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HEALTH PLANS/POLICY: eHealthinsurance still skipping stats 101

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eHealthinsurance is out with its annual report of what premiums are in different cities and they’re still comparing the price of rotten month old apples with sweet juicy, juicy mangoes. And amazingly enough they’re different. Basically some states ban underwriting and therefore have insurance which is more expensive. So what I said last year when they said that prices were going down still applies—

On further review there are more questions than answers. Who got insurance? Was this group more underwritten (i.e. healthier) than the previous year? And what benefits were they getting compared to last year?  And were there changes in deductibles, co-pays and out of pocket maximums?

Just saying that the premium went down is a bit like saying the average price of a BMW 3 series is less this year on average because more people are buying them without the fully loaded options. And if it’s really true that apples for apples the premiums went down why didn’t eHealthinsurance.com put that information in the report?

Although last year apparently “prices went down” and this year they didn’t say that, so it’s pretty damn likely that if you compared apples to apples of the stripped-down underwritten plans they’re looking at, prices went up.

Of course in practical terms this report is useless. I’m a great example in that I applied for two identical policies from different carriers on eHealthinsurance—both quotes about $100 a month for a $2500 deductible plan. But when the underwriting was done, one was still $100 a month and the other wouldn’t take me at all and suggested I went in the guaranteed issue pool at $400 a month for a $4000 deductible. So quoting price without knowing what the individuals concerned need to go through to get the insurance and therefore knowing the actual price is useless.

I do note one little thing in their report. They say that St Louis Missouri has the cheapest children’s insurance premiums ($29 a month) and yet there are 119,000 uninsured kids in Missouri. In other words very cheap—or even free given the numbers who don’t sign up for the SCHIP programs—isn’t cheap enough to get kids (and adults) insured. eHealthinsurance seems to be surprised about this.

The only logical conclusion is that health insurance needs to be compulsory and automatic (although not of course free to those who can afford it). And in fact even eHealthinsurance could do OK in such a system, although the logical ramifications of it would be horrendous for many of the plans they broker for.

TECH: Why we love HISTalk

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Every so often Mr HIStalk reminds me why he’s the best blogger in Healthcare IT and possibly far beyond:

Kaiser Permanente’s Northwest region president resigns, seemingly because of computer problems that hurt earnings. "Kaiser launched a computer system to govern billing for its high-deductible health plan and for Medicare enrollees, but halted billing for both products in June 2005 due to a technical glitch." If you had all the money that various tentacles of Kaiser have spent on botched IT projects, you could be up there on the dais with Bill Gates and Warren Buffett, giving it away to the less fortunate, which would be just about everyone.

TECH: IOM reccomends ePrescribing by 2010

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The IOM is out with another report on medication errors in which it recommends the use of ePrescribing for all scripts by 2010. And it’s made it into the news, at least into the AP Headlines where the tale is told that drug errors hurt 1.5 million.

Perhaps someone should let whoever took the ePrescribing mandate out of the final language in the MMA in 2003 (after it made it through in the House version of the bill) know that they’re killing people and costing payers a fortune. But then again I wouldn’t want to point fingers at anyone in particular.

 

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TECH: PHR has opportunity to go mainstream

Wellpoint is going to roll out the WebMD PHR based system which has been working at Empire Blues (Wellchoice) for about a year to the rest of its plans to the rest of its plans. So theoretically up to 34 million people will have access to a PHR. I wrote about the WebMD solution before, so I won’t go into it much, but there are two quick points beyond the fact that (at last!) PHRs have the opportunity to go mainstream.

1) This is a vindication of the ASP model—these records live on WebMD’s servers rather than on Wellpoint’s. I never thought that the big insurers would allow another company to take their consumers’ data for fear that they would also take their consumers as well. That was certainly a concern of the plans that we were trying to sell PHRs to at i-Beacon which was why we sold enterprise software rather than an ASP service. WellMed (the company who’s PHR is the core of WebMD’s current service) was always an ASP model. And the answer is, the lowered costs of the ASP model outweigh the fear that WebMD will make it easy for another plan to assume the members data. One WebMD insider told me that they will be introducing a way to move data between plans. So the member will find “data lock” is NOT a reason to avoid moving plans, and technically they may not even have to take it off the server, assuming that WebMD is the back end for both plans. And of course potentially WebMD can start offering other health plan services and even start competing with its clients. But that’s another story.

2) Just as the private sector starts to sort this out with providers using Epic’s MyHealth to give access to the records, and WebMD starting to make real strides, CMS is starting experimentation, and Foundations are getting into the mix too with grants to help figure out what applications are needed. Are they not a bit late to the party?

And finally—it’s about bloody time!!

DISEASE MANAGEMENT BOSTON JULY 30 – AUG 2At a three day conference in Boston MA, scheduled between July 31 and Aug 2, industry leaders from managed care companies, employer groups purchasing healthcare services, providers, third party administrators, physicians, healthcare technology players, nursing and pharmacy practitioners, disease management experts will meet at the 4th Annual Disease Management Conference. The event is posted online at www.srinstitute.com/ch142.  Learn about advertising on THCB.  

QUALITY/PHYSICIANS: Just what we need now, another grandstanding politician on end of life issues

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I’ve been having a backchat email with the people from the Tenet Shareholders Committee. They are enjoying the legal  attack on the Louisiana physician who is supposed to have performed a mercy killing or provided ample pain medication at Tenet’s Memorial Hospital a little too much for my taste. Admittedly they are so opposed to Tenet that this one is too easy for them. But I doubt this one has anything to do with Tenet, which frankly didn’t do much to help its patients (HCA was a little more honorable).

But where the hell was the Louisiana or New Orleans AG (or for that matter any other level of government) when desperate physicians, nurses and patients needed help? Absolutely effing nowhere. A humane person wouldn’t leave a dog to slowly die or drown in the 105 degree heat, let alone another human. And it seems to me that in absolutely desperate circumstances, Dr Anna Pou did what she felt was best for those patients.Yet six months later a grandstanding DA gets his jollies off by sending physicians and nurses on trial for homicide.

This is total bullshit. A series of studies in the 1990s showed that physicians routinely ignored DNR orders. I don’t recall any of them being prosecuted, but they probably caused more harm and inflicted way more distress on patients than Dr. Pou would have done under any normal circumstances…..and let us not forget—those were anything but normal circumstances. If I was a patient there suffering with no water, no power,and no hope other than suffering a long agonizing death—I’d have been very grateful for the relief Dr. Pou’s care would have given me in my final hours.

And now we’re going to send her to jail?!

 

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