Tag: Insurers

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

Athena announces payer rankings

May 29, 2008• 1

By Matthew Holt

AthenaHealth has announced its rankings on the best and worst payers in health care. Athena CEO Jon Bush discussed the PayerView rankings on the CNBC Squawkbox with Ron Williams, CEO of Aetna, the No. 1 ranked fastest payer. Williams pontificated about how great it will be when all the stuff Aetna is putting in motion is up and running.

Johnbush
Then, he got a tough question about the pressure that high-deductible health plans have put on physicians by making them figure out payments from consumers and insurers. This is a real problem for doctors and getting worse. The amusing thing is that the question came not from the journalists but from Bush.

After Williams’ somewhat waffly answer, Bush said that he’s looking forward to announcing real-time claim adjudication with Aetna any time now. I’m not sure if Bush intended that as a slam or a promise (maybe both), but it seems AthenaHealth has had it with Humana and United Healthcare for a while.

Here’s the video and here’s the press release. New York’s Medicaid program is the worst payer, as if you were surprised.

Health Plans mark it up and pass it on

May 27, 2008• 1

By Matthew Holt

Buried in a quick notice in BusinessWeek was this paragraph:

Health insurance companies have plenty of critics. Now they have one more: Leemore Dafny, an assistant professor at Northwestern University’s Kellogg School of Management. Insurers argue that because they compete against one another, they keep prices down, saving everyone money. Not necessarily, says Dafny in a March paper, "Are Health Insurance Markets Competitive?" Dafny looked at data from 1998 to 2005, provided to her by a benefits consulting firm, that tracked the behavior of 200 major companies to see whether they shopped around to find the cheapest insurers. Dafny found that when these big companies made more money, their insurance providers raised their premiums. But instead of dropping the carrier to get a better deal, Dafny writes, companies generally stuck with their health insurers and paid more. "Carriers can and do take advantage of a firm’s increased profits and extract higher prices from them," she says.

Here’s how this works:

Florida makes health insurance more affordable. Maybe.

May 23, 2008• 15

By Donald Johnson

Donald E. L. Johnson, a former editor and publisher of Health Care Strategic Management and a former editor of Modern Healthcare, has been writing about health care business, insurance, stocks and politics s since 1976 and has been blogging at www.businessword.com since early 2003.

If you’ve been uninsured in Florida for more than six months, you may be able to buy a stripped down health insurance policy
for as little as $150 a month regardless of your health status and
pre-existing medical conditions. But there are gotchas that could cost
you thousands and even bankrupt you if you get sick.

The new legislation is primarily aimed at people who can afford
health insurance but have chosen to be self-insured so they can spend
their money on something besides health insurance. Nationally, some 14
million people who can afford to buy health insurance don’t. They
effectively self-insure themselves against financially catastrophic
risks. Many become bankrupt after they require financially catastrophic
health care and can’t pay their bills.

In Florida, insurers will be able to offer policies that cover a lot
of primary care and preventive care services, the maintenance services
that you should pay for out of pocket and should not be insured. But
those policies may have onerous caps on payments for expensive hospital
stays and illnesses, according to a report by the New York Times.

To buy real insurance that covers financially catastrophic illnesses, consumers will have to buy optional coverage.

In other words, the new law enacted by Florida has authorized
insurers to sell savings accounts where they are paid to hold
consumers’ dollars until they need primary and preventive care. But
insurers can sell policies that don’t provide the catastrophic coverage
almost everyone needs sooner or later.

The NY Times reports:

The low-cost plans have to include preventive services,
office visits, screenings, surgery, prescription drugs, durable medical
equipment and diabetes supplies.

Some options offered by insurers have to include catastrophic and
hospital coverage. But an insurance company could, for instance, choose
to limit the number of days of hospitalization it will cover or place a
dollar cap on reimbursing certain services.

That makes no sense. Florida politicians have got it backwards. They’re
requiring insurers to cover routine maintenance and not the kinds of
medical care that put people into bankruptcy.

