Tag: Policy

Jack says cover the uninsured & spend less!

Dec 18, 2008• 5

By Matthew Holt

It’s no secret what the Dartmouth group’s solution for the health care system has been — reduce practice variation, get surgery and physician resource use rates similar to the Mayo Clinics’ of the world, and take the huge savings that would be generated to cover the uninsured. In fact Wennberg, Skinner, Fisher & Weinstein, now joined by “gone native” journalist Shannon Brownlee, have a new White Paper out—their own open letter to Obama’s mob.

Along the way that requires demand-side reductions (achieved by shared decision making) and supply side changes.

Shifting costs from public to private payers

Dec 12, 2008• 22

By Charlie Baker

The other day, the American Hospital Association, the Blue Cross /
Blue Shield Association, Premera Blue Cross and America’s Health
Insurance Plans (FYI – HPHC is a member and I’m on the Board of
AHIP) released a joint study on public and private payment rates.

The
study was prepared by Milliman, Inc., one of the nation’s most well
known number-crunching health care consulting firms. Readers of
this blog will not be surprised to learn that the study shows that
Medicare and Medicaid pay a lot less for health care services than the
Blue Cross and private health plans pay. But I must say, even I was
a little surprised by the size of the differential.

Holland, pay-or-play and the WSJ Opinion page making sense?

Dec 10, 2008• 8

By Matthew Holt

Don’t worry, the WSJ Opinion only makes sense because they let Zeke Emmanuel and Ron Wyden write an op-ed. The article is called Why Tie Health Insurance to a Job? and it’s impossible to argue with the logic about why we ought to move away from employer-based insurance.

There is of course an argument amongst those of us who both want to move to a social insurance system and want to have universal insurance as to whether this should be done in the voucher-type model that Emmanuel & Vic Fuchs have proposed (which looks a little like how the Dutch now do it) or whether we need to go to a modified single/multiple payer system like the French/Japanese/Brits/Australians.

I gave a talk in Canada the other night suggesting that there was some potential for convergence, and I used the very recent Commonwealth Fund data looking at the experiences of the chronically ill in seven nations. What is very interesting to me is that in terms of access to primary care and in terms of disease management, the Canadians and Americans look roughly similar—and not too good. As for specialty care, well as we know the Canadians & Brits ration by time and the Americans ration by money (or socio-economic status).

Confessions of A Physician EMR Champion, Part 2: Empowering Health IT for the Connected Medical Home

Dec 8, 2008• 9

By David C. Kibbe Kibbe

In a post here three weeks ago, I explained that I am engaging physician audiences in a conversation about participatory medicine, using a talk and presentation entitled "Confessions of a Physician EMR Champion.”

I “confess” my own misplaced hope in the EMR movement, and that I’m finally embracing the reality that most investments in health IT have not met expectations.

My broad message is that the key lesson of this failure has been that adoption of health IT without understanding the fundamental interactions between people, business process, and technology wastes both human and economic capital.

To be successful, the adoption of health IT by physicians, nurses, and staff must extend communication and health data exchange beyond their practices and bill payers to include the patient and family members, the patient’s team of health and wellness professionals, and ancillary service providers such as pharmacists and lab technicians in the community.

Health IT must be able to support coordination and continuity of care, as well as accountability for doing the right things for patients. I now realize most EMRs are not sufficient to this task, and I was wrong to think they would evolve in this direction.

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.

Addressing an epidemic of overtreatment

Dec 3, 2008• 6

By John Halamka & Rich Parker

Health care costs in the U.S. are approaching 17 percent of the GDP and may be as high as 20 percent in the next few years.

What is causing the US to have the highest cost and lowest value for the healthcare dollar? Simple – it’s overtreatment.

Overtreatment
takes many forms – from over ordering expensive diagnostic tests to the
prescribing of expensive and sometimes unneeded therapeutics.

Extracting more value from the health care dollar

Dec 2, 2008• 1

By Sarah Arnquist

Americans spend more money on health care than any other nation, but get far less in return, say multiple health care executives in Sunday’s Washington Post.

That’s not news to readers of this blog, but probably is not yet common knowledge among the general American taxpayer. That might change. The news media seems to be writing about this "value gap" more frequently, particularly in citing the growing momentum behind creating a center for comparative effectiveness research to evaluate drugs, devices and treatments to find out what works best.

Defining and measuring value is not easy, but increasingly public and
private health care purchasers are using their market power to demand higher quality care. Whether the science is
ready to support this "value-based purchasing" is the topic at the ECRI Institute’s annual conference today and tomorrow. (I’m attending the conference and will report on it tomorrow.)

Open Wide: Here comes the change you thought would never happen

Nov 25, 2008• 22

By Jeff Goldsmith

The morning after the election, I posted a speculative blog in Health Affairs on three possible scenarios for President-elect Obama’s implementing health reform: folding it into a bold, ambitious emergency legislative package (Complete the New Deal), carving funding out of the current $2.5 trillion national health spend (Braveheart), and postponing implementation until the economy recovers but taking steps now to prepare for it (Wait/Lay the Groundwork).

At the time, the Wait/Lay the Groundwork option seemed 70 percent likely. But with economic conditions worsening, I’m now convinced Obama will probably opt instead for the Complete the New Deal option, and try to implement health reform in the first 120 days of his Presidency, before the health care industry “dragon” can even stir from its cave.

Let’s call Obama’s program The Real Deal. We can already see its contours: an economic stimulus program including highway construction and other state-directed public works, a green energy spending initiative, emergency housing assistance including a foreclosure prevention measure, an auto industry bailout, labor law reform and income supports through tax credits for low income people.

Is much more than we think really possible?

Nov 7, 2008• 1

By Matthew Holt

On THCB today Maggie Mahar basically tells the health reform crowd to be patient. But two members of the unreconstructed left in other venues don’t agree. In the NY Times Paul Krugman says that deficit spending is OK, and correctly points out that Obama has a real mandate to fix the underlying problems of middle America (and yes that would include health care). And yes polling data shows that on balance America is as liberal now as it was in the 1960s. 35 years of blind-ish belief in conservatism is more or less over.

And if you want to see the optimist’s view on what Obama might do, Jonathan Cohn has a long article in The New Republic called Surgical Prep explaining why now is the time for health care reform and how the brass knuckles approach is being put together to get it done.

I’m not sure I’m there but let’s not underestimate how big a political win this was.

Now, a real bipartisan opportunity in health care exists

Nov 6, 2008• 2

By Robert Laszewski

President-Elect Obama, and about every candidate for Congress, has said he wants to change the partisan tone in Washington. Obama, the Democratic Congressional leadership, and the Republicans have a terrific opportunity to do just that on health care when they all come to Washington early next year.

As I posted earlier, I do not believe there is any chance we can see the enactment of the comprehensive Obama health plan in the near term.

But there are a number of important steps that can be taken next year and each of them have enjoyed strong bipartisan support during the past year: