Announcing the Launch of The Health Tactics Social Network

Today our team is launching the Health Tactics Social Network.

The Affordable Care Act, popularly known as Obamacare, has been in place now for several years and it has withstood a number of challenges, including at the Supreme Court.

Even within this structure, however, prices have begun to rise, significantly for some. And we are beginning to see news reports about local exchanges failing financially and large insurers questioning their continued participation.

We at Health Tactics do not take a political stand. Instead, we believe that whichever path our health system takes, much will continue to fall on the individual and those who love and support them. Not just the measurable costs that appear on a bill, but things like rides, meals, errands, simple love and emotional support. And yes, items that cost money and are not covered. Sometimes lots of money.

This is where the Health Tactics Social Network comes in.

We are not here to complain, or to be an advocacy organization. We accept that “it is what it is”, even if we want more. What we are here for is to help people find each other, care for each other and deal with reality. And by doing this, we can help those in need put their lives back together.

Consider:

    Several people with the same condition have more collective knowledge about that condition than all but the most specialized physicians. Pool that knowledge.

    Much of what it takes to fully care for yourself or someone else actually falls outside of the structured medical system- everything from exercises to nutrition to a good nights sleep. And this is where people helping people will succeed in cases where the for-profit system has either failed us or abandoned us when the approved visits run out.

    And many times, there are those special, wonderful doctors and hospitals, and the rest of us need to know who and where they are. And not because we saw their advertisement, but because someone we trust who was in a similar situation told us about them. The true message gets lost in all of the marketing noise.

People helping people- that is what the Health Tactics Social Network is all about.

How does it work?
Almost everyone is in Facebook. And when you have professional networking needs, most people think of Linked-In. Beginning today and in the future, when you have personal health care needs, think of The Health Tactics Social Network.

A group in our network is designed solely to support the health care needs of the member. You can use a group differently, but this design is what makes us unique.

In the illustration below, 12 people join Mary’s Care Group. The sole purpose of the group is to care for Mary.

MarysGroup

Members of the group can upload documents or images for other group members to see. Mary, for example, might upload a list of her medications so others in the group have that information.

Mary could also create two groups, and have her private medical information available to one group, and other things like a food shopping list or a list of important phone numbers available to the other group. Her spouse might want to be in both groups.

The Health Tactics Social Network will also work well for athletes. Paul is a runner on his school team. In this illustration, 11 people join Paul’s Training Group. The sole purpose of the group is to support Paul’s training.

As before, members can upload documents, such as a schedule, or images, such as a map of a running trail.

PaulsGroup

How do you set it up?
This is a very easy, three step process:

First, as in any social network, everyone involved must join The Health Tactics Social Network.

Second, as in any social network, people who want to engage on any significant level must be “friends”.

Third and finally, you must create your group (easy!) and invite those friends that you want to join it.

That’s it! Group members can immediately begin providing support to their friend or loved one.

Some tips:
When creating your group, you will have some choices, as below:

GroupChoices

We strongly suggest that new users select “by invitation only” and “group creator only”.

Otherwise, friends will be able to join your group at will (and since this is your health, not all of your friends should see everything), and participants will be able to invite other people (same issue).

These choices are available because some people create groups that they want to grow large and without their effort, such as a general membership discussion group. Members are certainly free to do this, but there are other social networks that support general membership discussion groups if that is the true goal.

Important note on HIPAA regulations and patient privacy: The Health Tactics Social Network and the entire Health Tactics site are built and designed around the core principle of consumer (patient) control of their own situation, which includes their own information. When patients choose to disclose their own information, HIPAA concerns have been met. However, when patient information is stored or handled by people or institutions other than the owner (patient), HIPAA concerns can and do arise.

For this reason, our user agreement contains language not found in most social networks. Users are strongly encouraged to read this language and understand it, as it discusses your disclosure of your own health information. It includes a disclaimer that specifically states neither Health Tactics nor The Health Tactics Social Network will bear any responsibility for personal health information that is initially disclosed by you, regardless of what members of your group or others may subsequently do with that information.

And finally…

Expert Scenario:
Pam is a Discharge Planner at a community hospital. She joins the Health Tactics Social Network and begins to “friend” patients she is working with in her professional capacity at the hospital. As people leave the hospital and recover they “move out of her view”, and as more patients enter the hospital, they “enter her view”, so Pam is constantly “unfriending” those who have been discharged and who have recovered, and “friending” new patients who will soon require discharge.

Pam encourages these patients to create a care group, make friends with her- either party can initiate the friend request- and invite her to join. Patients are free to decline Pam’s recommendation. This is all up to the consumer (patient). And of course, Pam, as a professional, should obtain written consent from the patient.

