What Good are Health Insurers?
As the health reform effort moves into the final stages, everyone seems to be taking a whack at health insurers. Some of the insurers’ wounds are self-inflicted, such as WellPoint’s announcement of 39% premium increase for individual policies in California. Some of the attacks are calculated to build public support for health reform, since every good crusade needs a good enemy. Some of the criticism has even suggested that we don’t need private health insurers. Michael Hiltzik asked the question in a recent column “What do we need health insurers for anyway?” James Surowiecki – usually a careful and thoughtful observer of business and economic issues – said the following in a recent article in the New Yorker:
Congress [in its health reform bills] is effectively making private insurers unnecessary, yet continuing to insist that we can’t do without them. The truth is that we could do just fine without them: an insurance system with community rating and universal access has no need of private insurers.
Surowiecki goes on to comment on what the world would look like without private health insurers:
In fact, the U.S. already has such a system: it’s known as Medicare. In most areas, it’s true, private companies do a better job of managing costs and providing services than the government does. But not when it comes to health care: over the past decade, Medicare’s spending has risen more slowly than that of private insurers. A single-payer system also has the advantage of spreading risk across the biggest patient pool possible. So if you want to make health insurance available to everyone, regardless of risk, the most sensible solution would be to expand Medicare to everyone.
Not so fast. I would feel more optimistic that this would work if we had a different political system. One of the limitations of this approach is that Medicare’s spending is ultimately determined through the political process. The U.S. political system – for better or worse — allows the health care industry (or any other well-funded interest group) to use its financial resources and lobbying power to increase the flow of government funds into the health sector. The idea that Medicare has a “hammer” to force providers to accept lower payment rates is largely an illusion. In the current system, Medicare can do this only because there is a safety valve, i.e., a large private insurance segment that pays much higher rates to providers. If Medicare gets larger or replaces private insurance altogether, there will be less opportunity to use the safety valve, so providers will step up their efforts to use political pressure to increase payment rates in Medicare. I simply don’t see a strong countervailing political force that would exert sufficient political pressure to hold down costs.Continue reading…
The History and Future of Medical Technology
If you are curious about how the amazing technologies found in modern hospitals and clinics came about, check out Ira Brodsky’s entertaining new book, The History and Future of Medical Technology. The hardback tells the story of the people behind each technology—their dreams, their struggles, and their lucky breaks.
Told in you-are-there fashion, it gives you a front row view of the discoveries and inventions that led to today’s imaging systems, implants, prosthetics and more. The book also covers pioneering work in areas including personal health technology, robotic surgery, nanomedicine, and brain-computer interface chips.
The book contains fourteen chapters: Better Living through Biomedical Engineering / The Hidden World / Medicine’s First Power Users / Fantastic Voyage / Human Electricity / The First Cyborgs / Wireless Chemistry / The Nuclear Option / Listening to the Body / Repair or Replace? Part I / Repair or Replace? Part II / The Vision Thing / Technology with Real Teeth / Bodies in Cyberspace.
The History and Future of Medical Technology is 321 pages and includes 26 illustrations. Published in May of this year, the book is available from Amazon and other resellers. For more information, including sample pages, visit the publisher’s website: http://www.telescopebooks.com.
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What’s wrong with this picture?
And the answer is not the quality of the model! In the comments please!
Webinar–Intro to Governance from Nat’l eHealth Collaborative
The first of a two event series on network governance, this is a key opportunity to explore the various considerations that go into the development of a comprehensive and sustainable governance structure for nationwide health information exchange.
Designed to provide a foundational understanding of the concepts that will be critical to an upcoming rulemaking regarding the governance of the nationwide health information network as called for in the HITECH Act, presentations and discussion will focus on network governance generally, examining some of the wide range of activities that make up “governance,” including regulations, public-private partnerships, advisory bodies, delegations of authority to stakeholder groups and others, forbearance, etc.
Not all Ratings Are Equal: Part II
By Read Part I here.
Why are all ratings not equal? Because they are designed for different purposes!
Herein lay the underlying truth to the many objections posed by organizations being rated. Rightfully so, the Three R’s (ratings, rankings and reviews) of providers must be kept in the context of overall purpose. This is one of the challenges to getting The Three R’s accepted and to making report cards right.
Health care is a big industry to rate and it is going to take more than one blog entry to develop a clearer picture of how best to move forward and embrace ratings systems, but let’s put down some context and history, as it is important to our current day objections and it is instructive to our future direction.
In the Beginning… in a fee-for-service market, before we had enough data to understand the enormous variability of clinical care, and before HCFA first contemplated releasing mortality data, performance measurement was all about financial performance measures. The ratings and rankings were quite simply all about financial and operating ratios, and hospitals were the institutional providers who were the rated with the CFO taking the bullet. Thanks to the public debt markets of the municipal bond industry, the hospital industry’s bricks, mortar and technology were mostly financed by long-term tax-exempt municipal bonds. Like most all other financial instruments these bonds are purchased and sold in the secondary markets long after the initial raising of capital, in some case decades. Being a predominantly not-for-profit industry, there exists no statutory reporting of a hospital’s financial results, and thus the Bloomberg terminals used by traders were void of hospital performance data, and the secondary bond market and the portfolio surveillance by large bond funds and bond insurers was a real challenge! No current data, no timely ratios, no real-time analysis…plenty of risk for those trading bonds. Sound familiar?
