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HEALTH PLANS: Blue Cross makes about-face on cancellations, with late afternoon UPDATE

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Lisa Girion in the LA Times reports that one of the uglier pieces of health plan activities in recent years may be drawing to a close. Wellpoint’s Blue Cross of California unit has agreed that it will only rescind policies in the future if there is obvious fraud, rather than an explainable oversight or error.

Blue Cross of California agreed Thursday to stop canceling individual health coverage unless it can show policyholder deception — a major shift by the state’s largest health insurer that could lead to sweeping industrywide changes. The move is part of an effort to settle a class-action lawsuit on behalf of as many as 6,000 people canceled since late 2001. It is an about-face for Blue Cross in what had become known as "use-it-and-lose-it" health coverage because the cancellations were often triggered by patients’ claims for treatment.

This is something of an improvement, although of course in a decent world there’d be guaranteed issue and community rating so the whole practice would be moot—and Wellpoint is fighting that in California. However, they need to cut the crap about “only 1,000 policies got rescinded and it’s less than 1%” which comes up in the article again. That’s of course lying with data. The vast majority of people in the individual market who get past the underwriting in the first place are healthy. That’s why the medical loss ratio for BC of California’s individual business is below 60%—yes apparently that’s the number. So there’s likely to be less than 10% of the enrollees and probably close to 5%, who are running up large bills in the first place. Which means that Blue Cross was scouring every one of those applications and canceling some 5–10% of them. They weren’t looking at the applications of the vast majority who didn’t have any major claims.

I still want to see how they settle the individual claimants who busted them for cancellations when BC clearly in error. Or are they in the class action too?

UPDATE: I’m adding this comment from the always sensible Barry Carol: "I wonder how much the new CEO (and former General Counsel), Angela
Braly, had to do with this settlement and whether former CEO, Larry
Glasscock, would have agreed to it. At any rate, it looks like common
sense has prevailed, and it’s about time."

This reminds me that recently Wellpoint changed its bonus structure to relate it to the overall health of their members. I was at a meeting with some Wellpoint employees (in their IT stack) last week, and they highly concerned about what that meant. But perhaps it means that the medical types (presumably led byCMO  Sam Nussbaum) are gaining the upper hand over the financial underwriting types–who’s leader as Barry points out, just got off the ship.

Meanwhile if you want some amusement looks at these comments about what some Wellpoint employees think about the new bonus policy!

POLICY: Podcast with Jon Kingsdale, Massachusetts Connector

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Crossposted from the  Worldhealthcareblog, this is the interview I did at WHCC with Jon Kingsdale, who created and is running the  Massachusetts Connector–the organization at the center of that reform effort. Many of you have many opinions about what’s going on in that state, so now you’ve heard it from the horses mouth, feel free to comment.

Matthew Holt:  This is Matthew Holt, again on the floor at the World Healthcare Blog this afternoon. Coming towards the end of the session, I have Jon Kingsdale with me. Jon is the executive director of the Commonwealth Insurance Health Connector Authority, better known as the Massachusetts Connector. This is the central body in the middle of the new Massachusetts Health Plan arrangement. And Jon gave a very interesting talk about how that is playing out in a session early this morning. So I thought I would grab him and grab a few minutes of his time. So Jon, thanks a lot for doing the conversation.

Jon Kingsdale:  My pleasure.

Matthew:  Let’s start in with the basics. Most people know that Massachusetts has gone in with some kind of individual combined with an employer mandate. And know that there’s some arrangement in the middle of that so people can actually buy into an affordable health plan. There’s been come controversy about what affordable means. But what’s the Connector doing in the middle of all that? What does the Connector do?

Jon:  Well, we have a number of functions, Matt. One is a whole set of regulatory functions to decide some of the tough policy issues, frankly, that the legislature grappled with and decided they wanted to let the next generation of decision makers handle.

Matthew:  Pass-off.

Jon:  You might well say that. I wouldn’t. So those include, what is the affordability schedule? So adults in Massachusetts, starting later in 2007, need to have health insurance if they can find something affordable. Well, given your income, what is determined to be affordable? And what is the minimum amount of insurance that you would have to have? So regulatory policy decisions like that, on the one hand.

And on the other hand, we’re actually running a couple of insurance programs, one that’s subsidized for low-income uninsured. And we set the benefits and the enrollee contribution and actually enroll people, and serve as a market for them. And the other is, private unsubsidized health insurance, particularly for uninsured individuals above 300% of the federal poverty level, who are going to be buying out of their own pocket. And a big piece of what we do there is organize the market for them and try to do almost like some group buying for them. And create sort of a shopping mall for health insurance.

