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UnitedHealth Customers Speak With their Feet, and it’s Time for Everyone to Listen by Miriam Bookey

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This week’s sobering news from UnitedHealth serves as a wake-up call to anyone in healthcare services. For better or worse, a consumer-driven health economy has put individual consumers in the driver’s seat when it comes to how, when and with whom they spend their healthcare dollars. They will leave in the hundreds of thousands if they’re not satisfied (315,000 from UnitedHealth, to be exact).

It’s clear that service providers are no longer working with passive ‘patients’ who ‘receive care.’ Instead, the patients are compelled to be active consumers, responsible for investigating their personal healthcare options, arranging their own care as well as that of children and aging parents, understanding what is or isn’t covered by health plans, utilizing HSAs, selecting responsive and responsible service providers, and taking the initiative to follow up with doctors and health plans after appointments.  It’s a big, complicated and thankless job. And it’s a world in which patients can and will leave their insurers and select care providers based on service, not on health plan.

Continued at the Health 2.0 Blog

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  1. Here’s some interesting insight from a recent Washington Times editorial dealing specifically with consumers taking healthcare costs into their own hands …
    Health crisis
    Health care in America is in crisis (“Five myths of health care,” Commentary, March 21). Turn on the news, listen to the political candidates or simply speak with your friends and neighbors who are in need of or seeking medical treatment. The cost is high; the availability of service is sometimes inadequate and often unavailable to far too many who need it.
    While it is abundantly clear that Americans in general, and the presidential candidates in particular, are keenly aware of the concern regarding ever-escalating health care costs, it appears their response is at best one-dimensional. In order to make a serious dent in the problem, we must own up to the fact that a multidimensional approach is necessary.
    Asking who will pay for health care is certainly important, and each of the candidates has mapped out their own particular approach. Sen. Barack Obama is calling for incentivizing insurance for all, while Sen. Hillary Clinton wants to mandate insurance for every American. Meanwhile, Sen. John McCain is attempting to offer tax breaks or credits to help enlist almost all of the uninsured. While they’ve done the important work of opening a dialogue on the issue and who will pay, they have not yet begun to answer the question of how to pay for what they are offering.
    It is significant to note that Mrs. Clinton has not explained how she will force people to buy insurance, presumably because the mention of any type of force might have voters running for cover.
    However, each plan addresses only how risk will be allocated. None of the offered plans discuss how we will begin to pay for the resulting benefits. For the Democrats, the closing of loopholes for the rich does not come close to the total cost by even the most conservative estimates. As an aside, with commitments to increase entitlement spending without raising taxes, even a third grader would question the math.
    Conversely, the Republican Mr. McCain will not close the loopholes of the rich and fails to indicate from where the funding will be obtained.
    The sad truth is health care spending in the United States is currently 16 percent of the Gross Domestic Product, according to the National Coalition on Health Care. Simply stated, that means for every dollar produced in this country, 16 percent goes to fund health care. Our health care costs far outpace our rate of inflation and, as a result, the problem is not getting better. Factor in the “graying of America,” where we will have a higher percentage of senior citizens in coming years, along with our recently legislated Medicare program, which lacks any discernible source of funding, and at best the outlook is bleak.
    In order to responsibly deal with health care costs, allocation of risk is not enough. We must seek meaningful and tangible ways to diminish the actual cost of health care.
    Mr. McCain has touched on tort reform, proposing that the reduction of settlements in medical malpractice cases would serve to lower the insurance premiums every doctor must pay, thus lowering overall health care costs. Other suggestions include allowing people to import medication from other locales to alleviate related medical costs.
    Yet another answer may be the recognition that there are overseas destinations providing comparable or substantially better levels of health care than what might be available in the United States for a fraction of the cost. In addition, access to doctors is generally believed to be better in certain foreign locations.
    Meanwhile, in the United States, the continued rise in health care costs is readily in evidence. In the last few weeks in the New York market alone, Cabrini Medical Center closed and Victory Memorial announced it will soon be auctioned.
    I do not think there is just one answer to the complexities of addressing the health care dilemma. However, I believe if we fail to keep an open mind and neglect to recognize that, as a complex problem, the answer must be multidimensional, we will not be able to adequately address our needs.
    MENDEL ZILBERBERG
    President and CEO, One World United
    Brooklyn

  2. The choice has become health insurance or health care. Consumers/patients want the latter, and have finally seen the scam in the lying, corrupt health insurance business, devoted as it is to screwing patients and providers when most needed. Their stockholders and officers could care less. They have an army of lawyers.
    Many good doctors, including me, have opted out of all insurance plans and programs. Insurance is no longer my problem. Visa, MasterCcard accepted.