Humana’s competition for change

May 20, 2008• 6

By Jen McCabe Gorman

Health benefits heavyweight Humana Inc. (HUM – 11.5M members) recently launched ChangeNow4Health, an ambitious, optimistic coalition inviting anyone to submit ideas to fix America’s ailing health care system.

The top three entries receive a $10k prize, and the top 20 get publication exposure galore, including a spot in Humana’s forthcoming e-book, “Tomorrow’s Health Care.” The big winning concepts have a chance to secure further funding and incubation support from Humana.

Full Disclosure: Shortly after this interview was conducted, ChangeNow4Health became a sponsor of The Health care Blog. However, if you think that in any way influenced the content of this article, you don’t know the Health 2.0 folks very well…

Cn4hds

On the second day of World Health care Congress 2008 in Washington D.C., I interviewed Elizabeth Bierbower, Humana’s Vice President of Product Innovation.

Bierbower, who has spent her career working with consumers, told me that ChangeNow4Health is looking for doable ideas that can quickly be put into play in the game as it is now, not how we wish it were.

They’re also harnessing the power of the semantic Web by partnering with Innocentive.com, an online community that posts projects from groups like the Rockefeller Foundation.

The contest has 4 categories:

Helping Consumers Make Smarter Health Care Decisions

Simplifying the Business of Health Care

Preventing Sickness and Maintaining Health

General Innovations in Health Care

The contest runs through July, and winners will be announced in August. Judges include industry experts, who are looking for “both an idea’s potential to bring about true change in a tangible way” and “feasibility for implementation now.”

Here’s a transcript of my conversation with Bierbower.

Health care coverage restored — good for patients, maybe too late for plans

May 16, 2008• 1

By Matthew Holt

Saint Lisa Girion (and I say that without a smirk on my face!) reports in the LA Times on the latest chapter in the story she started about the ongoing saga of the retroactive cancellations of health insurance by all the big players in the California individual market.

Now Kaiser Permanente (which really should have been above this type of a mess in the first place) has decided to reinstate over a 1,000 of its cancellations, and Health Net, which was fined $9m in arbitration for one cancellation alone, has added a few more. This will intensify the pressure on Wellpoint, United Healthcare, and Blue Shield (the only one still fighting for the right to rescind coverage retroactively) to similarly cave. Kaiser, by the way, is also paying a paltry $300,000 fine. Health Net must be envious.

However, even if the others cave in and reinstate coverage, and pay for claims they previously denied, there are three remaining issues dangling from the controversy.

First, the Department of Managed Healthcare, which brokered the Kaiser deal, only regulates HMOs. Some “insurance” companies, like the Wellpoint and Blue Shield subsidiaries which did some of the cancellations, are regulated by the elected State insurance Commissioner Steve Poizner, who despite the R after his name, has been very aggressive in going after them. Adnd the City Attorney of Los Angeles, Rocky Delgadillo, is suing Health Net and Wellpoint in related cases. So the insurers legal problems with the government certainly aren’t over.

Then there are the lawyers. William Shernoff, the attorney who’s been going after Wellpoint since the stories first came out, told the LA Times that …

He would tell clients to "accept the reinstatements because that’s wonderful to get the medical care — that is important." But, he added, "as far as damages for past harm, there’s no doubt in my mind that the best place for them to get their full damages will be in court rather than in an arbitration process."

In other words, the plans can’t get away with just paying back what they owe. Shernoff is still coming after them for more. And $9 million multiplied by lots of cases smells very tempting to a lawyer who knows he’s on the winning side.

Health 2.0 Consciousness Dawns – Even In Jacksonville, FL!

May 15, 2008• 2

by BRIAN KLEPPER

Today, Matthew, Michael Millenson and I are converging at a Robert Wood Johnson Foundation conference on public reporting of health care pricing/performance information in Amelia Island, FL, three short barrier islands north of my home in Atlantic Beach. (Always helpful, Michael suggested to the conference organizers that I should be required to walk or take public transportation, to compensate for the fact that everyone else has to come in by airplane.)

