Tag: Insurers

HEALTH PLANS/POLICY: Underwriting–pernicious and ridiculous

Jan 2, 2007• 21

Lisa Girion in the LA Times kicks butt and takes names, exposing the individual insurance market for the fake gong-show that it is. She found a member of the LA insurance commission rejected by all three major health insurers in the state because of asthma. Of course THCB readers got my own extremely personal perspective on this process last year when one insurer totally rejected me, while another gave me the best underwritten rate—while both were looking at the same information! That’s even better proof that the current system is a lottery.

We need one pool.

HEALTH PLANS: Wellpoint not out of the California woods yet

Dec 28, 2006• 1

This Wellpoint policy retroactive cancellation story is not exactly going away —
Doctors seek to sue Blue Cross

HEALTH PLANS/TECH: Looks like the Deal’s over–or is it?

Dec 21, 2006• 6

So it looks like from Justen Deal’s website that he’s essentially going to be fired in absentia by Kaiser. My assumption is that he knew this was going to happen all along, and was essentially preparing the way for some kind of entry into politics and/or law career. Kaiser too seems to yet again be getting unnecessarily gummed up about the whole thing—for example according to Deal having people from the insurer side handle the case, rather than from the medical group which he works for.

I don’t know much about employment law, but I do know that California is an “at-will” state, which means that you can fire anyone for basically any reason. It’s obvious from Halvorson’s reaction, let alone the exasperated comments from Permanente’s Andy Wiesenthal on THCB, that they had no further interest in communicating with Deal after he went public, and didn’t want him around. So I don’t see why that didn’t happen straight away. Making up a (fake?) policy about “not abusing the email system” is basically a waste of time.

Deal seems to be appealing to a base of supporters within KP in order to “right” the ship. But if there really is malfeasance and/or an Enron-type meltdown going on within KP over HealthConnect–as opposed to normal teething problems from a huge IT installation (which as you know I suspect to be very, very unlikely) –the best route would be to go to those people who do oversee non-profits. That is regulators and the politicians who supervise them.

Given the various issues that Kaiser is having with the State DMHC over other aspects of its behavior , I suspect that Deal must be involved in some protracted discussions with local politicians. After all if there really is financial mismanagement going within KP, then Chuck Grassley is interested in this type of thing, as is Pete Stark.

If on the other hand, Deal is not pursuing those options, then I’m a little curious as to what this whole thing has been about. As an appeal to the massed ranks of KP employees about HealthConnect might seem appropriate if it was a worker’s collective, but it’s hardly likely to sway the board. Unless of course there’s something going on in the works that we can’t see.

HEALTH PLANS: Embarrased non-profit insurers still trying to hide the money

Dec 14, 2006• 1

A long time ago (1993) in a universe far, far away pharma companies were somewhat concerned about public perceptions of their profits. Bob Leitman (long time at Harris, now at Greenfield) told me how, on a visit to a pharma company long subsumed into a bigger one, he went to the bathroom in the new building. He was staggered at the quantity of marble inside. When he remarked as much to his client, the reply he got was “well we had to hide the money somewhere!”

Apparently lots of non-profit insurers are now having the same problem

Blue Cross of Northeastern Pennsylvania said it will spend $175 million to bolster health care systems in the region and support a proposed medical school in Scranton, though the use of the money drew fire from critics of the health insurer’s expected $420 million surplus.

HEALTH PLANS/TECH: PHRs–Can this woman ever tell the truth?

Dec 14, 2006• 4

Time for the Karen Ignagni lie of the day.

It comes in a session during which AHIP and the Blues talk about their sponsorship of a common model for PHRs (or at least for payer-based PHRs). It’s hard to know how she manages to slip in a whopper during a session that’s relatively non-controversial—or at least one supporting an initiative that most of us think is a good idea. (Even if there are grave doubts as to whether health plans really believe in portable health data or records that can be moved from plan to plan, or even could put it together if they did believe it—it’s clear that Kaiser, which is way, way ahead of these guys, has no idea about portability).

Here’s the lie. She says that there are 70m people using online PHRs now. When called on it, she doesn’t bother to justify her numbers. She then says that soon 100m will have access to these from health plans. That number is so wrong, it’s just amazing. Harris and Forrester both think that much fewer than 5% of the population (e.g. less than 15 million) have got PHRs, and Markle and Manhattan disagree but both say that the potential market is between 20m and 60m. So how does she come up with 70m people having one already? Who the hell knows? It must be a derivative of the number of members for whom their plan has a web site they can create an account on (most of those Wellpoint members with WebMD, by the way). I’m prepared to bet her annual salary that the total number of people who have ever actually visited a health plan web site is less than 70 million. After all that would constitute more than 50% of all Internet users.

