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Health care coverage restored — good for patients, maybe too late for plans

• 1

By Matthew Holt

Saint Lisa Girion (and I say that without a smirk on my face!) reports in the LA Times on the latest chapter in the story she started about the ongoing saga of the retroactive cancellations of health insurance by all the big players in the California individual market.

Now Kaiser Permanente (which really should have been above this type of a mess in the first place) has decided to reinstate over a 1,000 of its cancellations, and Health Net, which was fined $9m in arbitration for one cancellation alone, has added a few more. This will intensify the pressure on Wellpoint, United Healthcare, and Blue Shield (the only one still fighting for the right to rescind coverage retroactively) to similarly cave. Kaiser, by the way, is also paying a paltry $300,000 fine. Health Net must be envious.

However, even if the others cave in and reinstate coverage, and pay for claims they previously denied, there are three remaining issues dangling from the controversy.

First, the Department of Managed Healthcare, which brokered the Kaiser deal, only regulates HMOs. Some “insurance” companies, like the Wellpoint and Blue Shield subsidiaries which did some of the cancellations, are regulated by the elected State insurance Commissioner Steve Poizner, who despite the R after his name, has been very aggressive in going after them. Adnd the City Attorney of Los Angeles, Rocky Delgadillo, is suing Health Net and Wellpoint in related cases. So the insurers legal problems with the government certainly aren’t over.

Then there are the lawyers. William Shernoff, the attorney who’s been going after Wellpoint since the stories first came out, told the LA Times that …

He would tell clients to "accept the reinstatements because that’s wonderful to get the medical care — that is important." But, he added, "as far as damages for past harm, there’s no doubt in my mind that the best place for them to get their full damages will be in court rather than in an arbitration process."

In other words, the plans can’t get away with just paying back what they owe. Shernoff is still coming after them for more. And $9 million multiplied by lots of cases smells very tempting to a lawyer who knows he’s on the winning side.

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Bitter doc wants more respect for primary care

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By Sarah Arnquist

A primary doctor ranted anonymously this weekend on Kevin MD’s blog about the lack of appreciation for primary care in his small Midwestern town and predicted its future demise.

The doctor practices in a medical shortage area, where the hospital administration has failed to sufficiently recruit and retain hospitalists. Here’s a portion of what he wrote:

"Not surprisingly, the recruitment and retention problem hit the hospitalist program simultaneously. Three hospitalists are now expected to manage 24-hour coverage with no relief in sight. And instead of offering the degree of compensation necessary to bring more physicians on board, the administration exploited the sense of crisis to convince the medical staff to consider opening the doors to Advanced Practice Nurses. This was the only solution, we were told, to the hospitalist shortage. The only way to stop taking extra call for free.""At this meeting, 100% of the subspecialists voted for allowing APNs to practice in the hospital. 75% of the primary care physicians dissented. The vote was overwhelmingly in favor of the measure. This happened in a system where some primary care doctors are making less than they would if they took a new position in a major city, and more than a couple subspecialists make seven figures. The abandonment of the greater medical good by our specialist friends eager to expand their already-overflowing coffers has filled me with renewed vitriol."

His rant has struck a chord in the medical blogosphere.

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More opportunity for online health management

By Jane Sarasohn-Kahn

Consumers, at least Californians, do a lot of looking for health
information on the Internet — but very little health management.

California HealthCare Foundation (CHCF) has taken a snapshot of
Californians’ use of the Internet in health care. The profile is
presented in CHCF’s report, Just Looking: Consumer Use of the Internet
to Manage Care.

Topline: insured, more affluent, and younger people use the Internet in health searching.

Chcfimage

As the chart at right details, the most popular care-related uses on the
Internet include searching for information about conditions and drugs,
finding a physician, checking ratings, and looking for claims and
benefit information online.

Some 13 percent of Californians are lucky enough to be making appointments online, and 12 percent are filling Rx’s online.

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New demands of ‘Millennial patients’

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By THCB Staff

"Millennial patients are the first generation of Americans to grow up with the Internet as a pervasive part of their lives. … They are amazed, bewildered, and ultimately angry with the inability to access their health care services in this way. They cannot understand, and they will not tolerate, this disparity in the ability to manage health care transactions as simply as they manage their financial transactions."

