Will Healthcare Reform Take Hold?

patchwork-nationI am following the health care reform budget story from a number of sources this morning, here’s one idea that I find interesting:

Dante Chinni Writing for the Christian Science Monitor: “Say this for the Obama administration, you can’t fault it for lacking big ideas. Following a speech full of big thoughts Tuesday night, the president released a budget proposal Thursday full of big numbers – a $1.75 trillion deficit, $2 trillion in cuts.”

“But the number that garnered some of the biggest attention was actually a “smaller” one – a $634 billion reserve fund for healthcare reform. The proposal made it clear that on top of handling an epic economic crisis, President Obama wants to take on one of Washington’s most discussed and thorniest issues.”

Chinni then acknowledges that finding consensus on a universal healthcare is going to be difficult and points to the Patchwork Nation demographic data that can be viewed on the csmonitor.com website. Patchwork Nation has identified 11 voter communities across the U.S., each with its on characteristics.

Writes, Chinni, “Yet as we know in Patchwork Nation, that big macro picture misses a lot of micro differences. For example, the percentage of uninsured people varies greatly from place to place.

Look at our “Service Worker Centers.” These are small towns with lots of small businesses, meaning that a lot of people who live there lack insurance.

Nationwide, “Service Worker Centers” contain 12 million people, spread over 278 counties.

Other communities, however, experience a very different reality with healthcare.

Our “Monied ‘Burb” communities, for instance, tend to hold more people with college degrees. They also have nearly twice as many people in professional jobs as the average US community does, and such jobs are more likely to offer healthcare. In other words, these communities may be less interested in large-scale healthcare changes.

And a lot of people live there – more than 84 million people. That translates to lots of votes in Congress.

Like Chinni, I will be checking in with the Patchwork Nation communities throughout this debate to gauge reactions. I also agree with Chinni’s assessment that  ultimately, the success of the White House’s healthcare plans may hinge on just how much the current crisis affects attitudes in the “Monied ‘Burbs” and other communities where people still have insurance.

New Tracking Poll Reveals Public’s Health Experiences and Views on Reform

The Kaiser Family Foundation released its first health care tracking poll of 2009 and the results show that a majority (62%) of Americans say that the country’s economic problems make it more important than ever to take on health care reform. They also say that if policymakers made the right changes, they could reform health care “without spending more money to do it.

The survey, conducted February 3 through February 12, 2009, among a nationally representative random sample of 1,204 adults, also found that seven in 10 Americans (72%) have a “great deal” or “fair amount” of trust in President Obama “to do or recommend the right thing for health care reform.”

The survey also explored what Americans hear when policymakers talk about health care reform. It fund that they predominantly are thinking about cost and coverage. When asked what “health care reform” means to them, 40 percent of the public respond with a cost concern – people paying less for care, care being more affordable, or lowering the prices of medical goods such as prescription drugs. Just as many (39%) describe reform as providing insurance to more people or helping the uninsured. Quality or delivery system reform did not leap to the minds of Americans with only nine percent mentioning it in their responses.

Furthermore, the survey found that slightly more than half (53%) of Americans say their household cut back on health care due to cost concerns in the past 12 months. The most common actions reported are relying on home remedies and over-the-counter drugs rather than visiting a doctor (35%) or skipping dental care (34%). Roughly one in four report putting off health care they needed (27%), one in five say they have not filled a prescription (21%), and one in six (15%) say they cut pills in half or skipped doses to make their prescription last longer.

Beyond actual financial hardship due to medical care, the survey also indicates a rise in worries associated with health care costs. Nearly half of Americans (45%) report they are “very” worried about having to pay more for their health care or health insurance, the highest proportion measured in Kaiser polls since late 2006. Roughly four in 10 (38%) are very worried about affording health care they need-a number that rises to 56 percent among those who believe someone in their household will lose a job this year.

The full question wording, results, charts and a brief on the poll can be viewed online at http://www.kff.org/kaiserpolls/posr022509pkg.cfm.

HSA Health Plans After Four Years.