If the member agrees, Pam and the hospital benefit from this wealth of individual care and home related information that is stored in one place- the individual patient groups, and which they have obtained consent to access.

The members of The Health Tactics Social Network- Pam’s patients- benefit from a smoother, higher quality hospital discharge and an improved transition to home care and recovery. The member’s family will better understand what is needed, and know where to find the key information they will need in caring for their loved one.

How to get going:
Visit www.healthtactics.com.

At the main site, select “Network” and you will be taken to The Health Tactics Social Network sign in page. Signing up is easy. After you have signed up, find friends and create your groups as described above.

The rest of the site:
The main Health Tactics site has eight sections, clearly visible on the navigation menu:

These eight sections are:

Home, where you can find the home page (pictured) and a description of the company;

HomePage

Network, which allows you to link directly to The Health Tactics Social Network;

NetworkPage

MediPilot, our own secure, private online personal health record.

MediPilotPage

Surveys, an embedded survey tool where we implement surveys and polls;

Blog, where we will post helpful tips about using the Network, posts from guest health care experts and other interesting content. You are at the Blog page now;

BlogPage

Forum; our online discussion forum where users can talk to each other;

Links, where we organize a wealth of health care related resources; and

Store, where we make available high quality health and lifestyle related products from 3d party vendors. This is what allows us to operate the rest of the site for free.

Everything at the site is absolutely free, except products purchased through the store. You will not see any ads or solicitations of any kind outside of the store. And we do not track, sell, monitor or mine your personal information in any way.

We hope that you enjoy and make valuable use of the site, and The Health Tactics Social Network!

Medical Tourism- A Growing Industry

One indicator of how expensive our health system has become is the rapid growth of the medical tourism industry. Patients Beyond Borders estimates the market is between $38 Billion and $55 Billion , and growing between 15 and 25% annually.

Depending on the specific procedures you need, it may be possible for you and a companion to fly to your destination, see the sights, stay in 5 star hotels, dine at 5 star restaurants, receive your medical services at a world class hospital, by doctors who, frequently , are American trained and board certified, and fly back to the US, all for less than the procedure alone costs in the US.

And, close by, Cuba shows signs of becoming a future destination for medical tourism. An interesting article in the New York Times on Medical Tourism discusses Cuba’s potential.

Something interesting to learn about…

February, 2015

Patient access to their own health information- it’s yours! Control it! #health

One of the best ways for someone to become self-sufficient is to engage, not just read. A useful way to engage is through blogs, which allow you to comment and even discuss online your questions and opinions on various subjects.

We have presented our links in a structured format, such that they help someone proceed down the path to independence. And the first section we feature is “Patient Access to Information on Themselves”. At the end of this post, we provide a link to a very useful blog post in this area, which may serve as a gateway for the reader- you- to reach out and become engaged. Our full list of links can be found at www.healthtactics.com/LinkIndex.html.

Background
The health care industry has long regarded patient files as “their” information. True, it is the providers that do the work- x-rays, lab tests, and other procedures that make up the medical record. But the information is about us, and much of it we give to the provider during a check-up, interview or on a form. So whose information is it?

The pendulum is shifting towards a view that it is the patient’s information. Yes, the provider should be compensated for copying costs or other administrative costs required to prepare that information for you, but you should definitely receive the information. And in the era of electronic patient records, it is easier than ever to request a copy or printout for the patient. So why is it so hard to get your health care information? Part of the answer, no doubt, is that information is power. And in this case, control of your record means the ability to continue to treat you and bill for those services.

We encourage you to read and become informed on this subject. Take charge of your health. Reach out and interact with the authors or other contributors to the blogs we recommend. Over time, we will mention blogs in each of the areas in our links section, designed to increase independence.

The first such link is to the Project Health Design blog, and can be found at http://projecthealthdesign.typepad.com/project_health_design/2013/02/index.html

While the Project Health Design blog is a wealth of information on a number of subjects, this post is specific to patient access to health information. Please enjoy, and we hope you return here for future recommendations on becoming more independent in managing your health.

Make the shell smaller, please!

So, Obamacare has passed, been legally upheld by the Supreme Court and appears to have met its enrollment goals.  So how far have we really come?  Not that far.  Let’s look at the statements and actions of some of those who actually run a portion of the system:

We need look no farther than The New York Times, May 26, 2014 for two separate indicators:

First, in an article titled “Hospitals Look to Health Law, Cutting Charity”, the author describes how some large hospital systems are reducing the level of charity care they provide, encouraging patients to sign up for Obamacare instead.  Or perhaps Medicaid.  Or if the patient doesn’t qualify for coverage, bill them directly.  One big shell game, as long as the hospital doesn’t have to eat the costs.  (The author didn’t say all of this- the author just stated the facts behind the cost shifting).

