Whoops. I almost missed this as it went out late last year. Here, at iHealthbeat, is the ever wonderful Jane Sarasohn Kahn’s 2007 Tech Forecast.
Above the Fold
PHYSICIANS: Remember, it’s a FFS world
Remember kids, almost all physicians work in a FFS world. HSC reminds us:
While the proportion of physicians in group practice whose compensation is based in part on quality measures increased from 17.6 percent in 2000-01 to 20.2 percent in 2004-05, far more physicians face financial incentives tied to individual productivity, according to a national study released today by the Center for Studying Health System Change (HSC).
Despite the small but statistically significant increase in quality-related physician compensation, financial incentives tied to physicians’ individual productivity continued to be much more common, consistently affecting about 70 percent of physicians in non-solo practice since 1996-97, the study found. Nevertheless, nearly all physicians with quality incentives also face productivity incentives.
So don’t be surprised about what’s happening.
POLICY/POLITICS: I love the guy’s moxie
Say what you like about Arnold, but you got to give him credit for being a proper flip-flopper with real moxie. While Bush drowns in his stay-the-course quagmire, Arnold has repudiated basically everything he claimed to care about when he first came into office, and is now running like the unaligned centrist everyone thought they were voting for back in 2003.
Today he called for universal coverage based on a comprehensive pay or play, surrounded by an individual mandate. He even brought back the notion of provider taxes, a beast last seen in the wild in the pre-HillaryCare years, but thought to be extinct having been shot by the AMA and AHA back then.
But my favorite of all is the fact that the pay-or-play employer mandate he’s calling for includes all employers with more than 10 employees. In November 2004, just 26 months ago, he told people to veto Prop 72, which had a pay-or-play system for employers with more than 20 employees. Boy, times and people change, don’t they!
POLICY/POLITICS: It’s all the illegal Austrian socialist’s fault
It’s all quite amusing. You wouldn’t know it, but there are no problems with health care in California, and what Arnie did yesterday was a display of showing his true feelings—a combination of handouts to illegal aliens and an introduction of European socialism.
At least that’s what you’d think if your only source was reading the Los Angeles Times reader comments about the proposal. Methinks that the FreeRepublic or Michelle Malkin crowd was sent over there….
(BTW I’ll be writing more about the Arnie plan at Spot-on tomorrow, but I wrote most of what I think the result will be there last week)
TECH: Healthcare Blogger and Reader Meet-up at HIMSS in New Orleans
Shahid Shah is the official HIMSS blogger, and he’s running a meet-up. When will it be? Depends on when you want it. Go to his site and have your say….Healthcare Blogger and Reader Meet-up at HIMSS in New Orleans
HEALTH PLANS/POLICY: And it’s a right, and a left, and another right–I’m not sure he can take any more…
You’d think the LA Times’s Lisa Girion would have had the human decency to stop beating up the health insurance industry. It’s getting close to the time when the referee should step in to save the insurers from further punishment. But oh no, it’s haymakers landing on the chin time after time.
This time she uncovers another little nuance about why the individual insurance market is such a disaster—entire classifications of occupations are automatically disqualified. Good article, go read it.
I’m reminded of two things. One, back in 1991 Mary Ann O’Sullivan then (I think) of Health Access gave a speech in which she described exactly the same thing. She quoted one insurer denying used car salesmen insurance because “you just can’t trust those people!”
Two, I paraglide, and on the paragliding list in a discussion about how to make sure that your health insurance covered paragliding we got a beautifully naive question from a recent immigrant from (I think) Hungary where the national paragliding association groups together and buys health insurance for its members. He suggested that the US national association did the same thing as the Hungarians! Some of us on the list suggested that this might not be the best way to go about finding affordable insurance.
TECH: Nerd med student builds “the GMR, An EMR That Doesn’t Suck”
Graham Walker, Stanford med student and blogger, is such a nerd that he’s built what he thinks is a better interface for an EMR–trying to make it a true desktop work-tool using Web2.0 type tools.
