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Tag: Insurers

POLICY/HEALTH PLANS: More communism at the Wall Street Journal

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More radical Bolshevism at the Wall Street Journal. Venessa Furhmans is now saying that Health Savings Plans (are) Start(ing) to Falter. How dare she!  She’s going to get it when Rupert takes over!

On the other hand, just dumping people into HSA and CDHPs was always going to raise dissatisfaction, and people, in general, do not want to shop at the point of care for medical treatment because it’s really, really hard.

In a survey published last month by Towers Perrin, an employee-benefits firm, employees enrolled in them said they felt less capable of finding a quality doctor or hospital, though they often were in the same network as colleagues in other plans. Only 29% said they tried to save money in their accounts for future medical expenses. Though the consulting firm says consumer-directed plans have much potential, its executives were surprised consumer responses were so negative. "If I were a product manager in any other industry and saw scores this low in customer satisfaction and understanding, I’d be thinking of pulling that product from the shelves or retooling it," says David Guilmette, managing director of Towers Perrin’s health-care consulting practice.

Still it’s a little ironic that a benefits guy is knocking CDHPs. After all, who the hell has been pushing them all this time?  And (to quote myself), remember kids, the CDHP is the bastard child of a one night stand between a benefits consultant with nothing to sell and a right-wing think tank that can’t do basic math.

TECH/PODCAST: Interview with Bob Fisher, CEO of Foresight

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Here’s the transcript of the recent podcast with Bob Fisher from Foresight. The original interview is here and a 7 minute cut down version is up on Foresight’s site too.

Matthew Holt:  This is Matthew Holt with the Health Care Blog. This morning I’m talking with Bob Fisher. Bob is the founder, president, and CEO of Foresight Corporation, which is an Ohio based technology company that works primarily with health plans. I had the great fortune of being a speaker at Foresight’s recent customer meeting down in lovely Phoenix, Arizona, where I very much enjoyed meeting with Bob and the rest of his crew.  It was really quite an interesting meeting because after I did my song and dance about the future of the health care system, the folks there really got into some of the nitty-gritty. It was almost a chance for Bob to pick his customers’ brains, I think, about what they’re seeing. He’s come back with a wide wealth of information, not only about what Foresight’s up to but also what some of America’s leading health plans are up to. So deep in the engine room, as it were. So, Bob, good morning, or I should say good afternoon to you. 

Bob Fisher:  Good afternoon, Matthew. I appreciate the opportunity. 

Matthew:  How are you doing? Have you been keeping well since the last time we were together only a few weeks back? 

Bob:  I came back with a head full of knowledge and a little bit of a tan, and today I have a head cold, but I’ll try and keep it out of the interview.

Matthew: So let’s start at the beginning. Foresight’s a pretty small company. You’ve been around since the very end of last century. 

Bob:  In 1990. 

Matthew:  Sorry. 1990? Boy, you’re a bit older than I remember. 

Bob:  Yeah, 17 years. 

Matthew:  Seventeen years. Actually you’re almost an old company in technology terms in that case. So, but for the average THCB reader, I suspect that you’re pretty much an unknown quantity. I mentioned you work with health plans. What do you guys do? What are your core missions, core business functions? 

Bob:  Matt, we work with health care organizations, providers, and especially payers as you mentioned, and we use technology to help them streamline their operations. That is in the areas of claims, payments, eligibility, that sort of thing. We call it transaction lifecycle management. Now, we have a decent chance of actually being known perhaps by some of The Health Care Blog readers because actually most large payers in the US today, including the majority of Blue Cross organizations, are using Foresight technology. They’re using it to reduce the claims rework, to assure accurate and timely payments, to provide any level of management reporting on an ad hoc basis, and to improve provider relations.

Continue reading…

POLICY/HEALTH PLANS: Marsha Gold, spoilsport communist!

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At Health Affairs Mathmatica’s Marsha Gold takes a look at the expansion of Medicare PFFS plans. Those are the ones that our friends at AHIP are so keen on, because of all the benefits they bring to poor elderly seniors (stop that sniggering at the back!). My word, is she “fair and balanced”!