Then, in the editorial section, same date, we see responses to an earlier article that blamed the pay of insurance executives for the high costs of care, and attempted to shift the spotlight away from physicians.  It was the responses (letters to the editor) that interested me.

No less than three physicians wanted us to know it wasn’t the doctor’s fault.  Not to be outdone, a hospital association executive pointed out that it wasn’t the hospital’s fault.  Finally a nurse wrote in saying guess what?  If we only paid them more… (actually I do think nurses are the “good guys”).

So it’s one big shell game, and it’s not the doctors, hospitals or nurses at fault.

Here’s the news, all of you experts- we know it’s one big shell game.  Just make the shell (costs) smaller!  So the part that falls on us is tolerable.

With all of your expertise and training, you must be able to conceive of a solution to the problems of the health system that is more sophisticated than simple cost shifting!  Two children can do that (“make him pay…no, no, make him pay!).

So now that Obamacare has passed, been upheld and met the enrollment goals, do we all now get to sit back?

No.  It’s time to focus on costs.  Aggressively.  Now.

#Obamacare- The focus needs to be on Costs.

Now that an estimated 6 million + people have signed up for Obamacare, how have we done?  Is 6 million enough? Is the mix of young and old the right mix? Did enough previously uninsured people sign up?

Long term success will hinge not on any of the above questions, but on what we do about costs.

I am not talking about the cost of the insurance premium.  After all, if you insure something expensive, the insurance policy will be expensive.  Rather, I am talking about the costs of the underlying products and services- physicians, hospitals, pharmaceuticals, devices and supplies.

Here are several steps we can take that will decrease the costs of care:

-Allow Medicare to use its purchasing power to negotiate with pharmaceutical companies

-Implement tort reform

-Expand the scope of practice of physician extenders

-Open more retail clinics

-Allow, and reimburse more at-home care

-Encourage, and reimburse, more remote home monitoring

-Allow the sale of insurance policies across state lines

-Encourage more price transparency.  Increase the publication of prices.

Every one of these suggestions is either not done today or is limited in order to protect the finances of a particular interest group, be it physicians, hospitals, pharmaceutical companies, insurers or attorneys.  And in all cases, it is the consumer who suffers, either through lack of access, higher prices or higher taxes.

Don’t misunderstand me- I support Obamacare.  I am glad to see it happening.  But we need to focus on costs. Aggressively.  Now.

Obamacare- So where have we landed?

Over the past few months, we have been bombarded with conflicting opinions about a number of issues related to Obamacare:

1)     The rollout.

2)     The “fix”, and the new rate of enrollments.

3)     Reduced hours for some.

4)     Some no longer feel the need to work, because insurance can be obtained through the exchanges.

5)     Higher costs for some, lower costs for others.

6)     An apparent slowdown in health care cost increases.

So is it working?

Regardless of the individual cases where a person’s premium might have gone up or down, we have begun the process of ensuring coverage for all.  We are not there yet, but the discussion has changed.

There are many who landed in a good position under the “old model”, where only some received coverage.  When restructuring our system so everyone can be covered, yes, some may have a little less.  But it is simply not morally correct to preserve the positions of those who were privileged enough to have health coverage at the expense of those who still need it.  Is it?  What do you think?

Is it acceptable that those who have health insurance receive “a little less” or pay “a little more” in order to extend health insurance coverage to a large number of additional people? Granted, “a little less” and “a little more” are relative terms.

Is it acceptable that those who have health insurance receive “a little less” or pay “a little more” in order to extend health insurance coverage to a large number of additional people?

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The only reasonable end-game is full transparency and significant downward pressure on prices.

As more and more people sign up for Obamacare, early indications are that there will be some adverse selection- more middle aged and older people, fewer young and healthy people.  This creates the “downward spiral” as those healthy people who signed up eventually drop out because prices are too high.  This worsens the risk pool and increases prices for those who remain.  Then more drop out.

This will accelerate as states and corporations discontinue coverage for some because they can now purchase coverage through Obamacare.  The people affected by this will mostly be retirees who are older and less healthy- more costs will be run through the exchanges.

If we don’t do something about the core issue of prices, this is not sustainable.

Whether the issue is people who only want catastrophic coverage but can no longer find it, or people who are forced to by coverage that cannot possibly apply to them (think 60 year olds purchasing maternity coverage), or part time workers whose hours are cut even further, there are many people who the market is presently ignoring, at great cost to the system as a whole and to those of us who participate in it.  And I am not talking about the price of insurance.  I am talking about the costs covered by the insurance- hospitals, physicians, drugs and devices.

We need to:

-force the publication of prices.  There have been several articles over the past year detailing how hospital and physician prices vary widely.  They seem unable to estimate prices until after you have received the service, then they are suddenly quite certain what you owe- and it’s a lot.

-broaden the scope of services for “physician extenders”, such as PAs and Nurse Practitioners.  If there is a “physician shortage”, the simple rule of supply and demand will ensure that they are in the “power position” in each and every discussion.  Allow more extenders, fix the shortage, reduce physician bargaining power and change the entire dynamic of the discussion with physicians.

-levy punishing fines, not token fines, when organizations are shown to have schemed the system, as one Florida hospital organization was recently shown to have done (driving up admissions and penalizing doctors who resisted).

-and yes- allow the market to provide products that are aligned with people’s needs.  If some want a catastrophic policy, they should be able to find one.  If a 60 year old couple does not want to buy maternity coverage, they should not have to.

I am not in favor of unfettered market freedom- after all, it is the market that gave us slavery and sexual trafficking.  I do believe, however, that a proper mix of regulation and market freedoms will provide the best answer.  Right now, we have swung too far in the direction of regulation, where attractive market options are forbidden by law.  We need to move back to a place where the market and regulations are in proper balance.  And if we provide transparency and allow the market to work, with some regulatory oversight, then prices will surely decline.

What should we do about Obamacare?

It has been painfully obvious during October that the HealthCare.gov site is not ready to serve large numbers of applicants.  One common response from supporters is that “Obamacare is more than a website”, which is true.  Getting past the panic and emotional arguments, let’s divide our thinking on the subject into two areas:

  1. How do we get people registered and signed up?
    1. Will the young and healthy sign up?  Why are some plans being cancelled?
  2. How will this all work out long-term?
    1. What happens when there is only 1 insurer in town?
    2. What about networks with restricted choice?

First, how do we get people registered and signed up?

This is actually the smaller question.  The site, along with other, lower tech means of registering (e.g. call centers), will eventually get fixed and people will be able to register through one method or another.  There may be some required policy fixes, such as a delay in imposing penalties, but over time, people will be able to register.  Compared to decades of a system where many had no hope of coverage, ever, even if it takes 1-2 years to get large numbers enrolled, we will land in a better place.

Please do not misunderstand- I am not saying “so what” to the problems, and I am not brushing them aside.  I am simply taking a longer view.

The more interesting question is, how will this work out long-term?”  I am focusing on two issues here, which have the potential to become, or already are serious structural problems within the industry.  These issues are:

  1. What happens when there are only 1 or 2 insurers in town, and prices have remained high?
  2. What about patient choice and the fact that many emerging networks are narrower, leaving out many popular hospitals and physicians?

Let’s discuss each of these in turn:

How do we get people registered and signed up? Will the young and healthy sign up?  And why are some health plans being cancelled?

The phrase “young and healthy” invites us to look at the young and healthy as one monolithic group with similar needs and issues.  The current dialogue masks, however, a major issue- one that half of this group feels very acutely- the prices for policies sold to young men will increase dramatically.  This is due primarily to the fact that men are now required to buy maternity coverage.  Let’s not discuss that men don’t have babies.  The present law has been crafted in a way that defines as “gender discrimination” any scenario other than men being required to buy maternity coverage.

I am not trying to start or continue a gender debate.  I am simply pointing out that asking young men to accept a large price increase because “it is good for everyone else” is asking a lot.  Please do not be surprised when young men decline to accept this dramatic price increase.

A related issue is the cancelling of policies presently in force because they do not meet the “Obamacare Standards”.  Same issue- a policy sold in the past to a young man, and which does not include maternity coverage, is no longer allowed to be sold.

So, taking away their present policy, offering only policies that include maternity coverage at much greater cost, and criminalizing those who do not buy these new policies, is a long term issue that will continue to weigh on the potential success of Obamacare.

 

What happens when there are only 1 (or 2) insurer(s) in town, and prices have remained high?

This is where the market takes over, and this will take time. Annual cycles.  When health plans in some states see that the neighboring state, or county, has only 1 or 2 health plans, and that prices are high, they will want to enter that market.  In an unrestricted market, large price differences will be evened out through competition.  This is exactly why we have such high prices now- competition has been stifled throughout the industry.

So my belief is that long term, new entrants will cause prices to drop in these areas where there is presently little competition.

 

What about patient choice and the fact that many emerging networks are narrower, leaving out many popular hospitals and physicians?

This is what will cause the large, “elite” institutions and networks to reduce their prices. 

When we have a situation where “you can go wherever you want, and somebody else will pay”, guess what?  Not only do consumers want to go the hospital of their choice, but that hospital is now incentivized to stand back, saying “that’s not enough money”, and to maintain that position until the payer, whether an insurer or the government, gives in and agrees to the higher prices.