In any case, we decided that we might as well seize the opportunity and hold a short symposium on market-based transformation for the Northeast Florida health care and business communities. Dean Chally of the University of North Florida’s College of Health graciously arranged the space on their beautiful campus, and so we’re set for a 7:30AM, 2 hour conference on Friday May 16th–that’s tomorrow.Michael will talk about public reporting, Matthew will present on the consumer side of H20, and I’ll hit H2O business-to-business analytics, the emerging medical home movement, and some wellness/prevention approaches that are gaining traction. Should be a fun morning. If you’re in the neighborhood, be sure to drop by and join us.

Health Plan Illiteracy: study finds many do not understand their benefits

May 7, 2008• 7

By Jane Sarasohn-Kahn

Health plan illiteracy is alive and well, according to J.D. Power and Associates. The consumer market research firm’s 2008 National Health Insurance Plan Study finds that one in two plan members don’t understand their plan.

In this second year of the survey, J.D. Power notes that, as consumers understand the benefits of their Benefit, their satisfaction with the plan increases. Thus, there is a virtuous cycle that happens between a plan and an enrollee when communication is clear and understood.

J.D. Power looked at member satisfaction in 107 health plans throughout the U.S. in terms of seven key metrics: coverage and benefits; choice of doctors, hospitals and pharmacies; information and communication; approval processes; claims processing; insurance statements; and customer service. The survey was conducted in November and December 2007.

Last year, Abt Associates found that most insured workers don’t understand simple health plan language. I abstracted some of Abt’s findings in this chart that I use in many of my presentations. Health plan illiteracy goes beyond general health illiteracy — this is people blessed with benefits who don’t ‘get’ them.

Practical Advice to Employers On Managing A Health Plan – Lynn Jennings

Apr 1, 2008• 3

On blogs like this, people like me write analytically about issues which are often, at best, conceptual to us.Not so to the guys in the rough and tumble world of health care finance. I remember that the first time I went to dinner with Lynn Jennings, I only knew that he was CEO of Alliance Underwriters, working in reinsurance, and that he is a former President and a current Board member of the Self-Insurance Institute of America (SIIA). SIIA is the national association of third party administration firms, the organizations that administer health plans for self-funded employer health plans. As we were walking into the restaurant, he turned to me and said, "In reinsurance you make a very sizable bet and find out three years later how things turned out."Over time, though, as I’ve come to know Lynn better, I’ve found he has a profoundly practical view of the world, supported by a belief that careful management makes it possible for health care to work far better than it usually does.Here is his advice to employers on managing employer-sponsored health plans. Whatever your philosophical orientation, these are sound recommendations for employers who must grapple with the difficult choices associated with employee health benefits.

Brian Klepper

For 40 years, I have worked in the complicated world of self-insured
group health plans. I have led a third party administrator (TPA),
underwritten stop-loss coverage and, with my wife Judy, overseen a
utilization management firm. Now I’m also building employer-based
clinics.

Rebuilding The Medical Home: What Walgreens Surely Sees

Mar 27, 2008• 11

By Brian Klepper

Though it probably went mostly unnoticed in the cacophony of health care stories, last week’s news that Walgreen’s had bought the two largest and most well-established worksite clinic firms, iTrax and Whole Health Management, was a harbinger of very big changes in health care. Walgreens, the ubiquitous drugstore company that, with Wal-Mart and CVS, has already leveraged its pharmacy platform to establish a strong footprint in retail clinics, undoubtedly startled many health care observers with its announcement. After all, isn’t the company doctor a relic?

Actually, no. The worksite clinic – and by way of disclosure for the better part of the last year I have
worked closely with a small, very innovative, Orlando-based startup worksite clinic
firm, WeCare TLC – has been
reinvented and refitted with 21st century tools, and offers the promise
of nothing less than a paradigm shift toward dramatically better care
at significantly lower cost. Understanding how these structures work and how they differ from both old-fashioned medical practices and retail clinics provides clues into what Walgreens likely sees and why that matters to American health care.