Tag: Jim Purcell

The Narrowing of the Network

The concept of restrictive (oh let’s call them euphemistically “narrowed”) networks has for decades been the third rail of healthcare. Ask Hillary Clinton, who put her foot on that third rail in the 1990’s while attempting to reform healthcare. In the same vein, HMOs in the 90’s also tried to restrict networks, resulting in vicious backlashes.

One of those backlashes was the enactment in many states of so-called “any willing provider” or “freedom of choice” legislation. At last look, some 27 states still have a form of such legislation on their books. Most credible studies show that such laws increase the cost of healthcare.

Moreover, the ability of insurers to remove physicians from their network in many states is severely restricted by so called “fair hearing” legislation that makes the pain of achieving physician expulsion worse than the pain of leaving under performing physicians in network.

We understand that when a physician cries “foul” against an insurer, public sentiment will favor the physician, and over the years, it certainly has been  reflected in this and other legislative attempts to tie insurers’ hands.  After all, no one wants to go to the prom with a health insurer.

As a result of this and other phenomina, there has been the highly chronicled swoop toward mediocrity in the delivery of healthcare in the United States. And insurers have certainly contributed here. Up to now, insurers have paid physicians using the fee for service payment method. This method merely requires physicians to demonstrate that they performed a function, at which point they are paid at an amount that does not vary regardless of quality or outcome. This is a completely volume driven environment with predictable results.

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Feeling the Bern on Universal Single-Player Healthcare

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“Elephant in the living room” is an English metaphorical idiom for an obvious untruth going unaddressed. In most political platforms about healthcare and its coverage, there is a most resolutely immovable elephant in our living room. It is there with every single candidate.  But with Bernie….

You’ve just got to love Bernie Sanders.  It makes me feel like I’m 22 years old in the 1960’s and dumb as all get out about how you pay for things. But let us consider Mr. Sanders’ healthcare proposal. From his own website:

“Bernie’s plan would create a federally administered single-payer health care program.  Universal single-payer health care means comprehensive coverage for all Americans.  Bernie’s plan will cover the entire continuum of health care, from inpatient to outpatient care; preventive to emergency care; primary care to specialty care, including long-term and palliative care; vision, hearing and oral health care; mental health and substance abuse services; as well as prescription medications, medical equipment, supplies, diagnostics and treatments. Patients will be able to choose a health care provider without worrying about whether that provider is in-network and will be able to get the care they need without having to read any fine print or trying to figure out how they can afford the out-of-pocket costs…[etc.].”

Bernie sure didn’t go half way on this one. All care, whenever, wherever, however. A fundamental right with no filter. OK. So he jumped in with both feet. You’ve got to admire his elan.  But what might this mean and how can he ignore what happened in his own home state?

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Mr.Trump’s Proposal for the Sale of Health Insurance Across State Lines

Donald Trump’s website has a position paper entitled “Healthcare Reform To Make America Great Again.”  And some of his suggested reforms make sense.  However, the question of the moment involves Item 2:

“Modify existing law that inhibits the sale of health insurance across state lines.  As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state.  By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up.”

This is not by any means a new proposal.  Despite being supported by most Republican Presidential candidates, it has lingered around for decades without going anywhere.  And for good reason.

The driving argument is that this would permit increased competition amongst insurers which would lower premiums.  While it is true that competition might increase, it is highly doubtful that the result would be lower premiums, and there are considerable consumer protection concerns as well.

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Stop Calling Them Patients!

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We have a healthcare system that is provider-centric indeed.  Why else would we call the consumers of their services “patients?”  Perhaps because they have to be patient.  Patient because they have to wait long after their appointed hour to be seen.  Patient while waiting in the Emergency Room.  Patient because the healthcare system is rigidly resistent to change.  Patient because even the most advanced providers measure quality based on “best practices” rather than outcomes.  Do you care about whether your physician employed best practices if your outcome was bad?  Ummm, nooo.

So let’s rename patients right now.  How about “consumers?”  For sure they are, although in today’s dysfunctional healthcare “system,” they rarely pay the providers whose care they consume.  But let us not hesitate over that anomalie, which may be slowly changing.  Up to now, we as consumers of healthcare rarely even choose our providers.  They are chosen for us by other providers.  And if we want to be good shoppers and choose ourselves?  How do we do that when we cannot determine how much a provider costs or how good he or she is?

Oliver Wyman’s Tom Main and Adrian Slywotzky got it right when they opened their superb article with the following observation:

“For many people, the word “consumer” sounds out of place in a discussion of healthcare.  And indeed some of the woes of our system arise precisely from our (mostly ineffective) effort to keep commerce away from medicine.  We thought we were protecting the autonomy of physicians, but inadvertently we created a system that rewards waste and failure and makes it difficult to deliver optimal care. Continue reading…

Wellness 2.0:  Better Health, Better Coverage

Screen Shot 2015-10-13 at 4.26.03 PMJust what on earth are businesses thinking?  Companies pay too much for poor quality health care coverage. If this were any other business expense, this wouldn’t be tolerated. Yet, expensive, sub-standard healthcare is something U.S. companies roll over and accept.  There are many reasons why, all unacceptable.

Fortunately, there’s a path that companies can take now to address healthcare costs: fostering healthier employee lifestyles.  This is perhaps the only avenue for immediate action that can lower healthcare costs for both employers and employees while cultivating a healthier, more productive workforce.  Your cynical side laughs?  Consider this:

“Only private business, not the federal government, can solve America’s epidemic of obesity, chronic disease, and runaway healthcare costs by investing in the health and fitness of their employees,” said Cleveland Clinic CEO Toby Cosgrove in an Affordable Care Act debate panel, a sentiment increasingly echoed inside and outside of healthcare.

Employers must move away from the adversarial, zero sum approach of increasing employees’ share of the cost of coverage to a more partnership-centered model of forging employer/workforce partnerships where both companies and employees support each other’s goals, not just in lowering coverage costs, but by improving health.  

Increasing coverage in this day and age? Unheard of! But this is not a pipe dream. If companies are willing to make the investment, on the condition that employees undertake required behavior modifications and achieve positive outcomes, it truly can happen. And though may have heard this before, up to now we’ve not done it right.Continue reading…