In fact, we see a trend where hospitals are buying up competitors in order to reduce local competition, so the payers have nowhere else to turn, and are forced to pay the higher price. (By the way, these hospitals run very touching ads about how much they care about patients- all while selling the receivables to very aggressive collectors).

Anyway, leaving these hospitals and medical groups out of the network, and making it stick, eventually causes the “elite” institution to reconsider and arrive at a more reasonable price.

Short term, expect much complaining about “limited choice”.  Long term, if we do not give in, we will see prices decline- after all, a hospital cannot survive if they won’t accept patients from Medicare and the major local insurers.

I can’t resist ending with a thought question on this point- If we got to eat wherever we wanted, and somebody else paid, where would we eat?  And what would happen to the prices at those restaurants over time?

 

Conclusion:

For Obamacare to work long term, we must have sensible answers to these structural issues, namely:

-Requiring young men to purchase maternity coverage will prevent many of them from enrolling, and turning them into criminals is not an efficient or effective answer.

-Markets with a small number of insurers must be made accessible to a larger number of insurers in order to create real competition.

-Limited networks must be allowed to remain.  If we bow to political pressure and let the “elite” hospitals and medical groups continue to charge much higher prices, the cost of health care will never become more reasonable.

 

There’s a lot here- what do you think?

 

Should men be required to buy maternity coverage?

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What should happen to people who do not buy health insurance as mandated by Obamacare?

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What should we do in markets where there is only one insurer and prices are high?

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What should we do about networks that exclude providers because their prices are too high (limited consumer choice)?

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It is time to break the provider “monopoly” in health care.

Many of us believe the health care discussion is actually about money, masquerading as “quality”.  We see a number of versions of this:

1) The wave of hospital mergers.  They are presented to the public as “improving quality”, but a recent article (AARP bulletin, June 2013) cites cost increases of up to 40% following a merger.

2) Network restrictions imposed by insurers.  Large health systems whose prices are rejected during contract negotiations generally claim that to eliminate them from a network will “compromise quality”.  Pressure is then put on the insurer to include the prestigious hospital system in the network at a typically higher cost.

We also see some promising developments:

1) A recent New York Times article (“Lessons in Maryland for costs at Hospitals”, August 28, 2013) describes some results of using hospital price controls and encouraging patients to receive care outside of the traditional hospital (lower costs, better quality statistics, more satisfied patients, and yes, more profitable institutions).

2)     An increase in the number of retail clinics, and an increase in the range of services they are able to provide.

There are some commonalities here:  when we, the patients, are no longer considered “captive” by the local providers, and instead have alternatives where we can go to receive our care, interesting things happen- costs tend to go down.  Quality tends to go up.

So what then, are the benefits of granting local monopolies to select groups of health care providers?  There is an interesting lesson now playing out in New York City:

A hospital in lower Manhattan, St. Vincent’s recently closed.  Prior to the closure, providers predicted a drop in “the quality of care provided to local residents”.  Politicians predicted a disaster.  And what happened?  Nothing!  Death rates have not soared, the community has not suffered- in fact, many urgent care centers opened up to fill the void.

Some may argue that access in the neighborhood has improved- minor conditions can now be seen efficiently and at low cost, as opposed to lengthy waits in an emergency room that is also serving those with contagious conditions.

I hope this trend not only continues, but accelerates.  A provider “monopoly” tends to benefit only the providers.  It is time for the consumer to be at the center of this system!

Health Care Reform- the Path Forward

We are moving towards a new equilibrium in Health Care- it won’t be perfect, but it will, hopefully, be an improvement over our present system.

There will be many adjustments required- some painful- on our way to this new equilibrium as all parties try to protect “the devil they know”.

In short, we are moving away from a system  a) with many uninsured, b) where employers provide insurance for some, c) where providers make hundreds of billions annually while delivering questionable quality, and d) where states must balance health costs against other priorities, such as infrastructure and education.

We are, hopefully, moving towards a system a) with far fewer uninsured, b) where employers provide insurance for most if not all employees, c) where providers incomes are more aligned with results, and d) where the balancing act faced by the states becomes somewhat easier to manage.

Now for the bumps in the road- some examples:

  1. Some states are avoiding or preventing an expansion of Medicaid and reducing benefits and eligibility as they try to protect state budgets.

  2. Providers are consolidating to increase their market power and negotiating leverage.  This is a powerful force designed to increase costs (which are provider’s revenues).

  3. Employers, as they try to protect profit margins, are reducing the hours of employees under a threshold so they will not be required to provide insurance for them.

  4. Young, healthy males are not signing up, largely because their costs, alone among all demographic groups, are expected to skyrocket.

My hope is that we, as a country will stay the course and see this through.  Early indications are that the individual market will see dramatic price reductions (notably New York and California).

Some states are taking a second look at the role of Medicaid- keep your eye on Arizona.