Benjamin Zycher, a Senior Fellow, Manhattan Institute for Policy Research has published a paper called: HSA Health-Insurance Plans After Four Years: What Have We Learned? In this paper, Zycher notes that it has now been four years since the legislation was passed allowing the establishliment of Health Savings Accounts (HSAs) which are are financial instruments linked to high-deductible health insurance plans (HDHPs). They allow households to set aside tax-free funds for routine medical expenses.

The report says that these policies are now used by over 6 million U.S. residents and that their use is growing at a rate higher than the one at which the assets in individual retirement accounts (IRAs) accumulated in the first years following their authorization. The researchers also found that HDHPs cover preventive-care services (physicals, immunizations, and other recommended screenings) at a rate that other types of insurance do.

This paper’s chief findings regarding HSAs are the following:

  • The number of individuals covered by HSA-qualified and high-deductible health plans, as a proportion of all those covered by private insurance, shows a rate of growth slightly higher than the rate at which the quantity of assets in IRAs in their early years reached an equal fraction of total retirement assets. (The latter criterion is used in the absence of enrollment figures.) The early data on defined-contribution assets as a proportion of total retirement assets are more difficult to interpret, but the data on the whole suggest that HSA-qualified health coverage has the potential to expand at least as sharply over time as IRAs and defined-contribution retirement plans did, assuming conducive legal and regulatory developments.
  • Suggesting even further room for improvement, survey data indicate that relatively low percentages of consumers are “extremely or very” familiar with HSA-qualified health coverage or find such plans “easy to understand.”
  • Less than half the funds in HSA accounts in 2007 were expended on health care, demonstrating these accounts’ viability as savings vehicles.
  • Premiums for HSA-qualified policies are significantly lower than those for other types of plans-by about 10 percent to 40 percent.
  • A wide range of preventive-care services counts toward plan deductibles (or are covered on a “first-dollar” basis) under most HSA-qualified policies. Unsurprisingly, the rates at which enrollees in HSA-qualified plans draw on preventive care or rely on treatment of chronic illness are roughly equal to the rates shown by policyholders in comprehensive plans.
  • While the ceiling for out-of-pocket spending by holders of high-deductible plans (including HSA-qualified plans) covering workers and their families tends to be higher than it is for other types of health plans (although the available data do not allow an estimate of how significant that difference is), there is some evidence that higher deductibles are almost entirely responsible for higher out-of-pocket expenditures. Out-of-pocket expenditures are, of course, only one element of total plan costs. The data for coverage purchased in the non-group market are more mixed.
  • For both covered workers and individuals, deductibles for HSA-qualified policies are significantly larger-by multiples of 1.2 to 4.7-than the deductibles for the other types of health coverage plans. But the deductibles for HSA-qualified plans recently have risen much more slowly.
  • Because spending on chronic illness, unlike spending on prevention under most HSA-qualified plans, does not enjoy first-dollar coverage, the chronically ill would be likely to draw down their HSA funds before they have time to accumulate. Even so, the right combination of a given plan’s deductibles, its out-of-pocket ceiling, and the marginal tax rate of a chronically ill person could make HSA-qualified coverage a better bargain than a traditional comprehensive insurance plan.

This is one of the most thoroughly documented studies of HSAs that I have seen published anywhere. This is certainly a keeper document for anyone interested in these types of health plans. Click here to link to the page and bookmark it.

http://www.manhattan-institute.org/html/mpr_08.htm

Sebelius at HHS. What Might it Mean?

The New York Times and Reuters are reporting that Kansas Governor Kathleen Sebelius has emerged as President Barack Obama‘s top choice for health secretary.

So what might this mean? Tom Daschle had written an entire book outlining his thoughts on healthcare reform. On the other hand, Sebelius has a record of eight years as Kansas Insurance Commissioner and two terms as Governor to review for clues on how she might try to steer healthcare reform at the federal level.

One thing we know about Sebelius is that she is a moderate Democrat from a mostly Republican state and an Obama ally, who has often been mentioned as a possibility for his Cabinet.