And would it really hurt her to tell the truth? Which is that health plans have been really weak about creating PHRs and could have done it 5 years ago and chose not to! (Yes, I know I’m bitter). Is their record thus far really that embarrassing? (It is, actually, but no where near as embarrassing as the rest of the industry’s performance in the last 5 years!) What’s changed is that now they realize the time has come to do something before it gets done too them, and now they say they will get us to the PHR land there very quickly. I happen to think that they have a good shot, but can’t for once Ignagni just tell the truth about the progress so far? I guess we know the answer.

(Note: slight edits to end para made 12/15 when I noticed it didnt make sense!)

HEALTH PLANS/POLICY: Kaiser Permanente’s plan to cover all Californians

Dec 13, 2006• 4

The plan is interesting in that it seems to basically contradict the AHIP plan that Halvorson was touting last week. That one called for subsidies for low income workers to buy into private health plans. This one calls for a state sponsored first dollar coverage plan in addition, plus an individual mandate plus a pay or play tax, plus two different pools for the non-poor to buy high deductible plans from (again both state sponsored). At least I think it’s what they’re saying. The major problem with this plan is that it’s so damn complicated I couldn’t figure out which special interest group was going to get the angriest, as it gets ignored by the rest of the public. It is worth noting that pay or play was turned down at the ballot box (2004) recently in this state and the version that was turned down had an exemption for small businesses. No such exception would exist under this plan. So maybe some anger (read: opposing political contributions) there…(are you watching WalMart?)

It’s also worth noting that they, like the Mass guys and everyone else look at the Medicaid and SCHIP enrollment levels, say “why don’t all those poor people just enroll in the plans that they’re already entitled to enroll in?” They seem to see that as a source of free (Federal) money. Well if they all did, then that money would actually have to come from somewhere…which is why those programs are under-enrolled to start with.

Still this is a serious effort. They’ve even done sums and everything. And we’re starting to count these policy documents by weight now, which indicates that it’s all getting somewhat serious and is picking up as a political issue.

POLICY/POLITICS/HEALTH PLANS: Igleheart, Glasscock, pussycats

Dec 6, 2006• 2

After a little prompting (i.e. 30 minutes after I posted a blog comment asking why it wasn’t up) Health Affairs has posted a letter I wrote two days ago in response to John Iglehart’s interview with Larry Glasscock in its web exclusives section. I already had some in depth discussion about that over here on THCB, so my letter attempts to use the rifle rather than the shotgun. Let me (and HA) know what you think.

HEALTH PLANS/POLICY: John Igleheart is a pussy

Dec 4, 2006• 3

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In a Conversation With Larry C. Glasscock, the CEO of Wellpoint, John Igleheart has either been massively restricted by Glasscock’s PR handlers or has revealed himself to be a complete pussy.

A little history: having been a senior exec at CareFirst (Blues of DC), Glasscock took over the fast growing regional Blues plans based around Anthem BCBS in Indiana, took them for-profit and made himself a fortune. A great American success story.

He then merged Anthem with the big other for-profit Blues agglomeration, Wellpoint which was run by Len Schaeffer, in 2005. I’ve had a fair bit to say about the variance between Len Schaeffer’s high-fallooting rhetoric and the actual on the ground performance of his company. Glasscock appears no better. And in many ways, he’s been much worse.

I’m not saying that Igleheart should necessarily have gone after him for the fact alone that he made $25m last year (not to mention the millions more in stock)—after all Wellpoint stock has done very well. But given that certain other health plan CEOs are in some hot water for their outright greed and fraudulent behavior, it might just have come up.

POLICY/HEALTH PLANS: Yet more debatable data on CDHPs

Dec 1, 2006• 4

HSC’s John Gabel (kind of a “neutral” in the debate) is out with a new study suggesting something that I think is true. The take up of CDHPs by workers offered them in a choice with other products (HMOs. PPOs) is slow. And that’s because they’re not being appropriately compensated with premium reductions in their take-home pay to off-set the much higher-deductibles.

And of course this goes back to how employees buy their health care in the first place—mostly unconsciously via their employers, not knowing the actual cost of their premiums. If you want a long lecture on why this makes employees poor purchasers of insurance, attend any Alain Enthoven Stanford Business School class.

The likely evolution of all this is that workers will find the deductibles and co-pays for their PPO and HMO products increasing to the level of the HDHPs pretty soon. That’s how employers will “get out” of health care benefits—until the possible day when they all look at each other and say “OK let’s drop them totally and let the government take over.” Which is what they all want, but no one is quite ready to make the first move.