Medicare is looking at the “gaming” of provider reimbursement, where hospitals acquire physician practices for the sole purpose of billing for the same procedures under a new number (the hospital’s billing number), and getting paid more without doing anything  differently.  This bears watching as well.

But we need to do more- we need to provide products with a range of benefit options aimed specifically at the employees whose hours have been cut.  It does little to offer a “bronze” plan which only transfers risk to the insured (by covering 60% of costs)- why not offer a product where the insured can decline some coverage types- why should a childless person be forced to buy pediatric coverage?

We also need to offer products aimed at healthy young males.  It will be tough to get someone to accept a near doubling  of rates simply because it is good for everyone else.

As health care reform rolls out and gains traction, my hope is that “profiteering” behaviors will be limited and that products will be allowed to emerge that will address, in a market driven manner, the present shortcomings in the system-  specifically, we need an expansion of Medicaid, we need to stop the provider consolidations done solely to increase reimbursement, and we need insurance products aimed at part-time employees and healthy young males- not products that lock in a major subsidy for other demographic groups.

What should we do to encourage young, healthy males to enroll in Obamacare?

As Obamacare is implemented, there are predictions of significant cost increases for some.  This is driven by several issues, including the enrollment of millions of new insureds, many with conditions that haven’t been treated in a long time (pent-up demand), and the apparent reluctance of young, healthy males to enroll.

Regarding this second point, just what did we expect?

Young, healthy males are effectively being asked to fund a “triple subsidy”:  The healthy subsidize the sick, the young subsidize the old, and according to Kathleen Sebelius, “men will see costs go up, women will see costs go down”.  This is because the policies are being priced without regard to gender.

So is it hard to see why young, healthy males are not attracted to the plan(s)?  They are expected to pay significantly into a system that is designed, and priced, for the benefit of others.

Personally, I do not think that criminalizing them or bankrupting them is the answer.  Before you say “make them pay anyway!”, ask yourself:

1) if you are older, would you be attracted to a product that is designed and priced to cover serious sports injuries? (not golf injuries, but football injuries).

2) if you are sick, would you be attracted to a product designed for the healthy- say, one that charged very high co-pays and co-insurance for surgery?

3) if you are a woman, would you be attracted to a product designed around the needs of men- say, one that did not cover breast cancer?

So what should we do to encourage young, healthy men to enroll?  We might try offering some products that have their needs in mind, such as catastrophic coverage only, or products where maternity and pediatric coverage are optional riders.  Having them in the system at some level is preferable to not having them in the system at all.  And history is full of plans that failed because only the sick enrolled, which drives up the cost.  Do we want a repeat of that?

I am not saying that anyone is good or bad- I am simply saying that we should not be surprised that young, healthy males are rejecting a product that is designed and priced with the needs of others in mind.

What do you think?  If you have another idea, please leave a comment and tell us about it!

What should we do to encourage young, healthy males to enroll in Obamacare?

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Is it time to restrict consumer choice again?

In a recent New York Times article, (“A Health Provider Finds Success in Keeping Hospital Beds Empty”, April 24, 2013), the author discusses an Illinois based Accountable Care Organization that appears to be having some success in reducing health care costs.

The article goes on to describe several methods the ACO is using, such as care coordination and physician report cards.  But the article also questions the sustainability of savings and points to issues outside of the hospital’s or physician’s control.   These challenges include patients seeing “out of network” providers, who may not have an incentive to control costs at all.  In fact, these other providers may still be practicing under the unrestrained fee-for-service model, where providers have many incentives to increase the volume of services provided.  This increased volume, and related increased costs, will be counted against the Accountable Care Organization’s performance numbers and may affect negatively any reward or bonus the ACO may have otherwise earned.

Now this point is not unfair.  Yes, maybe the patient goes out-of-network because the ACO physicians don’t keep convenient hours, or maybe the quality is perceived to be better elsewhere.  But maybe the patient wants to go to the doctor they know, or the one who is closest.  Should the ACO be penalized for this?

So what should we do about this?  Should patient convenience trump other concerns?  Should all of us pay, through increased premiums, so someone else can visit whichever doctor or hospital they want, regardless of costs?  What should we do as a society?

Here are some thoughts:

a)      Should insurers ban out-of-network visits, meaning no coverage for them?

b)      Should out-of-network visits be made financially unattractive, by reducing coverage to something like 50%?

c)       Is it possible to exempt the ACO from the costs of out-of-network care (and if we did that, are we rewarding the ACO whose service is poor or whose hours are inconvenient)?

d)      Is there some other option?

What do you think?

How should the system treat visits to out-of-network providers that threaten the financial performance of Accountable Care Organizations?