Perspectives on current MA trends are largely in the eye–and orientation–of the beholder. If one believes that all choice is good and competition brings prices down, MMA has clearly been successful in expanding choice and competition. Because higher payments are driving the market, beneficiaries who enroll also benefit because benefits, even in the more limited plans, probably compare favorably against those of Medicare alone for not that much more premium. It could be that once attracted to MA, enrollees can be moved to more managed products, as some firms have indicated that they want to do.If one tends to believe less in the market, some aspects of current trends are a concern. Most narrowly, the current expansion is fueled by MA payment rates that exceed what traditional Medicare now pays. At least in the short run, this means that Medicare pays more for each beneficiary that is attracted to MA. The added fiscal burden on Medicare is especially high for PFFS plans, because firms are benefiting from "floor" payments. Although individual enrollees may gain, beneficiaries as a whole may be harmed if higher payments add to the fiscal stress on Medicare, making the program less viable in the long run. Choice also makes demands on beneficiaries’ time, is challenging for many not familiar with the issues or those with cognitive limits, and adds the risk that coverage will be unstable if the forces that facilitate firms’ development of PFFS plans also make it easy for them to exit MA.Do the benefits exceed the risk? Although people will differ in their calculations, I suggest that the answer could well be negative.

The joke is that her piece is called Medicare Advantage In 2006-2007: What Congress Intended?

Err, yes Marsha, it pretty clearly was what Congress (or at least the staffers who wrote the law at AHIP’s behest) intended. We, the taxpayer, meanwhile just need to drop trou and bend over.

HEALTH PLANS: Blue Cross makes about-face on cancellations, with late afternoon UPDATE

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Lisa Girion in the LA Times reports that one of the uglier pieces of health plan activities in recent years may be drawing to a close. Wellpoint’s Blue Cross of California unit has agreed that it will only rescind policies in the future if there is obvious fraud, rather than an explainable oversight or error.

Blue Cross of California agreed Thursday to stop canceling individual health coverage unless it can show policyholder deception — a major shift by the state’s largest health insurer that could lead to sweeping industrywide changes. The move is part of an effort to settle a class-action lawsuit on behalf of as many as 6,000 people canceled since late 2001. It is an about-face for Blue Cross in what had become known as "use-it-and-lose-it" health coverage because the cancellations were often triggered by patients’ claims for treatment.

This is something of an improvement, although of course in a decent world there’d be guaranteed issue and community rating so the whole practice would be moot—and Wellpoint is fighting that in California. However, they need to cut the crap about “only 1,000 policies got rescinded and it’s less than 1%” which comes up in the article again. That’s of course lying with data. The vast majority of people in the individual market who get past the underwriting in the first place are healthy. That’s why the medical loss ratio for BC of California’s individual business is below 60%—yes apparently that’s the number. So there’s likely to be less than 10% of the enrollees and probably close to 5%, who are running up large bills in the first place. Which means that Blue Cross was scouring every one of those applications and canceling some 5–10% of them. They weren’t looking at the applications of the vast majority who didn’t have any major claims.

I still want to see how they settle the individual claimants who busted them for cancellations when BC clearly in error. Or are they in the class action too?

UPDATE: I’m adding this comment from the always sensible Barry Carol: "I wonder how much the new CEO (and former General Counsel), Angela
Braly, had to do with this settlement and whether former CEO, Larry
Glasscock, would have agreed to it. At any rate, it looks like common
sense has prevailed, and it’s about time."

This reminds me that recently Wellpoint changed its bonus structure to relate it to the overall health of their members. I was at a meeting with some Wellpoint employees (in their IT stack) last week, and they highly concerned about what that meant. But perhaps it means that the medical types (presumably led byCMO  Sam Nussbaum) are gaining the upper hand over the financial underwriting types–who’s leader as Barry points out, just got off the ship.

Meanwhile if you want some amusement looks at these comments about what some Wellpoint employees think about the new bonus policy!

TECH/HEALTH PLANS: AthenaHealth causing trouble again

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AthenaHealth caused a ruckus last year when it put out  a ranking of how fast health plans were paying doctors. Now they’re at it again. Cigna ranked No. 1 and United didn’t do so well. Of course if just speed of payment were the problem in American health care, it would have been fixed long ago.

But surely there’s much else in their data that would be interesting to know about. For example, I’m looking forward to AthenaHealth telling us from its data what activities of its physician customers were appropriate given their patients’ conditions. I’m interviewing AthenaHealth CEO Jonathan Bush in a few days, and I’ll ask him about that.

Any other suggested questions?

