
RIP, Benazir Bhutto. Many may think this isn’t the right forum, but to me, if you don’t stand for something, you stand for nothing. And nothing means you have no standing. . .
Categories: Uncategorized
The AMA announced today that it led a $3 million grass roots campaign to avert the proposed 10% cut in Medicare physician payment, which resulted in a 0.5% increase through June 30, 2008, a $3.1 billion increase instead.
While it falls short of a proposed 2-year plan, it’s still a big win - nice going, AMA! (See also ‘RVU update #7′)
Per the AMA, key elements of 2007 Medicare-SCHIP package are as follows:
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Replaces 10.1 percent cut with 0.5 percent increase through June 30, 2008. If Congress fails to take action before the end of next June, physicians will face a cut of approximately 10.6 percent
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Authorizes additional 1.5 percent bonus for Medicare physician quality reporting initiative (PQRI activities) through Dec. 31, 2008
Extends floor for work geographic adjustment and physician scarcity bonus through June 30, 2008
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Budget offsets: remove $1.5 billion from Medicare Advantage stabilization fund; eliminate physician payment fund carried over from 2006 Medicare package and reduce payments for some Part B drugs
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Extends therapy cap exceptions, pathology billing exception and premium assistance for some low-income seniors for six months
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Extends SCHIP funding through March 31, 2009 (additional funding for current enrollment)
If you would like to join the effort or get involved:
- Join the Physician Grassroots Network at http://www.ama-assn.org/grassroots
- Register for the AMA National Advocacy Conference: The AMA’s National Advocacy Conference scheduled for April 1-2 in Washington, D.C., provides a timely opportunity for medicine to make “house calls” on Capitol Hill. Join your colleagues in meetings with Members of Congress to press for real reforms http://www.ama-assn.org/go/nac
- Find out more about AMPAC. With so much at stake in the 2008 congressional elections, the American Medical Association Political Action Committee (AMPAC) is gearing up to be a pivotal force in key races for the U. S. House and Senate. A new major donor category, Capitol Club Gold, has been created to assure adequate resources for this effort. AMPAC is consistently recognized as one of the most effective political action committees in the country. To learn more about AMPAC, visit http://www.ampaconline.org/
Categories: Financial
Categories: Articles and Publications
I subscribe to lots of newsletters and various forums for information. Today I received an email from HealthDecisions.org with the following three headlines, and I have to admit I’m confused.
1. Insurers Seek Bigger Reach In Coverage - New York Times, 12/19/2007
2. New AHIP Survey Finds Individual Health Care Coverage Accessible and Affordable - AHIP, 12/19,/2007
3. AHIP Releases Individual Market Guarantee Access Proposal - AHIP, 12/19/2007
The first story acknowledges that too many people simply cannot obtain health insurance on their own, and that the insurance industry plans on Wednesday to propose a series of steps the companies say would let more individuals, even those who have health problems, obtain coverage. Meanwhile, America’s Health Insurance Plans (AHIP) released a ‘comprehensive survey’ of the individual health insurance market stating that health care coverage is more accessible and affordable ‘than is widely known’. The survey found that ‘premiums are affordable, most who applied were offered coverage, and that consumers have access to a wide variety of benefit options to meet their individual needs. In addition, health savings accounts (HSAs) continue to be a popular coverage option among consumers’. But what does that mean? That because some people can afford the premiums, and were granted coverage, that these plans somehow qualify as ‘affordabe’ for all?
At the same, AHIP released an article acknowledging that the individual health market needs serious reform before it can ‘address the unique challenges’ facing the individual health insurance market. “We believe that plans and the states, working together, can guarantee access to affordable insurance for everyone in the individual market,” said Jay Gellert, President and CEO of Health Net, Inc. and Co-Chairman of the Individual Market Task Force.
So which is it? That individuals can afford individual plans but just don’t know it? Or that it’s possible to obtain cost-effective individual coverage, but just not quite yet? But the more interesting aspect of all this is the Individual Market Task Force itself. Who’s on the Force? A group of insurance company executives, of course. Now don’t you think there is something fundamentally wrong with that picture?
Categories: Uncategorized
Harris County Medical Society released its first “Payor Survey,” in which 487 local health professionals rated the six largest insurance companies in the region on care, payment and customer service. Except, they couldn’t actually rank them because they all came in at “the cellar level”. The insurance companies rated are Aetna, Blue Cross Blue Shield of Texas, Cigna, Humana, UniCare and United Healthcare.
About 500 members of the Harris County Medical Society responded to a survey on the top six health insurers in the Houston area. Some results:
• 70 percent said insurance companies had denied claims for medically necessary procedures.
• 66 percent said they had trouble getting insurance company preauthorization for scans and other imaging.
• 83 percent said the red tape and delayed payments involving insurance companies require them to have at least one employee per doctor to deal with filing and billing issues.
Read the full story here.