Front-Line Managers are Key to Wellness Program Participation
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What’s the difference between a company with a high participation rate in wellness programs and a low one? As it turns out, front-line managers—the people who run the daily operations and work the most closely with their colleagues—are actually the ones who can have the most influence, and can best help improve their company’s wellness participation rates.
Finding the answer to increasing wellness participation has vexed employers for years. We’ve done a good job at getting younger, healthier employees to participate in wellness. And employers recognize and appreciate the benefits of comprehensive and integrated wellness programs.
But we haven’t quite found out how to motivate people who have tried and failed or those who have multiple conditions and don’t think anything can help; who think they are too busy; or who simply would rather go home and have a pizza, six pack and watch TV.
Unfortunately it’s individuals with poor lifestyle habits who are costing employers the most. On average, for every $1 of medical and pharmacy costs there is about $2.3 of health-related productivity costs that employers must pay—and that figure is much greater for some conditions. We must find ways to get these non-participants in wellness programs motivated and involved –- for our good—and theirs.
Back to the role of managers; we work with large employers and health plans nationwide. Several times a year we meet with employers at a Summit to share best practices as well as research and analysis we’ve conducted on outcomes from specific health and wellness programs. There’s a good cross section of employers at the Summit who struggle every day to find ways to hold down costs and help their workers become healthier and more productive.
Having Your Cake and Eating It Too
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Have you ever wondered how anyone could possibly think that the Patient Protection and Affordable Care Act (PPACA) would lead to less health care spending?
Consider that the act is expected to (a) insure more than half the uninsured, (b) push most people with private insurance into more generous plans and (c) give just about everyone more generous preventive care. Doesn’t more insurance always mean more spending?
A big part of the answer is a little known change in PPACA on its way to final passage. In an obvious effort to keep the bill’s cost under control, lawmakers zeroed out all the funding for new doctors, nurses and other paramedical personnel. It doesn’t matter what extra benefits are promised if there is no one to deliver on the promises! Hence, the CBO’s low-ball spending estimate.
The problem is that groups with a special interest in health care — particularly the elderly and the disabled — noticed this sleight of hand and became alarmed. With a severe doctor shortage in the making, if your plan pays well below market rates you’re at risk of being pushed to the end of the waiting lines. And this has created a political hot potato for the White House.
The Red, White and Blue Buttons
The Health 2.0 Developer Challenge announced more details this week on its Blue Button Challenge, including the recruitment of Craig Newmark as a judge. The challenge comes from Markle Foundation & the Robert Wood Johnson Foundation, and it’s looking for solutions that will best use that new data source and make it meaningful for consumers. In the post below, Margalit gives a few hints as to what she’d like to see!–Matthew
On August 3rd President Obama announced the advent of a new button: The
Blue Button. The Blue Button is a health data download button. Consumers
can presumably click on the Blue Button and their medical records will
then commence downloading to their computer (securely, of course).
Anybody can get a complete medical record on demand; with no delays from
the busy medical records department and no special fees and no rims and
rims of paper records to carry around. Sounds like an awesome step
forward for medical records portability.
The Centers for Medicare & Medicaid Services (CMS) will make Blue Buttons available for Medicare beneficiaries and so is the Veterans Administration (VA). The Markle Foundation issued a policy paper and a challenge to developers to do something meaningful with the Blue Button data (in partnership
with Health 2.0). Crunching the numbers yields about 30% of us with full
electronic access to our medical records by virtue of a Blue Button.
This is all very exciting and definitely warrants a closer look.
The VA delivers health care and it has an EHR (VistA) and gigantic
amounts of electronic medical records to share. The VA also has a
website, My HealtheVet, where
members can access their latest medical records, view benefits and
perform simple transactions, such as requesting meds refills and
updating information. My HealtheVet, which is truly a PHR, will now be
sporting a Blue Button, so members can download their electronic medical
records in ASCII text format. The VA has a sample download file and it looks very useful.
And The Best Job In Academic Medicine Goes To…
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With all due respect to the Pentagon, humankind has not invented a more complex organization than the modern academic medical center. The combination of high tech and high touch, the Byzantine regulations, the toxic medico-legal environment, the extraordinary pace of change…. Well, you get the idea.
But the most daunting challenges stem from trying to satisfy the AMC’s tripartite mission: providing high-quality, safe, patient-centric, and efficient clinical care across a spectrum of services; training the next generation of physicians and other caregivers; and performing cutting-edge research and innovation. Think about blending the missions of Target, Apple, Yale, and Nordstrom, and you’ll have a sense of the problem.
Unfortunately, the typical management structure of academic medical centers makes running this monstrosity even more difficult. The vast majority of AMCs are actually two (if not more) organizations blended (sort of) into one: a school/university, and a clinical delivery system. This structure arose through happenstance, and the fault lines it creates are increasingly jagged.Continue reading…
