Tag: Medicare Advantage

Slicing the health reform pie

Dec 12, 2008• 15

By Robert Laszewski

I doubt anyone would disagree with the statement that America’s health care costs are too high, continue to grow at an unsustainable rate, and reform is critical to control costs, get everyone covered, and improve quality.

In the wake of the election, I see one positive and magnanimous press release after another coming from the health care special interests. The press is full of daily stories touting the coming health care reform efforts as different this time. The stakeholders understand things are different, know we have to do something, and are ready to cooperate, goes the reasoning. Really?

Now, Sleepless in San Francisco

Dec 5, 2008• 1

By Matthew Holt

Having returned from Seattle, the persistent itching from the sand-fly bites of Roatan has awakened me at 5 a.m. So I’m commenting on three pieces of news, which I’ve commented on before here and at Spot-On.

First, United HealthGroup has introduced two new things this week. One is is a consumer portal/WebMD competitor called myOptumHealth, which gave a sneak preview (and was a sponsor) at the Health 2.0 Conference in October.

At first blush I like the look of what they’ve pulled together, although the about us section doesn’t exactly tell you much about who owns Optum! But the really interesting product United launched this week was aimed right at me. It’s an option to repurchase your individual health insurance without being re-underwritten and rejected.

Sleepless in Seattle

Dec 4, 2008• 10

By Matthew Holt

In a 36 hour span I left the mountains of Copa Ruinas in Western Honduras, had dinner in South Beach, Miami and after stopping off to see that Health 2.0 central in SF hadn’t collapsed, ended up in Seattle. I woke up early (had to get that in there to match the title) and hustled off to the main symphony hall because it’s the 25^th anniversary of the Group Health Center for Health Studies. (The research arm of Group Health Cooperative of Puget Sound)

There the question of the day is, why haven’t integrated group practices (like Group Health & Kaiser) spread across the nation? And is there something that the new Administration can do to help make it so?

Private Medicare plans face uphill battle to prove efficiency

Sep 9, 2008• 3

By Robert Laszewski

I have been struck by the optimism regarding private Medicare presented by health plan executives during the recent earnings season and the analysts failure to press them on just how their numbers will add-up to sustain the long-term viability of a private Medicare strategy.

The typical private Medicare health plan operates on a medical cost ratio in the mid-80s. Let’s assume 86% for medical costs and the remaining 14% for overhead, profit, and taxes.

Government-run Medicare operates on about 3% overhead. One can argue that many federal Medicare costs are paid for elsewhere but that is the number the private plans have to compete against. So private Medicare plans spend 14% on overhead and Medicare charges
itself 3% — that’s an 11% disadvantage for the private market right
out of the box.

The Problem with Medicare Advantage

Jul 10, 2008• 16

By MAGGIE MAHAR

Everyone understands why Congress was so reluctant to cut physicians’ fees. Reimbursements for primary care physicians are very low—so low that 30 percent of Medicare recipients who are looking for a new medical home can’t find one. Cut fees, and fewer doctors will take Medicare patients. The AMA, seniors and the AARP are all up-in-arms. Few politicians like to disappoint this trio.

But why are so many Congressmen willing to cut Medicare Advantage? After all, one out of five seniors is in the program: Won’t they be upset?

The truth is that, as many seniors have discovered, Medicare Advantage fee-for-service (the plan Congress has now voted to phase out by 2011) is not turning out to be an advantage for them.

Here is what David Fillman, an International Vice President of the American Federation of State, County and Municipal Employees (AFSCME), which represents some 1.4 million workers, had to say about MA’s fee-for-service insurance when he testified before Congress in January:

“Insurance companies have targeted our employers for the hard sell, including offers to pass through some of the federal subsidies to state and local governments.”

Senate votes to reign in private Medicare

Jul 9, 2008• 19

By Robert Laszewski

Robert Laszweski has been a fixture in Washington health policy circles for
the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog.

Ted Kennedy came to the Senate floor and led Senate Democrats to an amazing victory in their first real attempt to rein-in private Medicare spending and rescind the 10.6 percent physician fee cuts.

The veto-proof margin puts President Bush’s threat to veto the Senate bill, which was approved by the House on another veto-proof 354-59 vote just before the holiday, in doubt. Why bother?

I was not surprised to see Senator Kennedy on the floor.

This vote was not about the doc cuts. It was about Medicare and its future. The doc cut was just the leverage Democrats were using to get at the private Medicare program.

Medicare is part of the Democratic legacy, and it is at the core of the Kennedy legacy.

AMA and AHIP go head to head with TV ads

Jul 2, 2008• 3

By Sarah Arnquist

The American Medical Association this week began a television ad campaign, lambasting Republican Senators who failed to prevent the July 1 automatic 10.6 percent Medicare physician fee cut.

In the one-minute ad, AMA President Nancy Nielsen says, "A group of Senators decided it was more important to protect the health insurers than seniors."

Just as Robert Laszewski predicted here last week, the doctors are coming out in full lobbying force.

But wait. The Association of Health Insurance Plans is also running ads filled with nice looking seniors saying that to protect seniors Congress must protect the Medicare Advantage program.

Who is a senior taking 10 prescription medications for six chronic diseases with a calendar full of doctor’s appointments to believe?

Here are the ads.

Run for the hills: the doctors are coming

Jun 30, 2008• 5

By Robert Laszewski

What is the one thing no human being should want to be next week?

A Republican Senator at a Fourth of July Picnic.

In the most amazing turn of events I have seen in 20 years of following health care policy in Washington, the Democrats have the Republicans backed into an awful corner over the issue of the July 1st automatic 10.6% Medicare physician fee cut and corresponding private Medicare cuts to pay for nixing it. Also at stake is another 5% physician fee cut set for January 1, 2009.

MA plans won this round but future looks bleak

Jun 20, 2008• 1

By Robert Laszweski

Congressional Democrats tried to take a big bite out of private Medicare last week in an attempt to pay for an 18-month fix to the upcoming July 1 10.6 percent reduction in Medicare physician payments.

The effort, led by Senate Finance Chair Max Baucus (D-MT) got only 54 of the 60 votes he needed to end debate and move the issue to a floor vote. While getting that floor vote would almost have certainly meant passage of the bill in the full Congress, President Bush would have vetoed any attempt to cut the payments to private Medicare plans and the Dems would not have had the votes in either chamber to override.

Now, Baucus and Senate Finance Committee ranking member Chuck Grassley (R-IA) will have to find a more modest way of fixing the doc problem––likely for just six months. The docs are not going to suffer a Medicare payment cut this summer.

All of this was expected and is what I have been saying for months would happen.

Four Big Trends – Brian Klepper

Jan 16, 2008• 9

Brian Several events and trends emerged over the last year that will reverberate throughout the health care
marketplace in 2008 and going forward. While none of these dominated the trade press like some other issues – electronic and personal health records, RHIOs, the evolving labor shortage, pay-for-performance reimbursement – these manifestations of change are occurring in the marketplace as well as through policy, and are moving health care forward in fundamentally positive and far-reaching ways.

Health 2.0The most significant for the long term in terms of its capacity to change how health care works is the Health 2.0 movement, which Matthew Holt and Indu Sabaiya have played a central role in facilitating and explaining. In some ways, Health 2.0 is simply a continuation of what has come before: companies creating new value through information and connecting with customers over the Web. Health 2.0 takes this approach into every area of health care data, often driven by companies outside of or at the margins of health care, who have no financial stake in perpetuating inappropriateness and waste, and who see an opportunity to make money by rationalizing the system.