UPDATE: Here’s the chart of AthenaHealth’s 2007 Payerview rankings. They’ve also put up a rather flashy website explaining it all.

PAYERVIEW NATIONAL PAYER RESULTS:

National Payer 2007 Rank 2006 Rank
CIGNA Healthcare 1 5
Aetna 2 4
Medicare – B 3 2
Humana 4 1
UnitedHealth Group 5 3
Wellpoint 6 7
Coventry Health Care 7 Not ranked
Champus/Tricare 8 6

HEALTH PLANS/POLICY: Ignagni–arguing out of both sides of her mouth, with UPDATE

My favorite lobbyist has a letter in the NY Times.
In which she argues that beneficiaries save money compared to regular
Medicare, and (this is the fun part) if payments are reduced then this
will have to be reflected in more charges to the poor. I have a long reply to this in waiting, but I’ve been persuaded to give my shorter version a shot at the NY Times letter’s page. If they don’t want to print it, then I’ll be back here with the long and the short version later in the week.

UPDATE: Not that this will surprise anyone remembering Medicare Risk Plans putting their sign-ups on the second story of a walk-up (I know no one eve proved those stories in the 90s…) but the NY Times today has a story about sales abuses in the Private Medicare FFS market which sound very like long distance phone "slamming" of 15 years or so ago. Except of course the victims are a little more vulnerable. Even CMS (which is at least partially run by Republicans who approved of the MMA) seems a little distressed by what’s going on.

TECH/HEALTH PLANS: Interview/Podcast with Mark Ganz, CEO Regence and Luis Machuca, CEO Kryptiq

This is the transcript from an interview I did at WHCC last week with Mark Ganz, the CEO of Regence, the Oregon based Blues plan that operates in the Pacfic Northwest, and Luis Machuca, the CEO of Portland-based health IT messaging company Kryptiq. Machuca is innovative as both and employer and a technology guy, and Ganz is, shall we say, not your typical insurance company executive!

Matthew Holt:  This is Matthew Holt with the World Healthcare Blog, reporting from the World Healthcare Congress, doing a podcast. It’s kind of funky back here because we are in this glass-enclosed blogger’s corner which they put together at the back of the exhibit hall, but they are still setting up the exhibit hall, so you can hear the vacuum cleaners in the background. But no matter, we are on with the first podcast of the day.Today we have got some very interesting folks: Mark Ganz, who is the president and CEO of the Regence Group, which is the big Blue’s plan in Oregon and the Pacific Northwest; and Luis Machuca, whose name I just got wrong again. [laughs]

Luis Machuca:  Machuca!

Matthew:  Machuca! Sorry, my pronunciation is–they never taught you that about proper Spanish accent in the English school I went to. He is the CEO of Kryptiq, which is an IT messaging company. Well, I should let Luis tell you about that. Mark has already been on the podium twice today in two different areas; Luis has just been talking about an initiative that is being run for his employees with Regence. So let’s start there; Luis, give us the quick find out about what are you doing with your employees and how you work with Regence and what innovative things you are doing around employee healthcare at Kryptiq.Luis:  Hi Matthew. So, really what Kryptiq is all about is building tools that enable healthcare transformation. We’ve really, from day one, always felt that transformation starts from the inside out. So before we try to transform the world of healthcare outside, and build tools for them, we wanted to make sure that we were sensitized to the notion of delivering the very best possible healthcare in the most efficient of ways. So we’ve done many things along those lines, starting with reimbursing for email and patient portal enable clinics for employees.More recently, and why Mark is here really, is to align with health plans who also embrace the notion of transformation and the notion of getting more decision in the hands of the employees, and more tools and information for employees to make the right decisions about their healthcare dollars.

Continue reading…

Health Plans: Pulitzer for WSJ by John Irvine

The Wall Street Journal wins a Pulitzer Prize for public service reporting for the critical series it ran on irregularities in the way stock options are awarded at some American companies. The investigation triggered a backdating scandal implicating executives at more than 150 firms and ultimately led to the downfall of UnitedHealth CEO William Mr. McGuire. The entire series is available on the Journal’s site for free. Meanwhile, The Oregonian picks up an award for breaking news reporting on the James Kim tragedy. The New York Daily News wins for editorials drawing attention to the serious – and by and large ignored – health problems faced by rescuers at Ground Zero.  

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