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A Comment on the “Time” Article

A recent article in Time Magazine (“Bitter Pill-Why Medical Bills Are Killing Us”, by Steven Brill), did a fine job of thrusting into the spotlight the profiteering behavior of some providers in our health care system.  While the article covered a lot of ground, his discussion of the behavior exhibited by hospitals and hospital systems was particularly interesting.  That is where I will focus.

To summarize, hospitals are wildly inconsistent in what they charge for specific services and service packages.  By packages, I mean the room, the procedure(s), the doctors, and the drugs required to treat you.  The costs are frequently hidden, and if pressed, hospitals will quote from a greatly inflated “charge master”.  One result is “non-profit” institutions that are incredibly profitable, while their patients experience financial devastation.

It almost seems as if the behavior is somewhat predatory (my words).  So what should we do?

Let’s start here- hospitals should be required to post conspicuously a price list for the 100 most common services or service packages.

If you are considering a hospital for an uncomplicated childbirth or a knee arthroscopy or a hernia repair, you should be able to look at a list and see what it costs.  The price should include all services, tests, supplies, labs and doctors expected to be involved. If the hospital chooses to post it’s charge master, fine (as opposed to an insurance rate, which may be prohibited by their contract).  Posting the charge master will allow consumers to compare prices.  Even if you wind up in the hospital because of an emergency, you can transfer to a more reasonably priced facility once the immediate crisis has passed.

Just this would prevent, or at least lessen, some of the financial horror stories described in the article.

So what do you think?

Should hospitals be required to post a price list for the most common service packages?

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Large Premium Increases?

A recent article describes large, double digit premium increases being requested by health insurers, and allowed, in some cases, without objection by regulators in the various states.  Now just what did we expect?

Insurers will soon be required to cover all applicants, without the ability to deny coverage for pre-existing conditions.  Many people will now enter the insured population who have been uninsured, and sick, for years.  Socially, this is a very good thing.  Financially, it is very expensive.

Do we expect insurers to just absorb these costs?  No, we should expect these costs to be built into future premiums.  Consider- would State Farm sell you a homeowners policy while your home is burning?  Of course not.  And if we required them to, that policy would be very, very expensive.  And if we forced them to average the cost of the burning house- many actually, over all policies, the price for all policies would increase dramatically.

And so it is with health care.  Accepting patients who are already ill, while socially positive, is very expensive.

Now I am not a defender of insurance companies.  But I do understand their role, and the simple reality is that if what you are insuring costs more, the insurance policy will cost more.  So as our health care system continues to evolve, we need to focus on costs– the cost of going to the doctor, the cost of staying in the hospital, of paying for drugs and of paying for devices and equipment.

If costs continue to rise, insuring those costs will only rise as well.

Health Reform: Should maternity care and pediatric coverage be considered “essential benefits” for women and men over 55 years old?

Now that health care reform, often called “Obamacare” will be implemented, one key question focuses on what is covered.  The Department of Health and Human Services (HHS) has recently released a list of “essential benefits”, that is, what must be covered by all plans in order to allow consumers to make fair comparisons.

The list is broken down into 10 categories, one of them being maternity coverage and another being pediatric coverage.

For women and men over 55, this might seem unreasonable.  And we are not just talking about the care that first comes to mind- should complications arise, maternity care brings with it care in a neonatal intensive care unit (NICU), the costs of a perinatologist and the costs of a neonatologist, all of which can be very, very expensive.

Then we get to pediatric coverage, which covers care over an 18 year time horizon, also very expensive.

For those over 55, the decision to have a child is exceedingly remote, if not impossible. And this is not a gender issue- it affects both women and men, and turns the concept of health insurance into one of health care subsidies.  One option is that maternity coverage and pediatric coverage be available as a “rider”, meaning available at an additional cost to those who want it.

So here is the question- should people over 55 be required to purchase maternity coverage? And by extension, should childless adults be required to purchase pediatric coverage?  What do you think?

Health Reform: Should maternity care and pediatric coverage be considered an "essential benefit" for women and men over 55 years old?

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The settlement of the Medicare lawsuit is a great thing!

The settlement last week of a significant lawsuit against Medicare now opens the door to increased treatments and therapies being provided to patients in their homes, and paid for by Medicare.

The specific change anticipated by the lawsuit involves a requirement that patients have some possibility of “improvement” in order for services to be approved for reimbursement by Medicare.  In the future, the possibility of improvement will no longer be a consideration.

This is long overdue and will change the lives of millions of patients and their families.

First, receiving necessary treatment will slow the pace of decline even if the possibility of actual improvement does not exist.  For people experiencing physical or cognitive impairment, receiving therapeutic services or treatments is at the very least compassionate.  It is also financially wise, which brings us to the second major benefit:

Paying for several months or years of therapy for a loved one can be financially devastating for all but the most wealthy families.  As a result, families experience the wrenching decision of paying for care for an elderly parent versus preparing the children for an advanced education.