  3. Thanks for your detailed response Michael. I surely didn’t mean to imply the NC chiro situation and ambulance chasing paints all chiros. Certainly not mine.
    I was weaned on Chiro care by a parent that looked on doctors as the enemy. When I was allowed/able to think for myself I learned chiros can’t treat/cure all and too many of them think they can. They also seem to adopt off-beat, unproven treatments too quickly. I will see a chiro first if I think I won’t need blood tests or emergency drugs to get me over a problem, the no harm option. But my aversion to taking any drug leads me away from docs at the get-go. My wife is being treated for a hip problem that NO doc could treat without just using pain killers or an operation, if that was even possible. She is improved after treatment. I don’t think she’ll be cured however, but you have to look at her spine curve to realize that early chiro care may have prevented this hip thing.
    The problem is not chiros though but doctors, who, like lawyers, spend too much time restricting competition which could be better spent looking at what will benefit the patient most. Here in NC the lawyers guard their lock on house sale closings when title companies could do it as well or better at less cost. They also guard the limited small claims options citizens have. County courts can’t even help a citizen fill out the small claims form. Ok that’s for a different blog. But docs have always looked at chiro as next to voodoo instead of trying to use it when it is more suitable for the patient. I think insurance looks at chiro the same way they look at paying for mental health care – at what point can you judge when the treatments are over. But I think more education from the chiro association would go a long way.

  4. Peter, I could not agree with you more especially with regard to the dirty politics and the ambulance chasing. What happened in NC is not reflective of the norm for chiropractic policy makers. It also is not exclusive to chiropractors. With regards to the ambulance chasing stuff and ickey marketing tactics I need to let the profession accept more responsibility. Yes, to some extent the profession has been ghetto-ized by the third party payors and some DC’s feel the need to act like we deserve it. Still, not an excuse. The bigger problem is that the positive PR apparatus for the profession has been lacking and all this junky stuff becomes our “public face.”
    Again, however, this junky marketing does not reflect the mainstream chiro. I have 18 DC’s in my general area and 2 of them have full page ads in the yellow pages and do a lot of personal injury work. Because of their over-exposure, and the lack of a strong positive PR program by the profession, people see this junky stuff as our public face locally. Nonetheless the chiro’s in my area who do not do this type of thing outnumber them 9:1.
    As far as other chiropractors price points I am going to withold comment. I will say your comment that there is typically a difference between the levels of billing between DC’s and MD’s is fairly accurate. However, in my practice, which I can comment on, there is no difference for two reasons: 1.) My state has insurance equality laws that guarantee like fees for like services outside of HMO contracts. It’s a fair law and it does not drive up costs. It does allow for fair competition among provider groups. If a provider decides to discount that fee by signing a network contract then that is their choice and the law does not protect them. 2.) I am actually on staff at a large medical facility (8 orthopedists, 4 PA’s and 3 chiro’s) and I stick to the practice’s pricing guidelines for non-covered services. We do not do the low self-esteem deep chiro discount. Our fee is our fee. Some discounts can be had with hardship cases but the savings in the reduced numbers of visits needed if the care is of higher quality.
    Having said that, I still am very busy and many patients regularly pay out of pocket if I am not in their network or they do not have out of network benefits. They do this because my chiro partners and I have evolved to become more patient centered. We spend 15-20 minutes with each patient at each encounter. The goal is to fix them as fast as we can (fewer visits)with the lowest overall cost (per case, not per visit) and wait for the referrals which are steady.
    We streamline patients paperwork and are extraorinarily accessible via the phone and email. Our staff has been ordered to be patient advocates instead of doctor helpers. Treatment is the highest quality of soft tissue/rehab based physical medicine coupled with standard chiropractic procedures that reduces the number of visits needed to fix a problem. Home stretching and exercise programs are installed in every case so they can manage their problems more independantly. Patients do not wait more than 15 minutes, ever. Waste of patients time or money does not occur.
    We could never provide this level of service if we relied solely on HMO’s. In a weird way, the HMO’s were destroying the quality of care, choking off competiton and funneling patients into much more expensive and less effective modalities. Mostly because of the biases you mention. And the patients knew it before we even did. We changed a few years ago and all we did was ask ourselves “what do the patients want?” This is what they wanted. This underscores the experience Miriam is relaying. The other side of this coin is that people are now understanding their insurance is expensive but not very valuable. Especially if it drives them away from high quality and highly effective care. They are voting in increasing numbers with their feet.
    Your comments regarding the Canadian system are interesting. Very similar to the battle we have with CMS right now. The logic is that by limiting the chripractic benefit they are limiting the cost. The same logic would say that by eliminating the chiropractic benefit they would eliminate the cost. Nope. The systems looks at chiro claims as a pile of unneccessary claims coming down on them when in reality it’s a cost shift issue. If we are reduced or eliminated, who is performing the service on those patients? Are they doing it better? Are they doing it cheaper? Are they doing it faster? We don’t treat chiropracic conditions. We treat the same conditions being treated by the PT’s and Ortho’s using chiropractic means. We are not an add-on but a cost shift savings. If they want to elminate costs they should eliminate the coverage for the entire condition and not a single provider group. If they maximize the providers that are doing it better, safer, faster and cheaper then we all win.
    What happens to all the lower back cases after you cut out the chiro’s? Do they disappear with the chiro’s? NO, they cost 4 times as much (overall) per case when they go through the ER, PCP, ortho, radiologist and then PT. Mostly with poorer outcomes. If you expand the chiropractic benefit you expand the savings. It’s been shown time and time again. The military and VA have been floored by the success of our full scope integration in terms of cost savings, effectiveness, and patient satisfaction.