Continue reading…

PODCAST/CONSUMERS/TECH: Interview with Joseph Kvedar, Partners’ Connected Health guru

This is the transcript of the podcast interview I did with Joseph Kvedar, from Partners Center for Connected Health. Coincidentally this past Tuesday in NYC, the Center, along with Continue Health Alliance and others, sponsored a meeting about the use of monitoring devices as part of a general strategy by leading edge employers to try to do something about the management of the chronically ill. There’ll be more from me about that later.

Matthew Holt:  Hi, this is Matthew Holt with The Health Care Blog, and I am doing another podcast. If you are one of those people who thinks that we have too much medical technology and too many medical facilities in America–I am deep in the belly of the beast. Sitting in the middle of the academic medical center triangle of Boston speaking with Joseph Kvedar. Joseph is the director of The Center for Connected Health. He also, for those of you who are paying careful attention, wrote an article in The Health Care Blog about Connected Health, just, I think, a week-and-a-half ago. Joseph, first off thank you very much for hosting me in your office.

 

Joseph Kvedar:  Delighted to be with you, Matthew.

 

Matthew:  You are also the Vice-chair and the Associate Professor of the Residency Program in the Department of Dermatology, so obviously you have a medical background. You know, that it’s not unusual in the AMC for somebody who is an academic physician to be also prodding around in another area. This center was, until recently, called The Center for Telemedicine.

 

Joseph:  Yes.

 

Matthew:  Also it is an integral part of Partners, what you are doing in terms of outreach into the community with technology. Why the change to Connected Health?

 

Joseph:  Well, we felt that most of what we are doing these days is not captured by what people traditionally think of when they use the word "telemedicine." I have spent a lot of in time in meetings over the last few years explaining that. So it just made sense for us to adopt a moniker that was a bit more fresh, a bit more 21st century, and could really allow us to have people engage with us and our vision in a more effective way.

 

Matthew:  That makes a lot of sense. My friends at Cisco think that they invented the term and that the NHS and everyone else is copying them. But the concept around connection and health seems to be really taking off. You can guess if that is a good thing or a bad thing, but I think it underscores a lot of what we are talking about. Now some of the things you brought up in the brief piece you wrote for The Health Care Blog I think are very interesting. Just capture, for those people who haven’t read it, the flavor of what you think the possibility of change that this kind of technology can bring.

 

Joseph:  Let’s use the example of diabetes. So today your average diabetic often views their condition as somewhat of puzzlement, somewhat of an accident. They may or may not understand the relationship between diet, exercise, and glucose. They may or may not understand how changing their activity level can help their condition. They are really left with occasional, brief, hurried visits to their doctor, and a lot of instructions, and often very little in the way of a true relationship or connection with healthcare.Now picture the same individual with a lot of physiologic feedback. Let’s say an accurate step count, once or twice daily a log of their glucose readings that is contextualized with their diet and their activity, and a medication reminder system. And I think that is, for us, all of that is what we mean by "connected health."

Continue reading…

INDUSTRY: You can’t buy publicity like this

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The kids at AHIP and PhRMA must be holding their heads in their hands this morning. Everyone in health care knows that Michael Moore’s Sicko is coming out soon. But in case you thought there wasn’t going to be enough publicity, the US Government has launched an investigation to see whether Moore’s trip to Cuba—where he followed some American patients seeking free care in a publicity stunt—violated US law. Apparently you have to be a journalist to go to Cuba…and by the Treasury department’s definition Moore might not be one.

This is so stupid that you have to believe that whoever launched this in the government is a mole for single payer interests or owns stock in the movie. Moore must be laughing his ass off with delight! 

PHYSICIANS: An Open Letter to Harvard Medical School By Dr. Terry Bennett

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Doctor Terry Bennett
became the focus of national attention two years ago when he brusquely told an
overweight patient that she was fat, warning that unless she changed her
lifestyle she faced serious healthcare problems. The woman complained to the state Medical Board.  Last year, the New Hampshire physician  fought off the attempt to punish him. The
experience convinced Bennett that the practice of medicine in America must change.