It is also beneficial to society as a whole, because when our loved one declines to a certain point, we bring them to the emergency room where they are frequently admitted to the hospital, at a much higher cost, much of which may have been completely preventable.

Granted, some fear an explosion in fraud as providers of various skill levels rush in to provide, and bill for services.  Fair point.  But I for one am optimistic that as we move further into the world of information exchange and both electronic and personal health records, that services can be effectively monitored and that the impact of fraud will be far, far less than the benefit to patients, their families and society as a whole.

What do you think?

Is it a good thing that Medicare will pay for home based services without the requirement that the patient have a possibility of improvement?

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Prepare yourself during 2013- knowledge required!

Now that the Supreme Court has upheld the Affordable Care Act, should we all just sit back and go for the ride? Hardly.

Progress among the states is a patchwork- only 13 states have moved forward setting up health exchanges- a key enabler. An additional 22 states have started planning. The remaining states continue to resist.

What this means is that when 2014 arrives, the states will not all be ready. Your ability to access decent, affordable care will depend very much on where you live.

And so you should be prepared to look out for yourself, to some degree- with knowledge, so talk to your physician and do your own research; with tools, so use a personal health record, know how to research the quality and cost of hospitals and physicians; and have a network, whether it be through a traditional advocacy group, or through an online social network.

As our system changes and improves, we will collectively be much better off. But during the transition, there will be gaps, and we will all need to become more self reliant.

It’s really going to be on us.

Now that the dust has settled somewhat on the recent Supreme Court decision, we are seeing some states dig in and harden their positions against expanding health care coverage.

I truly believe that at the end of all of this, we will have a significant portion of our population who either:

  • continues to lack health coverage,
  • has coverage, but no physicians or hospitals will accept it, or
  • has coverage, but so much is excluded that the financial burden on families continues to be devastating.

And so the path forward, for many, will require:

  • a very high level of personal involvement
  • engagement with an effective support network and/ or advocacy group
  • active use of online research and management tools
  • activism- vote- engage your elected representatives.

Stay tuned, as this blog will comment on each of these issues.

 

Maybe Doctors Can Learn From Lawyers

On May 2, an article was published in the New York Times, titled “Top Judge Makes Free Legal Work Mandatory for Joining State Bar”.  The article describes how more and more people need urgent legal services but cannot afford them.  It goes on to describe the pros and cons of requiring lawyers to provide some free services (pro bono) as a condition for joining the New York State Bar.

We have a similar problem in health care- a large number of people who cannot afford health care services.  And I am not talking about insurance.  I am talking about the doctor and hospital visit.

In health care, we have doctors refusing to see patients because Medicare or Medicaid do not pay enough.  And these patients have nowhere else to turn.  The doctors use the threat of refusal as a key part of their strategy when negotiating for higher reimbursement.

How can we allow this?

In a previous post on this blog, I have proposed that doctors be required to accept Medicare as a condition for receiving or renewing their DEA license (federal level- the DEA license is what allows them to prescribe), and to accept Medicaid as a condition for receiving or renewing their Medical license (State level).

We place physicians on a professional and social pedestal, and their incomes are higher than that of any other profession.  In return, we should require something of them- not grant the right to walk away from persons in need.  Doctors, take a lesson from the lawyers, or lose your protected, lucrative turf!

 

We (the consumer) are about to get trashed!

I saw three articles that disturbed me last week.  Taken together, they are no less than frightening.  All were printed in the New York Times.

First came an article titled “Insurers alter cost formula- patients pay” (New York Times, April 24).  The main point is that insurers have changed the way in which they reimburse doctors and hospitals.  The reimbursement has gone down, so the patient’s portion has gone up.

The second article, also printed in the New York Times on April 24, is called “Pricing confusion adds to pain at hospitals”.  The main point here is that hospital bills appear to have no rhyme or reason, with the price for the same procedure in the same geographic area varying wildly, sometimes by a factor of ten or more.

Finally, in the New York Times on April 25, “Debt collectors pursue patients in hospitals” describes how employees of a collection firm, “Accretive Health” are actually allowed front line positions in their client hospitals where they can, and do, get right in patient’s faces demanding payment for expected or past services, sometimes before emergency services are provided.

Now put all of this together-

  1. We don’t know what something will cost and may be off by a factor of 10
  2. Whatever it does cost falls more and more on our shoulders to pay
  3. We will subjected to very extreme collection practices, including denial of services, until we pay what we owe.

Now compare this to the experience of citizens of every other advanced country in the world- costs are simply not allowed to come between a person and their need for health care.

We, the consumer, are about to get trashed, and it is time to do something about it! (Stay tuned for future posts).