The Amish Health Care Plan

An article on reminds us that not all health plans are insurance plans. The article titled, “The Amish way of healthcare finance,” explains that the Amish have legally opted out of participating in the Affordable Care Act, but that does not mean they are doing without a plan for taking care of their member’s health care needs..

The article says that various Amish communities have negotiated prices with local hospitals for its members in exchange for quick cash payments. The communities then use a combination of church aid and benefit auctions to raise money for any member who is unable to pay their bill, according to Reuters.

“We have our own healthcare,” an anonymous Amish community member told Reuters. “They [hospitals] give you a bill,” he said. “If you can’t pay it, your church will.”

See the full story at: Wins National Healthcare Website Awards.

Baylor Health Care System’s website – – took home the gold at the thirteenth annual Healthcare Internet Conference and silver at this year’s W3 Awards.

The Healthcare Internet Conference awards program recognizes the best websites of healthcare organizations, online health companies, pharmaceutical and medical equipment firms, suppliers and business improvement initiatives. More than 1,100 entries were received from a wide range of healthcare organizations in 12 different categories. received gold in the “Best Site Design” category for hospital systems.

The W3 Awards recognize creative excellence on the web by awarding outstanding websites, web marketing and web video produced by some of the nation’s best interactive agencies, designers and creators worldwide.

“We are honored by these awards that we think show the success of our web strategy,” says Steve Tatum, vice president of marketing, Baylor Health Care System. “We know that more than half of patients in America seek out health information online and we want to be a resource for not only those wanting to know more about our system of hospitals, but for those who simply want health information from a nationally recognized source.” was redesigned in 2008 and now features an easy-to-use physician finder tool, health risk assessment tools, a multimedia encyclopedia and improved navigation. The current site was designed around what market research showed were consumer preferences.

About Baylor Health Care System

Baylor Health Care System is a network of hospitals, primary care and specialty care centers, rehabilitation clinics, affiliated ambulatory surgery centers and the Baylor Research Institute. One of the largest private-sector employers in Dallas/Fort Worth, Baylor employs roughly 20,000 people and has more than 4,000 physicians on its medical staffs. Baylor University Medical Center, flagship hospital of the system, is a major patient care, teaching and research center for the Southwest. For fiscal year 2008, Baylor reported $446 million in community benefit to the Texas Department of State Health Services. For more information about Baylor Health Care System, visit or call 1-800-4BAYLOR.

Source: Baylor Health Care System

Web Site:

Healthcare Reform Debate Heats Up

This was the week when the gloves started to come off for those in Washington who are key players in the health care reform debate. Up until now, principals on both sides of the aisle had been talking about how a bi-partisan effort could produce reform that would lead to affordable, accessible, and quality health care.

This week talk became tougher. The Washington Post this morning reported that House Democrats, in consultation with the White House, will give Republican lawmakers until September to reach a compromise on President Obama’s signature health-care initiative — otherwise, they will use a shortcut to move the measure through Congress without Republican votes.

These “shortcuts” known as budget reconciliation, would permit lawmakers to roll Obama’s health-care proposals into a bill that cannot be filibustered, meaning Democrats could push it through the Senate with 51 votes, instead of the usual 60. Since Democrats control 58 seats in the Senate, they could approve a reconciliation bill without Republican votes or the support of some reluctant conservatives in their own party.

Meanwhile, on the Republican side, Sen. Chuck Grassley (R-IA), the ranking minority member of the Senate Finance Committee made statements that suggest he may be less helpful in reaching bipartisan consensus than reform advocates have hoped.

According to an article published on Grassley said that erecting some form of new government benefit, which Democrats refer to as the public plan option, is a deal-breaker for Republicans.

“This is a deal-breaker for Republicans if it’s in and it’s a deal-breaker for Democrats if it’s not in,” Grassley said during a briefing with reporters hosted by the nonpartisan Kaiser Family Foundation on Thursday. “I think it’s a step toward single-payer, government-run healthcare for everyone,” he said.

The article noted that, despite the obstacle of how to handle the public plan option, Grassley reiterated his view that comprehensive health reform is necessary and that it must be legislated in 2009.

This debate promises to get very interesting.

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, 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, 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.

Pay Me to Stay Healthy

An interesting story showed up recently on the web page of an Omaha TV news station, KETV. The story noted that there is a bill, now in the Ways and Means Committee, that would allow people to set aside money in their health savings accounts (HSAs) or flexible savings accounts (FSAs) to use toward fitness programs and fitness equipment.

While the piece did not mention the bill by name or number, I suspect that they were referring to the Personal Health Investment Today (PHIT) Bill (H.R. 245) which was introduced in January by Gerald (Jerry) Weller, (R, IL) and would amend the Internal Revenue Code of 1986 to treat certain amounts paid for exercise equipment and physical fitness programs as amounts paid for medical care.

In other words we could use our HSA’s and FSAs as mechanisms to pay for health clubs and fitness equipment with pre-tax dollars just like we can use these funds to pay for IRS-approved medical expenses today.

It really is a novel idea that we would pay to help people stay healthy rather than to just spend money once they get sick.

It is no surprise that the International Health, Racquet & Sports club Association (IHRSA) a non-profit trade association representing health and fitness facilities, gyms, spas, sports clubs, and suppliers worldwide has come out in support of the proposal. In an news release published in April of this year, the IHRSA said that H.R. 245 “takes a giant step toward a healthier America.”