But because the HDHP is becoming an evolution of the PPO product that already exists, the argument will about choice will soon be moot. Karen Ignagni may well say that all (or actually 30%) the new small employer HDHP buyers were uninsured, but it’s pretty obvious that most (70%) of the new HDHP wielding employees were people with PPOs before who are being forced into HDHPs by their employers. And that’s certainly what’s happening with Intel and other larger employers who are “offering” HDHPs.

However this news release is most remarkable for this quote from Ignagni: “Ignagni said the plans are popular in certain niches but that it was too soon to say if they will gain wide acceptance.” She’s actually telling the truth! Mark that one down in your diary.

TECH/HEALTH PLANS/QUALITY: Lonny Reisman, Active Health Management transcript

Nov 22, 2006• 5

Here’s the transcript from the podcast I did with Lonny Reisman, a week or so back. Really interesting stuff for those of you interested in the future of patient care management.

Matthew Holt: So welcome to another forecast here at The Health Care Blog. I’m Matthew Holt, and today very exciting that we’re talking with somebody’s who’s really been a technology pioneer and a medical pioneer in developing tools for active health management, and surprising enough, his company is called Active Health Management and I’m talking with Lonny Reisman. Lonny, how are you today?

Lonny Reisman: I’m well, thank you. How are you?

Matthew: We’re doing pretty well over here. One of the first fall and somewhat foggy days in San Francisco, but at least we’re not going to endure that terrible New York winter you’re going to have to go through [laughter]. Anyway, let me very briefly give a sense to, in essence, what your organization does. And there are a couple of things that people who may or may not necessarily have heard of Active Health Management should know. First off is that you are in the business of taking data, all kinds of different data about medical information about patients, putting it all together and spitting it back out and using it to try and help and inform and change medical decisions by those patients and physicians. And the second one is that you’ve been so successful at that, that last year, Aetna decided to write a very big check, $400 million to buy you, and now you’re part of that large insurance company. So with that it’s a very brief introduction. why don’t you say a little bit about what Active Health Management does, how you got started, and what kind of impact you’ve been having in the healthcare system and the part of it you’re specializing in.

Lonny: Sure. Why don’t I start with my background, which will give you a sense of how we have come to be here. I’m board-certified in internal medicine in cardiology, I’m a physician, and during the 1990s I was leading a bit of a dual existence. I was practicing clinical medicine here in New York City, had a fairly typical practice, but I also was consulting with a large human resources consulting firm, William M Mercer, and was charged with evaluating health plans around the United States, mostly from my perspective on the basis of quality but obviously the premiums and the costs associated for those health plans was a consideration as well. In considering what I was experiencing as a practitioner and what I saw as a consultant evaluating health plans, saw an opportunity to better take advantage of clinical data that were available in the managed care world which weren’t being fully exploited. So specifically as I visited health plans I saw that they had the capacity to collect drug information, laboratory results, information about procedures and diagnoses and basically had the thought that if in fact that information could be used to support doctors and patients in making decisions, that in fact we’d be able to raise the bar with regard to the level of clinical excellence being provided to patients all over the United States. So fundamentally, the observation that I made, which ended up being relevant to what I was experiencing as a practitioner was that to the extend that the care that was being provided by me and others was fragmented, specifically I didn’t necessarily know what other doctors were doing to my patients or for my patients, to the extent that all of the information about a patient or much of it could be aggregated at the health plan level, we decided to take advantage of that.

The other component of Active Health, which again sort of derives from my own experience and perhaps insecurity, is that I recognized early on in my career that it’s very, very difficult to keep up. So there are thousands of articles, relevant articles, published yearly and the issue is how does one not only read and assimilate and remember those articles, but how does a physician relate the information in an article that they’ve read to the particulars that relate to a patient sitting in front of that doctor during the course of an office visit.

Matthew: They can’t is basically the answer, correct?

Lonny: Can’t do it, right, exactly. It’s just too much. So the basic notion and this is as true today as it was in 1998 when we started the company was if in fact you could provide the treating physician with more clinical data on the member than they have access to—again the patients frequently see multiple doctors—and then if you could expose those data to thousands of clinical rules that represent incontrovertible standards of clinical excellence and use technology to highlight discrepancies between what was actually happening to the patient as manifested in their data as opposed to what should be happening as displayed in the literature, we in fact could pinpoint changes that needed to be applied to individual patients by doctors that related to everything from preventive care to diagnostic services to therapeutics to follow-up, and basically started the company with the notion that we would have those data, have a technology that would analyze those data and communicate first with doctors and then over the years with patients in order to again introduce this level of consistency to the healthcare system. And from there we’ve evolved into other sort of disease management like capabilities which I’ll elaborate on. But the fundamental premise behind the company is what I’ve articulated.