  5. Michael, I see what you are saying, that when the deductible for MD visits is equal to or greater than that for Chiropractors, people will have little financial incentive to stick with the MD and can seek out alternate care that they feel will cure them. I guess it also goes to say that if primary care is covered the insured/uninsured can use that care as well, instead of less expensive or possibly unsuitable alternate care. I use Chiros as does my wife (insured) for treatment we feel is more appropriate to our condition. Our Chiro charges $30 per visit but I wonder what Chiros would charge if they could convince insurance to cover their treatments at the same rates. Here in NC two Chiros attempted to bribe (money passed in bathroom) the then powewful speaker of the house to promote/vote for a bill that would force insurance to pay the same rates for their services as they do for MDs. That politician (Jim Black) is now in jail. If Chiros were paid equally as MDs maybe there’d be less ambulance chasing for neck/back injuries.
    Even in a single-pay system people want (and get) a relationship with their care provider. In Canada not all Chiro services are covered but they make a living there as well.

  6. This loss had next to nothing to do with the consumerism movement. UHC said they lost business customers, not individual customers. That means that employers made the move on behalf of their employees. The employees (the ultimate consumer) are not in the driver seat in the current employer based model. They really are at the mercy of their employer for the plan they are in. They can complain and have an indirect effect but they really don’t vote with their feet.
    Also, when it is considered that UHC has over 20 million insureds a loss of 315,000 is hardly earth shattering. That is not to say it is not a concern because UHC has always been growing their business. To go backwards is foreign to UHC. This is especially true when you look back 20-25 years and they had no insureds. They have gone from almost zero to 20 million + because they were better than the Blues etc in almost every phase of the business. They did not get to where they are today by providing bad service. They have built their business by taking customers from other plans.
    I am glad to see that UHC is willing to admit the problem and step up to the plate to make the necessary changes. Time will tell whether the execution matches the rhetoric.
    For those that really are serious about consumerism they should be demanding an end to the employer based health care model. I am not talking about going to a government model. Let individuals get the same tax benefit that they get with the employer based model. Also, require insurers to take all applicants. That would be a true consumer model. If I don’t like UHC I move to Humana. If I don’t like CIGNA I move to Aetna.
    This is the easiest way to reform the current system without major disruptions.

  7. It is a trend, Peter. A pretty strong one too. Those of us actually treating patients will attest to it. Patients in droves are ignoring the arbitrary and profit driven restrictions placed on them by their carriers and are accessing care through out-of-pocket means based almost solely on the quality, type and level of service they recieve by their provider. This is probably not reflected in the wonky studies because most of their data is culled from the carriers.
    A full third of my patients pay out of pocket and many of them have insurance, but choose not to use it. When co-pays and in-network deductibles magically approach, or are equal to, the cost of the covered benefit patients start ignoring which providers are “in” the network and who is “out” because finacially it make no difference to them anymore. Doctors also are independantly deciding not to be “in” some networks they cannot work with and are picking and choosing to be “in” the ones that work for their style of practice. Doctors and patients are finding each other again (a trend) and exactly the way Miriam outlines it.
    Some insurance companies have actually devalued their own product and I think that is what UHC is admitting to. Sorry, and not to offend those in the industry, but patients simply do not want a relationship with their carrier but desperately want one with their providers. To the patients “consumer driven health insurance” really means “get out of the way and let me see the doctor I want.”

  8. “we recognize that this is a health system that needs to work for everyone, not just for us.”
    “The company also said its employees will be given incentives for quality and patient advocacy first, and productivity second.”
    I wonder when/if BCBS will have this sort of visionary realization?
    Most of the article references doctors, so how many of the 315K “customers” they lost were docs and how many were patients? And were those patients part of group plans or individual plans? Don’t get too excited Michael, unless the “Amen” was truly god sent, I doubt we’ll see much of a trend in the overall industry.

  9. Rob,
    315K leaving in a year out of several (8?) million is big, but still well under 10%. Not everyone has a practical alternative to leave their employer-sponsored insurance, but some do. Larger employers often offer multiple insurers to choose from, so employees can switch at open enrollment. Also, some people can join their spouse’s insurance if they don’t like their own.

  10. I think the appropriate response is: hmmmm ….
    I’m not sure that I’ve ever heard a company blame it’s own customer service to quite this extent in a statement before. Let alone an insurer!

  11. Interesting. Every time I’ve tried to find out the exclusions in an employer’s health plan, I’ve been told by HR that I’m not allowed to see that. It’s none of my business. It’s not policy. It’s confidential.
    And it’s not like I can change plans.
    So I’m not sure what you mean by that.
    But. Maybe that’s changing.

  12. Hooray! It’s about time consumers start to become informed health care consumers. The reasons for our high medical costs in the US are many, but lack of active consumerism by those who utilize health care services is part of the equation.

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