Here are some key healthcare initiatives that Sebelius has introduced to Kansas:

  • Under Gov. Sebelius Kansas streamlined and consolidated its health care purchasing into a single division. http://bit.ly/14tq4a
  • Gov. Sebelius organized a Cost Containment Commission of business leaders, providers, insurers, and patient advocates. http://bit.ly/14tq4a
  • KS now participates in the I-Save-Rx initiative, to buy drugs from state-approved pharmacies in Canada and Europe. http://bit.ly/14tq4a
  • This past year, Gov. Sebelius urged the Legislature to insure all Kansas children from birth to age five. It failed. http://bit.ly/14tq4a
  • Gov. Sebelius proposed state-subsidized private insurance plans for small businesses that didn’t offer health insurance. http://bit.ly/GRlkX
  • Gov. Sebelius proposed to fund KS health care reform with a $50 million tax increase on cigarettes and tobacco products. http://bit.ly/GRlkX
  • Gov. Sebelius’ critics complained the least expensive carton of cigarettes isn’t in line with neighboring states and Indian reservations.
  • Gov. Sebelius asked for a commission to seek ways to drive down the administrative costs of health care. http://bit.ly/GRlkX

This record seems to be consistent with President Obama’s promise to make healthcare reform evolve form the current employer-sponsored system with a hint of consumerism. It also points perhaps to a federal charter for health plans with a nod to promoting wellness and streamlining administrative costs.

Stimulus Package Leads to Duty to Die?

I have been reading a lot on blogs and websites this past weekend about how the stimulus package just passed by Congress is gong to lead the United States strait into a “European system of free heath care for all, a rationing of health care, and even something called “Duty to Die” meaning that someday the “United States Government will determine that you have a ‘duty,’ an obligation, to die.”

After seeing so many of these opinion pieces I began to scratch my head.  Yes, Congress has included some healthcare provisions in the stimulus package, but mostly they attempt to alleviate some the the growing health coverage issues now being exacerbated by the growing unemployment rate, certainly an economic issue. But, how has this turned into doomsday scenarios where senior citizens are being euthanized by government decree?

It was certainly a relief to this morning run across a well researched article appearing in the  Billings Gazette. Maybe it is the clear Montana air, but something has given Mike Dennison, a writer for the Gazette’s State Bureau, the courage to actually pull back the covers on these monolithic, unfeeling European heath systems and get a good look at  how they came about and how they actually work.

What Dennison found is that there are quite a few differences in the plans and that they all came about as a reflection of the culture and circumstances the countries found themselves in at the time they were instituted.

For example, Dennison tells us that Great Britain and France built their systems out the the destruction of World War II. Each country took a different approach to providing health care to it citizens. Each one is working reasonably well for their citizens.

Another, European country, Switzerland,  had a track record of private health insurance coverage, and has achieved universal health coverage by requiring all citizens to buy private insurance. Subsidies are provided to limit the cost, according to one’s income. Does this system sound familiar to anyone in Massachusetts?

After a quick look at the Canadian system, Dennison returns to the United States and concludes that healthcare reform in this country, like elsewhere ,  will undoubtedly build on top of our current system which happens to one that combines a public/private approach to providing health care.

Dennison references  U.S. Sen. Max Baucus, who has taken a leading role in national health care reform. Baucus, who is also from Montana, recently published a white paper entitled Call to Action, Health Reform 2009, where he lays out his vision for healthcare reform.

Dennison sums up Baucaus’ approach as one that plays off the mixed-bag of programs the U.S. currently has in place.

“His general proposal would expand Medicare and the Children’s Health Insurance Program, two taxpayer-funded insurance programs (like Canada). It would strengthen the Veterans Administration and Indian Health Service, which are socialized systems serving a specific population (British model). It would require people to buy private health insurance, while leaving in place our current system of employer-based insurance (France and Switzerland).”

Dennison goes on to write, “This “Baucus approach,” which also resembles the approach favored by President Barack Obama, is a cautious one, which isn’t necessarily bad.”

I think that this is the conclusion that most reasonable people would draw if they bothered to look at the facts, as Dennison has done, rather than jump to their keyboards to spread fear as many of the bloggers and option writers are now doing.

A Twitter “friend” of mine commented over the weekend that this is “Harry and Louis on steroids.”

We can only hope that more responsible journalists, bloggers, and opinion writers will take the time to explore this issue the way the Mr. Dennison has and that we can have a healthcare reform debate based on facts and not fearf-spreading speculation.