Those are the words of regular THCB contributor Scott Shreeve in an article he wrote for the April issue of MDNG magazine. Shreeve adeptly describes the next generation of patients, whom he calls millennial patients. All at once, he says, they are consumers, providers and partners in managing their health.

Then, he talks about what it means to be a millennial provider in a new technology-dependent world. Shreeve says the health care industry’s initial lag in adopting health IT can play out to its advantage — so long as it hurries up.

"By observing the wider technology adoption patterns in fast-adopting industries like  financial services, we can reliably predict what trends will soon be impacting health care. We can also get a  sense of how consumers, traditionally called patients within health care, will respond as they adopt—and push their providers to adopt — the technologies that will simplify their health care interactions."

Implications of McCain’s plan analyzed at Spot-On

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By THCB Staff

Over at Spot-On, Matthew predicts what would happen if Sen. John McCain were to win the presidential election this fall, and the Republicans took Congress, and they passed his health plan.

Matthew describes the basic tenets in McCain’s plan and their implications in (nearly) jargon-free lingo, and then concludes, "His halfway solution is worse than no change."

Health 2.0 Consciousness Dawns – Even In Jacksonville, FL!

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by BRIAN KLEPPER

Today, Matthew, Michael Millenson and I are converging at a Robert Wood Johnson Foundation conference on public reporting of health care pricing/performance information in Amelia Island, FL, three short barrier islands north of my home in Atlantic Beach. (Always helpful, Michael suggested to the conference organizers that I should be required to walk or take public transportation, to compensate for the fact that everyone else has to come in by airplane.)

In any case, we decided that we might as well seize the opportunity and hold a short symposium on market-based transformation for the Northeast Florida health care and business communities. Dean Chally of the University of North Florida’s College of Health graciously arranged the space on their beautiful campus, and so we’re set for a 7:30AM, 2 hour conference on Friday May 16th–that’s tomorrow.Michael will talk about public reporting, Matthew will present on the consumer side of H20, and I’ll hit H2O business-to-business analytics, the emerging medical home movement, and some wellness/prevention approaches that are gaining traction. Should be a fun morning. If you’re in the neighborhood, be sure to drop by and join us.

POST-MORTEM: California health reform

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By Sarah Arnquist

The debate over why health reform failed in California sparked up again following the release of a Field Poll in late April that found that nearly three-quarters of California respondents supported Gov. Arnold Schwarzenegger’s plan.

Following the poll’s release, Schwarzenegger told
the Associated Press he’s not giving up and will push his $14-billion plan forward. Despite his optimism, most
wonks in Sacramento have called it dead at least though 2009.

In a recent column, Sen. Sheila Kuehl, D-Santa Monica, diverts any blame for the reform’s failure from the vehemently opposed single-payer coalition, which she leads from her perch as chair of the all-powerful Senate Health Committee and author of the single-payer bill SB 840. Kuehl blames reform’s failure the governor’s unwillingness to challenge the insurance companies."In fact, the Governor’s plan appropriately fell," Kuehl writes, "because of the Governor’s own reluctance to make the difficult policy decisions necessary for the plan to be in any way affordable to the state as well as to businesses and individuals, but which would have stirred up strong opposition from insurance companies."

Well, not everyone agrees.

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A business plan to make pregnancy safer

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By Sarah Arnquist

India successfully test launched a ballistic missile last week that could strike Beijing on a moment’s notice. Yet, 120,000 women here die annually giving birth.Lifespringmom

How does a country with the technology to produce nuclear weapons and launch ballistic missiles also have  the highest maternal mortality rate in the world? It’s 10 times higher than China’s.

LifeSpring Hospitals Ltd. aims to make a dent in India’s abysmal maternal and infant mortality rates by providing high quality care at affordable rates to lower middle-class women. The chain of maternity and children’s hospitals officially launched last year and has the ambitious goal of operating more than 30 hospitals in three years.

(I’m volunteering at LifeSpring’s corporate office in Hyderabad for two months before heading to grad school.)

LifeSpring charges about $40 for a normal delivery and a two-night stay in its general ward. A private room costs $120. LifeSpring promises its families, who earn about $2 to $4 a day, they won’t be inundated with unexpected costs. The prices are posted on the waiting room wall.

LifeSpring isn’t a charity. This is a for-profit business that believes making money is the only way to guarantee a sustainable future.

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