I applaud Harris County for its efforts, and for helping to force a dialogue where there previously has been none. In response to their efforts, most Payors have responded one way or another. Cigna cites its improvement in the denial category as evidenced in AthenaHealth’s Payor View rankings (see Physicians Practice article here) and points to its use of physician focus groups as a way of showing engagement with the issues.
United could take a leaf out of Cigna’s book. The WSJ reported Wednesday that ‘Bad Service Cost UnitedHealth 315,000 Customers’. The CEO, Mr. Hemsley, admits that UHC is the ‘industry’s worst’ at resolving billing issues with providers. While it is refreshing to hear admissions of this nature, where is the game plan for remediation?
Perhaps as more provider-perspective rankings are made available, these issues may finally be adequately confronted. The quarterly Verden report - available late January 2008 - ranks insurers on data generated from the Verden Alert subscription service, which tracks policy and procedure changes issued by 160 companies nationally.
You’ll hear about it here first!
Categories: Managed Care · Ranking Systems
Advocates believe CDHPs promote better decision making regarding patients’ use of health care services. According to a McKinsey study, CDHC patients were twice as likely as patients in traditional plans to ask about cost and three times as likely to choose a less expensive treatment option, and chronic patients were 20 percent more likely to follow treament regimes carefully. Well that works great for insurers - premiums coming in without reimbursements going out.
Critics believe that CDHPs cause consumers, particularly those who are poorer and less educated, to avoid needed and appropriate health care because of the cost burden and lack of available information needed to make informed, appropriate choices. I suppose cost-sharing the price of the premium with an employer is taxing enough, doesn’t leave much left over to contribute to deductible expenses.
But these are just two sides of an octagon, in my opinion. The latest profit-maker for insurers, CDHPs are big business. Not only does this model allow for more profit from premium dollars that only need to be spent in the event of catastrophic illness, it has also opened the door to banking for many of the larger companies.
Let’s think about this.
First, if your CDHP comes with a high deductible, and you are relatively healthy, then the premiums you pay will never be used. Many plans come with deductibles of $3,000 and up. A tyical family of four plan may have a deductible of $5,000 and roughly $12,000 in premiums per year. If everyone is healthy, and the majority of insurance consumers are, then you have the privilege of paying for any health care costs throughout the year out of your own pocket while handing over thousands for insurance benefits you won’t use. Rather than shopping around to save money, I’d be more likely to want to reach the deductible limit in order for my benefits to kick in. You want something to show for those dollars, right?
Second, it costs you to have a health savings acocunt (HSA/HRA). I had the pleasure of being covered by a UnitedHealthcare CDHP plan, who owns a bank specifically created to manage consumer and employer contributions deposited toward deductible expenses. When I received my account information, I made sure to read the fine print. It was full of charges - a monthly fee for the privilege of owning the account, a per-transaction fee any time I used the funds for health care related expenses, and even a fee for recieving statements. And I got the impression that reading the fine print had resulted in charges too. . .
So can someone please explain where the value proposition is in this for the consumer? High premiums (though lower than ‘traditional’ plans), large out-of-pocket expenses, nickled and dimed for the privilege of having an HSA/HRA, and none of the premiums being returned in the form of covered health care services - I just don’t see the value in it.
But the insurance companies sure do. Caa-ching!
Categories: Financial · Managed Care
I don’t know about you, but I’m tired of hearing managed care companies talk about health care ’affordability’. They seem to think that by offering bare-bones health plans at prices that are lower than more comprehensive policies, they are fulfilling the needs of society and ensuring that health insurance is within reach for more consumers.
But is that really the case? Many of these new plans come with lifetime caps not significant enough to cover any real catastrophic event. Several are targeted toward the young and healthy, ensuring healthy profits from an under-tapped maket. At least plans are being offered to consumers that previously had no other options, so that can be seen as progress, but is it progress in the right direction?
I think not. Insurance companies are profit maximizers, not cost minimizers. Until the focus shifts from taking as much profit as possible from the system to truly minimizing the cost of running such a system, we are simply seeing costs being shifted around. The winners? Managed care companies of course.
Categories: Financial · Managed Care
Today I spoke with a journalist about medical cost ratios. At one point in the conversation he asked me if I thought managed care had the potential to contain costs, even though they seem to be adding to their bottom lines currently instead. And then it struck me - managed care companies are the ones setting the price for health care.
Let’s look at it this way - MCOs set the price of premiums, then determine how much of those premium dollars they are going to pay out on rendered services. Contrary to what the industry would have us believe, it’s not the other way ’round (services rendered drive premiums). Of course they cannot directly control utilization of servces, but they can control access to them, create ways to not pay for them, lower payments for them, and deny claims associated with them. So, if I’m an insurer, I simply need to be creative enough to figure out how to hold on to premium dollars, and then charge more to society for that privilege in the next underwriting cycle.
How else can we explain why medical cost ratios are going down and premiums are going up? At what point do insurers begin to cap their charges? Well, they won’t, because we continue to pay, pay, pay.
Categories: Financial · Managed Care