By the way, if you are interested in reading hte New Yorker article that provided much of Dennison’s background, it can be found at: http://bit.ly/DU6gr

Universal Healthcare is Not a Dirty Word.

Now that the stimulus package has passed Congress and awaits the President’s signature, the debate has started in earnest about the how to address health care reform. I think most reasonable people agree that our current system falls short on three major tests: access, quality, and cost. Where reasonable people disagree is in how to solve for these shortfalls.

One side argues that the United States should abandon the existing employer-based system for a government-run, single payer system. This is no doubt a very costly approach and one of which most Americans will not approve.

On the other side, there is a call to allow free-market approaches to work to solve the problems in healthcare. Let’s face it, the free market has now had over 50 years to work this out, and we still have problems with access, quality, and cost.

Today, there are 47 million American who do not have health care coverage. Yes, many choose not to be covered. So, let’s agree that the real crisis is not the uninsured, but the uninsurable. These include those who have pre-existing health conditions and who cannot buy health insurance at any price, unless they work for an employer who offers coverage. Many more are disabled, work for employers who do not offer coverage, are among the growing ranks of the unemployed, or simply cannot afford coverage.

I am potentially one of these. As a cancer survivor, and a person over 50 who is otherwise in great shape, I am dependent on staying employed by an employer that offers me affordable heath insurance, and fortunately I am. Still, I am limited in my options and my family is at risk. Early retirement is not an option, starting my own business is not an option, and if I were to lose my job, my wife, children, and I would be left no health insurance. It can a very fast slide into desperation for many who thought they were solidly in the middle class.

So, let’s have the debate begin. How do we improve healthcare access, quality, and affordability? But, if you are going to engage in the debate, let’s agree on one basic idea:

Universal Healthcare is not a bad word. It does not automatically mean “socialized medicine” or government-run, single payer system.

Standardized Patient Health Insurance Identification Cards get a Boost.

mgma-cardStandardized patient health insurance identification cards got a big boost earlier this month when it was announced that Humana had joined United HealthGroup by pledging its support to the Medical Group Management Association’s, (MGMA’s), Project SwipeIT.

According to the MGMA website, Project SwipeIT “is a health care industry-wide initiative meant to advance the adoption of standardized patient identification (ID) cards containing WEDI compliant, machine-readable information.”

mgma-backA news report carried by aafp.org, said that Project SwipeIT, launched in late January, and is an industry-wide initiative to advance the adoption of standardized patient health insurance ID cards containing machine-readable information. As part of the project, MGMA has asked health insurers, vendors and health care providers to work toward supporting the standardized cards by Jan. 1, 2010.

The aafp.org story notes that the new ID cards are designed to provide real-time patient information at the point of care. The cards comply with standards developed by the Workgroup for Electronic Data Interchange, which should ensure uniformity of information, appearance and technology.

The MMGA website says that everyone will benefit from using the cards. Patients will have less hassle from denied claims. Providers will save money on labor and copying, and will get paid more quickly and accurately. Insurers will save by doing less manual work on rejected claims. Ultimately, employers should see savings from less growth in health care costs.

MGMA estimates that machine-readable patient ID cards could save physician offices and hospitals as much as $1 billion a year by reducing unnecessary administrative efforts and denied claims.

The cost of a WEDI-compliant, machine-readable card is 50 cents - only a fraction more than the nonstandardized, plastic or paper cards that most insurers use now, according to MGMA. The group maintains that the savings that insurers will see from reduced claim denials, provider inquiries, re-work and labor will far exceed this cost. As for the providers, MGMA says that a card reader to scan the new cards costs less than $200.

MGMA is asking insurers to agree to issue WEDI-compliant, machine-readable cards by January 2010Standardized patient health insurance identification cards got a big boost earlier this month when it was announced that Humana had joined United HealthGroup by pledging its support to the Medical Group Management Association’s, (MGMA’s), Project SwipeIT.

According to the MGMA website, Project SwipeIT “is a health care industry-wide initiative meant to advance the adoption of standardized patient identification (ID) cards containing WEDI compliant, machine-readable information.”