The group went on to note that by allowing for exercise and physical fitness programs and certain exercise equipment to be paid for out of pre-tax dollars, PHIT will help provide the level of support many Americans need to be able to adopt healthier lifestyles and become more physically active.

The IHRSA press release cites the Centers for Disease Control and Prevention, saying that people who participate in moderate-intensity or vigorous-intensity physical activity
on a regular basis lower their risk of coronary heart disease, stroke, non-insulin- dependent (type 2) diabetes mellitus, high blood pressure, and colon cancer. Yet, more than 50 percent of American adults don’t get enough physical activity to provide health benefits. And a startling 30 percent — more than 60 million people 20 years and older — are obese.

Its is certainly worth giving this idea a shot. Unfortunately, the bill has not gotten much traction in Congress (currently eight co-sponsors), nor has it received much publicity. No doubt it will die in the House Ways and Means Committee as did its 2006 predecessor H. R. 5479. What a shame.

Highmark Issues Health Care Gift Card

I can’t let the week go by without commenting on the story that appeared Monday in The Wall Street Journal about the Pittsburgh-based health plan, Highmark, announcing that it is selling a Healthcare Visa Gift Card. That’s right, a gift card like the ones you buy at the appliance giant Best Buy or at your favorite book store, only this one is to pay for health care. Very interesting.

According to the article, the card will be restricted to certain merchant codes so that they can only be used at medical providers or merchants that Visa categorizes as health related, including physician’s offices, pharmacies and health clubs. At least for now the cards aren’t available at grocery or retail stores — they can only be purchased online or by calling a toll-free number.

Who will buy these cards loaded with $25 to $5,000? Highmark believes that the card will fill the needs of many people who want to help others — from college students to baby boomers — with various expensive health-related needs. They expect to sell “several hundred thousand” gift cards, mostly between $75 and $100 over the next year.

Having spent two days last week at the Visa Prepaid Card Forum in San Francisco, I am a big fan of using the latest prepaid and debit card technology to make paying for healthcare easier. Over the next few years, millions of these cards will be issued to make using Flexible Spending Accounts (FSAs), Health Reimbursement Arrangements (HRAs) and Health Spending Accounts (HSAs) more convenient for consumers.

New IRS regulations requiring retailers who want to participate in this huge market to maintain a special inventory system to flag eligible expenses will take the guesswork out of using account based plans. It will also reduce the need for consumers to file claims or send receipts to their plan administrator to prove the card was used appropriately.

But, a healthcare gift card? I am not sure. It strikes me that Highmark is doing this because they can, not because there is a pressing consumer need for such a stored value card. However, it is innovation and worthy of taking note.

Yes, we are expensive, but we do poor work.

A news story carried by Reuters on Thursday led with a summary of findings from a new report stating that Americans spend double what people in other industrialized countries do on health care, but they have more trouble seeing doctors, are the victims of more errors and go without treatment more often.

This appears to be another twist on the expression, Yes, we are expensive, but we do poor work. In any other context we would have a little laugh at that idea, but would never acknowledge that we were so careless with our own money that we would actually hire anyone who subscribed to such a motto at least not for long.

What if your plumber, auto mechanic, or dry cleaner posted a sign that read:

Yes, we are expensive, but we do poor work.

How long would it take you to find a new one? Not very long, I trust, as we are all careful with our hard-earned money. We would not long tolerate a mechanic with whom it was difficult to get an appointment and who made frequent errors. But now we find out that we Americans each spent $6,697 on healthcare in 2005 — a whopping 16 percent of gross domestic product — at a merchant that had that sign posted in the back room if not in the front window. What were we thinking?

Let me point out right now, that I am not blaming health care providers. Health care is the United States is the most responsive and dynamic in the world. Higher prices enable the system to cater to patient desires for convenience and innovation and as a result our system excels in treatment of some specific diseases, such as breast and prostrate cancer.

I am not blaming insurance carriers either. They have been struggling for decades to come up with plans that employers can afford and that employees will find acceptable. Meaning that they feature low out-of-pocket costs and a fair amount to freedom to seek care when and how we choose.

I am sticking the blame on the government. Yes, the government that started this crazy system that grew out of World War II wage freezes. Crazy is a system where we have to depend on our employers to provide us with medical coverage. Of course at first, we patients were part of the process. We were sensitive to the overall cost of health care and found the insurance to be a financial lifesaver when something unpredictable and serious happened to us or a family member.

By the late seventies it was necessary for employers to make the first real push to control what was becoming out of control spending. The answer was managed care. The promise was lower costs for employers and convenient co-pays for the employee instead of a percentage of the total bill. The tradeoff was that we had to go though a primary care physician who managed our care including our visits to specialists and stays in the hospital. We hated it.

So what happened? The employers and insurance carriers said, Ok, you can go see anyone you want, any time you want and still pay a co-pay as long you stay in the network. Fine, we can do that. But the costs started mounting again. Why? Because we all now believe that doctor visits cost $20 and all prescription drugs are $10, Of course the real cost is much more, but how would we know? We as consumers have been insulated from the real cost of health care because the insurers and the providers have negotiated the prices and let us in on the true cost only after the fact. This should be enough to prove that negotiations at a corporate or government level can not solve the problem.

It takes the everyday negotiations of the marketplace to really have an impact. Mechanics and dry cleaners who are expensive and do poor work are soon adjusting their business models, or they are closing their doors. It is time we apply the same logic to our health care system.