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Tag: Insurers

PHARMA/HEALTH PLANS: Responding to propaganda with idiot propaganda

Michael_moore_2Michael Moore dissects U.S. health care. So the first excerpts of "Sicko" have been shown, and the spin from the industry is already quite remarkable.

We can’t control what a major Hollywood entertainer does," said Mohit Ghose, a spokesman for the trade group America’s Health Insurance Plans. "Our focus remains on a positive agenda of high-quality health care for more Americans."<SNIP>

Ken Johnson, senior vice president of the trade group Pharmaceutical Researchers and Manufacturers of America, said industry officials were "freaking out and pulling their hair out" when they first got word of Moore’s documentary. They have since calmed down, Johnson said. "Michael Moore is a political activist with a track record for sensationalism. He has no intention of being fair and balanced," Johnson said.

Because when you think of health insurers the very first thing that comes to mind is them creating a "positive agenda of high quality health care for ‘more’ Americans" and of course when you think of  big Pharma, "fair and balanced" is exactly what popped into your head.

My suggestion is that until they can put together a fact-based rebuttal–we know that Moore plays fast and loose with the facts–both those organizations should shut the hell up. Otherwise the focus may shift to their not-entirely-glorious track records of telling the truth in public.

HEALTH PLANS/POLICY: A health plan CEO who genuinely believes in universal coverage

Health Plan CEO Georganne Chapin believes managed care can evolve with universal coverage! I thought her money quote was pretty amusing.

So then, if Americans are interested in universal coverage, the industry supports it, and the money is already in the system, when will it happen? “In 1996, I said it would come in 10 years,” Chapin says. “We still have four more months.”

Of course she runs a non-profit Medicaid HMO, so her attitudes may not represent those of a typical AHIP member CEO!

HEALTH PLANS/QUALITY: BC California on P4P

My erstwhile colleagues at FierceHealthcare have an interview up with Dr. Michael Belman, staff VP and Medical Director, Blue Cross of California. It’s a pretty good introduction, for those of you who don’t know much about it, to the P4P program in California.

On the other hand they never asked him what kind of wonderful results that Wellpoint got from dumping $40m worth of computers onto the doctors of America without any metrics or intent to actually make them integrate said computers into their workflow. (I suspect eBay got some sellers’ commissions out of it, though). Nor did they ask whether paying for performance includes paying bonuses to their underwriting staff to find ways to cancel members’ policies retroactively.

Oh well, perhaps that’ll be in the next interview!

INTERNATIONAL: Maybe privatization in the UK will not be quite so swift

Strike one for the little guy. A pensioner (that’s a “senior” to us Yanks) has won a court battle to stop a US healthcare giant from taking over a GP practice. The giant in question is United HealthGroup which apparently has also got a few other problems.

Perhaps doctors and hospitals in Arizona, St Louis and the outer boroughs of New York City should be flying in 67 year old Ms Pam Smith, 67, a former hosiery worker and Labour councillor from the huge metropolis of Langwith, Derbyshire, to advise them on how to “work” with United?

HEALTH PLANS: Roy Poses keeps up his attack dog tactics

Roy Poses at Health Care Renewal keeps up his attack dog stance on the United HealthGroup board. Although I can’t exactly agree with all of his criticisms—for instance Mary Mudlinger’s attempt to increase the use of NPs is probably a good thing—he is the only person out there pointing out the inherent difficulty for academics being on a corporate board that has, at the least, potential conflicts of interest with their academic missions.

Of course the real dirt is that the UHC board including McGuire contributed to Thomas H. Kean’s son’s political campaign while Kean (the ex-NJ governor and chair of the ineffectual 9–11 commission) was on the compensation committee. Yup, that committee which agreed with the options backdating (or at least had it happen on its watch).

Anyway, I’m glad Roy’s on this, so I can slack off!

QUALITY/POLICY/HEALTH PLANS: Cranky, confused, aimless and spineless

And in the all talk and no action department…

Ian Morrison and Bob Leitman used to go around America calling employers’ attitude towards buying health care for their employees“cranky, confused, aimless and spineless”….that was in the early 1990s. It’s all different now, eh?  Well not quite. Deloitte survyed 71 big employers to find out how they were cracking the P4P whip on the system.

The joint Center/ERIC study looked at the views and attitudes of 71 major employers on value-based purchasing, also known as “pay for performance.” Some 10 percent of respondents are currently engaged in value-based reimbursement programs with health plans and/or provider networks, indicating a growing receptiveness to developing regional or pilot programs. However, 38 percent of surveyed employers are waiting for more concrete evidence that the concept can deliver a better return on investment.

Hmm.. so only 10% of big employers are doing anything about P4P. Employees working for employers with more than 1,000 employees represent about 13% of the private sector workforce (yup I scouted the Stat Abstract for that number). So less than 2% of employers are doing anything about P4P. In other words not enough for providers to take note of, so nothing will happen until Medicare makes its move.

HEALTH PLANS/POLICY: And for those of you suffering from the voluntary pooling delusion…

PacAdvantage, nee CalHIPC, was the biggest small business purchasing pool in the nation. It was supposed to be a model for the Clinton-era Regional Health Alliances, but because that reform never happened, it was forced to soldier on and accept all the small businesses that wanted to join.

What happens to voluntary purchasing pools? Simple economics—they only get customers who can’t get a better deal in the underwritten insurance market and so they go into a death spiral where the people in them are too sick to be supported by the premiums they charge. Today PacAdvantage announced that it was closing down, throwing 110,000 people into the small group and individual market, where by definition, no insurer wants them (unless they’re like me—very lucky).