A news report carried by aafp.org, said that Project SwipeIT, launched in late January, and is an industry-wide initiative to advance the adoption of standardized patient health insurance ID cards containing machine-readable information. As part of the project, MGMA has asked health insurers, vendors and health care providers to work toward supporting the standardized cards by Jan. 1, 2010.

The aafp.org story notes that the new ID cards are designed to provide real-time patient information at the point of care. The cards comply with standards developed by the Workgroup for Electronic Data Interchange, which should ensure uniformity of information, appearance and technology.

The MMGA website says that everyone will benefit from using the cards. Patients will have less hassle from denied claims. Providers will save money on labor and copying, and will get paid more quickly and accurately. Insurers will save by doing less manual work on rejected claims. Ultimately, employers should see savings from less growth in health care costs.

MGMA estimates that machine-readable patient ID cards could save physician offices and hospitals as much as $1 billion a year by reducing unnecessary administrative efforts and denied claims.

The cost of a WEDI-compliant, machine-readable card is 50 cents - only a fraction more than the nonstandardized, plastic or paper cards that most insurers use now, according to MGMA. The group maintains that the savings that insurers will see from reduced claim denials, provider inquiries, re-work and labor will far exceed this cost. As for the providers, MGMA says that a card reader to scan the new cards costs less than $200.

MGMA is asking insurers to agree to issue WEDI-compliant, machine-readable cards by January 2010.

New Marketing Tool Captures Brands’ “Share of Voice” on the Social Web.

When my call went out a few weeks ago to find health plans that were using social media as a means of engaging their members, one of the people who got in touch with me was Gretchen Miller of Vitrue, Inc.

Gretchen was quick to tell me that, while she was not with a health plan, she did have a tool that could tell me which health plans are doing well in this space.

Gretchen is with a firm called Vitrue, a social media marketing company for the Fortune 1,000, that provides a comprehensive social media marketing approach with a core technology platform to help brands launch campaigns, communities, Facebook applications, and just maintain an overall social presence on the web.

Gretchen told me that Vitrue had recently launched the Vitrue Social Media Index (SMI), which is designed to capture a brand’s share of voice on the social web. She told me that if I could give her a list of health plans that are using social media , she could give me measurements of their success in terms of their being present on sites like Facebook, MySpace, Twitter, YouTube and others.

Gretchen went on to explain that many of her firm’s clients struggle with social media issues such as:

  • Social media is too new and changing too fast for me to understand how to use it?
  • I know social media is important to my brand, but how to measure it?
  • There is too much data, what does it all mean?

The SMI was created to help answer some of these questions.

Gretchen said, “SMI is a simple, yet powerful tool to help marketers understand how their brand stacks up to their peers/competitors in the social space. It includes data from the most important social media sites on the web including blogs, video and photo sharing sites, social networks, and micro-blogs.”

But, SMI is more than just a snapshot in time; Gretchen said that it also provides trends, allowing brands to see how “social share of voice” fluctuates based on marketing campaigns, competitors’ activities, and external events. You can see tool at http://vitrue.com/smi/.

So how do various health plans stack up in their social networking activity? I provided Gretchen with a list of health plans. Some of them I have written about in this blog regarding their use of social media. Others were brands that I selected because they are well known names nationally or regionally. The chart below shows how they stacked up.

vitrue-smi-health-care-providers-jan-feb-2009

What the SMI tool found was that, right now, Humana has a commanding presence on the social web with this competitive set.

You can also dig in and see Humana’s SMI score as of today, by going to:

http://vitrue.com/smi/?q1=humana&q2=

Here is the breakout on where Humana has a presence on social media sites as of February 6, 2009:

  • 47.13% video sharing sites
  • 28.81% micro-blogs
  • 2.73% photo sharing sites
  • 9.87% on blogs
  • 11.48% social networks

Fun stuff and a great tool for bring some classical marketing measurements to these fast evolving new media.

If you are looking for more insight into social brands check out The Vitrue 100 – Top Social Brands of 2008 at http://vitrue.com/blog/. Any guesses as to which brand was #1?

Website Helps Patients and Physicians Determine Fair Healthcare Pricing.

logo-full2Jeffrey Rice, MD, JD, trained at Duke University as a radiologist, but while still in residency his career took an atypical turn. Rice got involved in the project of linking the Duke University Health System with an insurance company to put together a managed healthcare plan.