Like many physicians he
believes that doctors are treated unfairly and that the healthcare system is on
the verge of collapse.  He argues that
out-of-control HMOs, high malpractice rates and the financial burden of earning
a medical education are ruining the  practice of medicine, creating a generation of
young doctors that has forgotten what makes a doctor a doctor.

Instead of sitting in
his office in Rochester, New Hampshire  and watching it happen, Dr.
Bennett has decided to do something about it by nominating himself for one of the highest profile jobs in
medicine. He recently launched a "write-in" campaign to interview for the Dean’s
job at Harvard Medical School, generally considered the cultural heart of
the medical profession in America. What follows is his open letter to the Harvard
search committee requesting an interview.  For the record, THCB neither
endorses nor opposes his candidacy. We
believe, however, that the views Dr. Bennett expresses are important and worthy of very careful
examination. He also turns out to be a gifted writer, which makes this piece a very compelling read. An insider at Harvard Medical School who must remain anonymous calls Dr. Bennett’s letter "one of the most beautiful pieces of writing on medicine I have ever read." I fully agree. —  John Irvine

To the search committeeHarvard Medical School

I would not press for the job of Dean of Harvard Medical School, at my age, and at my station in life, if I did not think the Dean’s job did not need a rethink, a change from, an inarguably good man, the present Dean and most of his predecessors, to a zealot, of sorts, with a considered and announced, very public, totally non-secret, pro patient anti "money only" agenda, one which will change the life/lives of the man/people on the streets of America, and by extension, the world.

Humor me a little:

Ask the first one hundred people you meet on the streets of Boston if they know the name of the present Dean of Harvard Medical School, or what, if anything, has he stood for, while he has been Dean, and how has his tenure positively impacted/affected their lives and those of their families?

What has the Dean of Harvard Medical School caused in the way of useful change in their lives? What has he changed, for the better, or at all?

I will be surprised if one person in one hundred knows his name, or thinks his existence in any way affects their lives, and so will you.

It is my belief that so much has changed for the worse in American Medicine, that the HMS Dean’s name should be a byword, his/her positions clearly known, and the positions inarguably pro bono publicum, as he/she struggles publicly to change the status quo, tries get the 45 million uninsured into a universal healthcare program of some kind or another, tries publicly to get US drug prices within the reach of patients, tries to get American community hospitals to return to full and fully charitable services offered to their communities, and vows to be producing debt free zealot "gonna go out and change the world" physicians from HMS to go out and effect the necessary change(s), before all is lost, forever.

Continue reading…

PHYSICIANS: Bennett YouTube Interview

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It turns out that Dr. Bennett is also a supporter of
universal healthcare.  He recently attended
a  rally for John Edwards, where Daily Kos caught up with him.

POLICY: Debating the Quality of VA Care By Eric Novack

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The many commenters and contributors
to THCB who have been touting the VA as the pinnacle of US health care—and
basing their conclusion that what we need is not ‘Medicare for All’,
but rather ‘VA Care for All’—have some explaining to do.

In this article, which reports the McClatchy
News Service’s investigation into the claims of the VA—the real
truth is not so rosy.

UPDATE: (5.11.07) Ed comments: McClatchy’s Washington bureau has set up a blog where you’ll find more detail on this story as well as related pieces on the military healthcare system.

POLICY: Freedom of Choice, Good for Education – Good for Healthcare By Eric Novack

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Proponents
of Sheila Kuehl’s ‘Single Payer’ health plan for California like to
lead with the argument that ‘Everybody in, nobody out’ is a good thing.
Of course, many of the same interest groups (ie. powerful lobbying
organizations in California) are vehemently opposed to school choice,
while demanding greater and greater regulations for what it means to be
a ‘qualified’ teacher.

Fascinating, then, the new study from USC’s Rossier School of Education.

The charter schools (read that to mean, more choices for students and
parents) do more with less funds, generally have fewer layers of
administration, and have fewer ‘licensed teachers’.

But it is all about outcomes these days—for both education and health care.
So how do charter schools stack up? From page 6 of the study:
California charter schools typically have smaller per-student
allocations than non-charter schools in their districts, yet charter schools have roughly equivalent levels of productivity: They get “more bang for their buck.”

Choice and freedom, and relieving the burden of excessive regulation and union
and other lobbyist control are good for education. The taxpayer
benefits. The student benefits. Society benefits.

So
why would the nurses union, whose members are on the ‘front lines’ of
healthcare, want to strip all choice and freedom out of healthcare?

H/T to the WSJ editorial page

assetto corsa mods