Tag: Insurers

Check the WSJ opinion section for more BS on Medicare Advantage

Jun 26, 2008• 2

By Matthew Holt

Scott Gottlieb, who passes for what the right call a health economist these days, has an opinion piece in the WSJ singing the praises of Medicare Advantage plans.

Anyone reading the article would think that Medicare Advantage plans provide better and cheaper care than the FFS program, showing the triumph of private enterprise over government welfare. And that’s why evil Democrats hate them so much.

Unbelievably, Gottlieb ignores the extra payments Medicare Advantage have received over the standard Medicare program since 2004. Even Karen Ignagni doesn’t do that any more. The AHIP crew has long changed its argument from “we do it better and cheaper” to “we help poor black and Hispanic seniors get better benefits, and the fact that we rake a ton off the top and the taxpayer gets screwed is just the cost of doing business, sorry!” But Gottleib is back in the dark ages. Is this really the best the right can do?

AMA endorses single-payer health care (sort of)

Jun 21, 2008• 12

By Michael Millenson

The American Medical Association has now added a second pillar to its
national health care reform plan. The first pillar, of course, has
always been “Don’t sue,” a sturdy principle that over the decades has
led the AMA to alliances with such notable victims of overzealous
attorneys as tobacco companies. (For historical perspective, see Howard
Wolinsky and Tom Brune’s 1994 book, The Serpent on the Staff.)

American Well: the first deal is with Hawaii Blues and HealthVault

Jun 21, 2008• 2

By Matthew Holt

When I left their party late Wednesday night my understanding was that that American Well had bought Microsoft and was moving all 85,000 employees to Hawaii.

Apparently that was MaiTai confusion, and the real story is that HMSA (Blues of Hawaii) is American Well’s first client. Ido and Roy Schoenberg, with their ace marketing whizzes headed by Yael Glassman, have been making lots of buzz with demonstrations of their tool—including a standing room only sponsored deep-dive at Health 2.0 in San Diego in March. We knew that there was at least one insurer in the works, and presumably there are many more, as the business model is dependent on working with insurers in state networks and allowing consumers to access the insurer’s PPO discounts.

Other than the leis and MaiTais that appeared at the party, Hawaii is a logical choice. Why? Well the Blues’ main competition in the state is Kaiser. Kaiser of course offers its members online appointments, asynchronous visits, and post-visit summaries from its HealthConnect system.

Essentially, with the addition of the American live online visit—with its inclusion of video, chat, patient summary, history and ability to order test and drugs—the Blues has now got part of those services. What most insurers don’t have is the storage of the data. That’s where HealthVault comes in—now that online activity can be stored and easily transferred.

From the AHIP fields….

Jun 20, 2008• 3

Fun and games were had by all at the America’s Health Insurance Plans
(AHIP) conference yesterday. (BTW Now I have a real journalist working
with me on THCB and she says I have to spell out those acronyms!!)

Outside a couple of thousand single payer advocates noisily demanded a ban on greedy health plans. Now I know that the AMA has a running battle with the insurers (Read Michael Millenson’s hilarious piece about that on THCB yesterday). It’s also the case that certain Democratic Senators have it in for them, although as Bob Laszweski notes, that too is "not quite yet" an issue. But it wasn’t them outside!

Still it was rather fun going to an event that had
a real rather than a software demo going on!

Now the single payer crowd’s time has not yet come, and there is a chance that the private health insurance industry won’t screw itself into oblivion. (Although my guess is that they’ll be ascendant in 10-15 years)

MA plans won this round but future looks bleak

Jun 20, 2008• 1

By Robert Laszweski

Congressional Democrats tried to take a big bite out of private Medicare last week in an attempt to pay for an 18-month fix to the upcoming July 1 10.6 percent reduction in Medicare physician payments.

The effort, led by Senate Finance Chair Max Baucus (D-MT) got only 54 of the 60 votes he needed to end debate and move the issue to a floor vote. While getting that floor vote would almost have certainly meant passage of the bill in the full Congress, President Bush would have vetoed any attempt to cut the payments to private Medicare plans and the Dems would not have had the votes in either chamber to override.

Now, Baucus and Senate Finance Committee ranking member Chuck Grassley (R-IA) will have to find a more modest way of fixing the doc problem––likely for just six months. The docs are not going to suffer a Medicare payment cut this summer.

All of this was expected and is what I have been saying for months would happen.