PacAdvantage is the type of organization that our friends in the “voluntary universal insurance” world (Cato, Galen et al) think is going to solve all of our problems, with no need for pesky mandates to buy insurance, or for community rating, or standardized benefits packages. I’m sad to say that I think Alain Enthoven has joined that philosophy, although I may be misinterpreting his views.

The answer is that there is no such thing as voluntary universal insurance, and there cannot be universal insurance without very different regulation of the insurance market. And the longer we let that go on, the closer comes the day of reckoning when there is no viable market for private insurance, and we go to single payer by default (or Brazil, take your pick).

Mark this one as a signal event, and if you don’t like that outcome, begin to figure out how to prevent that awful day.

CODA. I just found this CHCF piece from November 2005 which explains in more detail why voluntary pools are doomed–although it doesn’t quite call a spade a spade and suggest that mandatory coverage is the obvious answer.

PBMs/HEALTH PLANS: Medco makes out; Kaiser not so pretty

So Medco is making even more money by switching to generics.

Medco Health Solutions Inc. reported a 24 percent jump in second-quarter earnings and raised its profit forecast, citing speculation that a generic version of the top-selling blood thinner Plavix may soon be available. Net income rose to $170.9 million, or 56 cents a share, driven by an increased number of customers and higher sales of generic drugs.

You wonder how long their customers will take to figure out that what they’re giving back in rebates they’re taking in spreads that they charge on generics. Apparently the answer is, a long time!

Meanwhile, Kaiser had not such a good quarter, in that their revenues and membership went up but their profits went down to $272m for the quarter.

Kaiser Permanente’s hospital and health plan units saw membership and revenue climb in the second quarter, but quarterly profits plummeted by $91 million or 25 percent from a year earlier, the giant health-care system reported Friday. Officials at Oakland-based Kaiser attributed the steep net income decline to increased operating expenses, "including those associated with the continued investment in facilities expansion, seismic retrofitting and care delivery programs." George Halvorson, chairman and CEO of Kaiser’s health plan and hospital operations, said in an Aug. 4 statement that the giant system is using its earnings "to make important investments" in programs, services, facilities and technology. No further details were immediately available. Systemwide revenue for the quarter jumped from $7.7 billion last year to $8.5 billion this year, a nearly 10.4 percent increase. Enrollment jumped by nearly 44,000 members to about 8.59 million nationwide, more than 75 percent of them in California.

Of course that’s not necessarily a bad thing — it may mean relatively more money was spent on patient care — and at least they avoided the real bloodbath that seemed to be developing at the end of last year when it lost $211 million in Q4. But there remains a whopping big fine to come for the kidney transplant fiasco, so they’re not out of the woods yet.

POLICY/HEALTH PLANS/PHARMA: Part D–a tale of two headlines

Most Beneficiaries Enrolled in Medicare Rx Benefit Satisfied With Drug Plan, Nearly Two in 10 Experienced Major Problem, Study Finds

or if you prefer

Poll shows 80% of those enrolled in Medicare drug plan satisfied

So go ahead and guess which headline came from a non-profit foundation’s news service and which one was from the inhouse newsletter for the trade group for health plans, which of course run the biggest Medicare PDP (Part D plans).

So when is a series of problems not a problem? Apparently if you don’t care much about consumer problems.

34%, of seniors who have used their drug plans have experienced what they perceived as problems, including 18% who described them as "major" problems and 16% who described them as "minor" problems. The experiences cited as problems included having unexpected costs, not being able to fill a prescription at the pharmacy, not receiving an enrollment card and having to change medications because a prescription is not covered. Ninety percent of seniors who experienced minor problems and 55% who experienced major problems feel the issues were resolved satisfactorily. (my emphasis)

So by my math 9% of Part D recipients have had major unresolved problems. Most consumer companies would freak out if they had that level of unsatisfied customers.

But don’t worry, for the $600 billion over 9 years (or whatever mythical number we’re now being quoted is the cost of Part D) that the taxpayer is spending, we’re sure saving all those recipients lots of cash right? Well not quite all—in fact not even most!

Of seniors who have used their Medicare drug plans, 46% say they are saving money on prescription drug costs, while 34% say they are paying about the same as before the drug benefit and 17% say they are paying more.

Oh well, at least the people who the bill was designed to help are benefiting. On Tuesday the NY Times told us that:

The summer revival in the pharmaceutical industry continued as Merck and Schering-Plough, two major American drug makers, reported second-quarter profits yesterday that were well ahead of analysts’ expectations. Medicare Part D, which offers prescription coverage for people over 65, is fueling the profits, as drug makers benefit from new prescriptions and somewhat higher prices for medicines, Wall Street analysts say. The number of prescriptions has risen 3 percent this year, and growth accelerated in June to more than 5 percent, according to a report from Merrill Lynch. Eventually, Part D could fuel a political reaction if prices continue to rise, but analysts expect the industry’s influence in Washington will delay any changes for years.

And the taxpayer isn’t getting screwed any more than they were going to be already in Part D are they? Well there’s this little nugget too

Overall prescriptions are also increasing, according to data from Citigroup and Merrill Lynch. For the year, total prescriptions in the United States are up about 3 percent, but they accelerated in June, rising 5.4 percent over the previous June. Drug makers have also increased prices for many popular drugs and are paying rebates to the private insurers who run the Medicare Part D program that are lower than the 15 percent rebates they paid to Medicaid.

Well at least the market is working—of course Adam Smith might not notice this as being the kind of free market he was thinking about.

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