That experience caused Rice to become interested ways of helping consumers learn how to talk about the quality of medical care that they received. That led to the development of CareSteps.com, a technology company that was eventually acquired by Healthways, the country’s largest disease management company.

With two successful company launches under his belt, Rice said he realized something about healthcare that had not been clear to him before. He said he began to understand that “when healthcare providers did not complete on price, they also didn’t compete on quality either”.

Rice said that the obvious examples of heath care providers competing on price are those who are generally not compensated through insurance plans such as cosmetic and lasik eye surgeons. Rice said that these two areas of medicine compete on price which also forces them to compete on quality.

So, Rice reasoned, if we can get providers to compete on price, it just might also raise the standard of care. Out of this line of thinking came HealthcareBlueBook.com, a free online guide to fair health care pricing.

Rice said, “If you pay for your own healthcare, have a high deductible or need a service your insurance does not fully cover, we can help. The Blue Book will help you find fair prices for surgery, hospital stays, doctor visits, medical tests and much more.”

The concept is simple, just enter your zip code and the type of physician’s visit or medical procedure that you need and the Blue Book will return the “fair” price for that service in your area.

For example, enter Colonoscopy (no biopsy), and the zip code 66210, and the Blue Book will return the following prices for each of the components of the procedure:

Physician fee: $476

Facility Services: $373

Anesthesia Services: $439

Rice said that the pricing is based on a mid-level price that a typical Preferred Provider Organization (PPO) would pay for the service after taking a discount from billed charges.

“Heath care pricing has a problem,” Rice noted. “Providers give their best prices to their worst customers. The lowest discounts are given to health plans that require the provider to do a large amount of paper work and then wait for reimbursement. The Healthcare Bluebook is a way for consumers and providers to quickly determine what a fair cash price would be for any particular service.”

Rice said that since the Healthcare Blue Book was released in early January, he has received very positive feedback from consumers and providers alike. “We know that people are using the site both before and after obtaining medical services.”

Rice said that he has also received interest from large employers who have embedded the Healthcare Blue Book into the benefits portals that their employees access for healthcare information.

Another group showing interest in the website are physicians who view the site as a potential source of new patients who are willing to pay cash for services if they are able easily negotiate a discount from full billed charges. The Healthcare Blue Book provides an easy an independent way for both the provider and the patient to determine a fair price.

Rice said he is already working on new ways to use the data and to create tools that will push this information to consumers at the time they need the information most. In the meantime, Rice still hasn’t gotten around to starting that medical practice.

Experiment Could Change Healthcare

There is a big experiment currently underway in the Arizona desert. No, it does not involve the testing of the latest stealth aircraft, but it does involve two giants in their industries and the results could change the way we manage healthcare in this country.

The New York Times reported that I.B.M. and giant insurer UnitedHealth Group is testing a new model of health care that many policy experts say holds great promise but has yet to prove itself.

According to the Times:

“The new approach, which is also being tested in various guises by other insurers around the country, is known as the “medical home” model of health care. Many experts hope it will prove one of the best ways to rein in the nation’s runaway medical costs, while making people healthier. The theory is that by providing a home base for patients and coordinating their treatment, doctors can improve care, prevent unnecessary visits to the emergency room, reduce hospitalizations and lower overall medical spending.”

The Medical Home Model is intended to return the practice of medicine to an earlier model when the family physician coordinated a patient’s care even when they were consulting a specialist or were in the hospital.

The Times article points out that the model being tested by United will “move away from paying doctors solely on the basis of how many services they provide, and will start rewarding them more for the overall quality of care patients receive.”

If this experiment proves to be successful, we may be witnessing the birth of the latest in a long line of healthcare financing models intended to help drive improvement in the quality of medical care that American’s receive, while controlling cost by eliminating redundant testing and more closely monitoring patient outcomes.

What, if any impact the medical home model may have on addressing the issue of expanding access to health care to those who are uninsured or underinsured is yet to be seen. However, it stands to reason that if healthcare can become more effective and more affordable, it will also become accessible to greater numbers of Americans.