Kaiser, Blues of Mass….health plans & consumers online

Jun 13, 2008• 1

Kaiser Permanente put out a new survey updating one they did last year which says that more and more people are going online, and now a sizable minority had a preference for doctors using an EMR. (It’s not clear whether they’ll yet change a doctor based on that). It does seem that they’re more likely to expect it and want it from their health plan — 61% wanted EHR’s to come from their health plan. (Here’s the PDF of of the survey, which has lots of extra information for you nerds). But here’s probably the key results

Q. If two doctors had exactly the same qualifications, but one used an electronic record system and the other did not, which ONE would you choose? (ROTATE) The doctor using an electronic record system 47%The doctor NOT using an electronic record system 29%Don’t know/Unsure (Volunteered) 22% Q If two health insurance companies had exactly the same qualifications, but one provided their members with access to an electronic record system and the other did not, which ONE would you choose? (ROTATE)

The one using an electronic record system 60%The one NOT using an electronic record system 25% Don’t know/Unsure (Volunteered) 14%

So Kaiser Permanente has not only created its own health record via its big Epic project, but it’s decided to at least pilot with Microsoft HealthVault. (See a little more and some controversy about that here). And some other health plans are starting to notice.

Today, the big news is that BCBS Massachusetts has decided that it too needs to dive into this. They’ve decided to make their consumers records interoperable with Google Health by the end of the year.

So are Kaiser and BCBS Mass outliers, or are they first trickle of a torrent?

My Group Health and “Killer Apps”

Jun 12, 2008• 4

By Jen McCabe Gorman

Here at the Center for Information Therapy’s Ix Conference,
transparency is the name of the game. Transparency in information transfer, information therapy, also literal transparency – we’re surrounded by tons of
glass and steel here, late-morning light is streaming in, and attendees zone out to a sweet view of the Washington Monument.

James Hereford, executive VP of Strategic Services
and Quality for Group Health Cooperative (Seattle), has the smooth
charm that tells you he has a sales background. He’s taking us on a tour of Group Health’s portal – My Group Health.

His pitch – "My Group Health" is a combo of killer apps, including:

1. EMRs

2.
Secure messaging (between doc and patient)…Group Health has
received/sent these from all over the world, every continent, including
Antarctica

3.
Automated results sharing (lab results)

4. After visit summary

5. Integrated health profile

Hereford’s thesis on the main difficulty of HIT adoption – it’s "completely
psychological." Providers (1k in the Group Health network) didn’t believe the patient should
have ANY information before they did. There’s a shocker.

But as James points out – "You don’t have to be a brain
surgeon to look at your lab results and figure out if they’re outside the
normal range."

More on consumer targeting for health plans

Jun 3, 2008• 4

By Matthew Holt

Wrapping up this morning’s Silverlink seminar….

Stan Nowak, Silverlink CEO, says we’re all part of an experiment in response rate from credit card marketing departments (previous speaker Fred Jubitz had talked lots about that!). It’s not cheap to do, but the best companies in consumer marketing are doing it because those experiments (sending out all those letters) can offer a small percentage lift. And they’re good at predicting who will do what based on these segments.

Microtrends, Consumer Health Segmentation, and more ….

Jun 3, 2008• 3

By Matthew Holt

I’m at a seminar put on by Silverlink (FD, they’re a THCB sponsor), but shockingly they haven’t asked me to speak! (By the way this seminar is like a rock band on tour, click here for the schedule). Here’s a quick hit on the first three speakers.

AHIP & Health 2.0 — caveat whatever the Latin is for movement

May 30, 2008• 3

By Matthew Holt

Last month, the trade group America’s Health Insurance Plans sponsored a seminar on Health 2.0 with Lynne Dunbrack at IDC Health Industry Insights and Roy Schoenberg from American Well. Any resemblance in Lynn’s presentation to the talk I’ve been giving since mid-2007 is I’m sure completely coincidental. (To be less snide, it’s all pretty obvious stuff, and many others are doing it, too). Meanwhile, next month at the big AHIP meeting in San Francisco, another analyst from a Massachusetts research outfit (Carlton Doty of Forrester) will be presenting on this “new” trend.

Now, I’m not exactly blaming these guys for getting into a good thing. Both American Well and David Sobel (who’s appearing with Doty) have been featured at Health 2.0 Conferences already, and Indu and I certainly didn’t discover them, the term Health 2.0, or the Internet. And given the “praise” I’ve heaped on AHIP and its President on THCB over the years, I wasn’t exactly sitting by the phone waiting for their call. Certainly slightly more, ahem, compliant pundits can do a great job instead — even if flying a guy from Boston to talk in San Francisco, when I could walk three blocks may not be the best use of their members’ money.

While it’s good that AHIP is introducing its member health plans to the potential of the Health 2.0 world, let’s not forget that the motivations of the organization don’t exactly square with where many of us think health care, including Health 2.0, should be going — and nor that matter do the Association’s President’s public pronouncements fit with the long-term interests of those of its members who do have something to offer society (e.g not Mega Life/HealthMarkets). Meanwhile, over the years, the quality of AHIP’s research and the veracity of its public statements about the value its members deliver to society have been laughable. So let’s be a little careful about AHIP’s role in Health 2.0

OK, rant over. You can all go back to Friday dog blogging

Charley