I’m not an expert on EMR interfaces, other than knowing most docs don’t like them, so go to his web site, and take a look at the movie demo. This may be how progress gets made.
Anyway, go take a look if the EMR in actual use is your bag.
POLIC: Tom Tommorrow explains how to get health care
It may be a cartoon, but it’s not really a joke.
TECH/CONSUMERS/BLOGS: Information Therapy and Other Ways to Change the World
Josh Seidman, the President of the Center for Information Therapy, and someone I must confess to knowing and liking, has descended into the mire and started his own blog. He told me that a friend had suggested it to him—I told him his friend can’t have liked him very much!
The blog is called Information Therapy…and Other Ways to Change the World. I must also confess that I’m partly responsible for the recent entry on PHRs as I’ll be a presenter with Josh at a webinar for the Center on PHRs and Information Therapy which is coming up on Tuesday January 23. The idea is that we’d generate a little interest and get a few potential new members for the Center to listen in. I was hoping to invite THCB readers to fill out the crowd. But within 12 hours of sending out the announcement, they’d had more than 100 sites sign up, which means that we’ll have to do it twice at least, and I’m not sure there’ll be room for any more.
I’d like to think that Josh and I are such a draw that we’re responsible for the crowd. But I tend to think that (in my view 6 years too late!) the PHR is finally starting to get the attention it deserves. If you are really keen to attend, send Dorothy Jeffress at the Ix Center an email, and she’ll see if she can squeeze you in.
TECH/CONSUMERS/HEALTH PLANS: Not much employer backing for HSAs
Those of us who feel that the CDHP movement is largely being used as cover by employers for reducing the benefits (i.e. compensation) that they’re paying employees will not be too surprised by this new analysis. The source, Vimo, though is somewhat surprising for two reasons. First, it’s a little technology start-up that’s providing comparison shopping for health, and second—as is clear when you listen to the interview I did with CEO Chini Krishnan—they are more than favorably disposed to the notion of individuals doing their own shopping for not just health insurance but all types of medical goods and services. So it’s hard to imagine them benefiting from bad news about HSAs. Yet what they’ve discovered, confirming research done by the more usual suspects such as HSC, is that as employers convert their benefit offerings over to the HDHPs, they are not funding their employees’ HSAs.
Here’s the key part from their analysis:
First, the difference (in numbers) between HDHP (3,168,000) and HSA (820,000) means that there are a lot of individuals within the group and individual markets who aren’t opening HSAs, even though they’re entitled to them. Second, HSA asset levels are also lackluster. The same AHIP study lists the average HDHP deductibles as HDHPs $2,378 for single coverage and $4,760 for family coverage. The average HSA balance in the Inside Consumer Directed Care survey ($1,180) is less than fifty percent of the average deductible for single coverage.The simple fact is that HSA creation and asset levels are lagging HDHP enrollment by a significant margin.
And realistically given that some people are funding their full HSAs, given that the average is well below half the maximum, the median HSA account probably contains close to $0. What’s going on then? Well Vimo knows the answer.
Certainly there are immediate and significant savings available when companies or individuals migrate to HDHPs. This cost differential can be pocketed as a one time gain, or it can be used to fund most or all of the HDHP deductible by depositing the difference into an associated Health Savings Account. It would seem that many employers are opting for the one time gain.
If you’re in a business which depends on these accounts and CDHPs being adopted by a bunch of happy consumers, you can see that there is plenty of potential for angst amongst employees who discover that the move to the CDHP is basically telling them that they have to dip into their own pocket for something the company used to provide. In what is a very considered and well put-together report—which I’d recommend you read all of—Vimo discusses the impact of this “transfer” on both consumers and employers. And true to their business model they are squarely on the side of looking out for consumers and employees.
I approve of them telling the truth, even if it’s a truth that opponents of the CDHP movement will highlight. After all, if this thing is done wrong, the longer term political consequences may be a future in which there is no such thing as a high-deductible plan or HSA—and that will leave Vimo with a whole different business problem.
