September 28, 2010
In their 2011 benefit packages, many employers will add wellness programs, increase cost sharing and audit dependents for eligibility, according to a new survey from Mercer.
The study found that 44% of respondents said they will add wellness programs; 39% will increase cost sharing and 31% will audit dependents for eligibility. Another 27% say they will put their health plan contract out for bid.
Within my own small-business community, I have seen many of these actions underway. Many parents with children have received new forms asking for birth certificates and other documents to verify eligibility for their dependents.
Add health management/wellness programs
Change plan design to increase cost sharing
Audit dependents for eligibility
Mercer “Survey on Health Care Reform: Getting Ready for 2011.”
September 26, 2010
Employes will face reduced choices and higher premiums next year because employers are opting-out of the “grandfather” provision.
This is the view of Scott Gottlieb, M.D., a resident fellow at the American Enterprise Institute, writing in today’s Washington Post.
Dr. Gottlieb said, “The administration estimated that up to 85% of employer-based plans would keep their benefits static to qualify for ‘grandfathering’ under the new rules, and avoid the full brunt of Obamacare’s expensive regulation. Now it looks like only about 50 percent of plans will qualify for grandfathering. What about the rest?
“They are opting for greater flexibility that comes with jettisoning their “grandfathered” status so that they can reduce benefits and raise co-pays to offset rising costs. The plans calculate that they can fully blunt the cost of Obamacare’s future rules by cutting benefits, and they’re right.”
Healthcare costs are like a giant balloon, squeeze it down on one side and it swells up on the other side.
September 23, 2010
The New York Times reported this week that “Medical groups that perform heart bypass surgery are now being rated alongside cars and toaster ovens in Consumer Reports.”
I’m sure they are not being rated side-by-side with toaster ovens, but we get the point – this is unusual.
The newspaper said the Society of Thoracic Surgeons, which has been collecting the information for a decade, gave the rankings to Consumer Reports.
The head of the society said his group figured public disclosure would be inevitable, and they wanted to provide meaningful data.
I applaud the cardiac surgeons for volunteering to undergo such scrutiny. It will be interesting to see if other specialists like orthopedic surgeons or neurosurgeons follow.
September 21, 2010
Although we have been reading about a lot of voter anger with the healthcare reform law, one new poll (CBSNews/New York Times) forecasts that it “is not likely to significantly affect voters’ decisions in November elections.”
The poll found 41% of respondents saying a candidate’s vote on the health reform law would “not make much difference” in whether they vote for the candidate. In addition, equal percentages, 28% each, said they are either “more likely” or ”less likely” to vote for a candidate who supported the overhaul. So it balances out.
In Tuesday’s Washington Post under the “community forum” readers blogged about their views on the reform law. They were split about 50-50, with both sides sometimes virulent.
For example, one business owner said, “I will no longer be an employer. No one should subject themselves to a jailable position of non compliance.”
Another critic said “Making workers more expensive is not a good idea when there are so many ways to automate or outsource a job.”
On the pro-reform side, one man wrote “My spouse has a serious medical condition and I am very glad now that we don’t need to worry about pre-existing condition clauses or having our insurance cancelled. Overall, I would say this is probably one of the best laws to be passed in a long time.”
September 15, 2010
The debate over privacy rights seems to be shaping up as a fight between providers (physicians, hospitals) and a few Internet-savvy consumers. I say “a few” because the vast majority of patients are either not aware of the issue or just don’t care.
Provider concerns are highlighted by a recent letter from AHIMA to the federal HHS Office for Civil Rights on a proposed rule which would make make changes to the HIPAA privacy, security and enforcement rules.
the AHIMA letter notes that a key issue for its members (generally physicians and CIOs from hospitals and medical groups) is the proposal to give patients have the right to restrict the flow of their medical records to their insurance companies for treatment.
AHIMA is concerned that some individuals will exercise their right to block health plans from accessing portions of their medical records. AHIMA notes providers often cannot get paid unless they provide the information the health plan requests.
On the other hand, we have yesterday’s announcement from Google that it is relaunching Google Health with a new focus on attracting users who want to “actively manage their health and wellness.”
Although not emphasized in yesterday’s announcement, Google is on record endorsing patient privacy controls including the ability to restrict information from insurers.
Google Health is currently positioned as a “PHR” and not an “EHR” but Google says it is moving in that direction, noting it wants to get PHR information “integrated” into EHRs and it is working to facilitate connections to hospitals.
Google notes, ”at the end of the day, if the consumer doesn’t know what to do with that information, or isn’t looking to act on it, the tool doesn’t get much engagement and doesn’t attract the broad use that it could.”
September 13, 2010
The healthcare reform law will increase utilization rates overall (no surprise). However, some programs, such as the accountable care organization initiative, will decrease utilization.
This is according to a new study available (free) from Thompson Reuters. For study, see The Influence of Reform on Local Coverage and Utilization.
Thompson Reuters analyzed numbers from the CBO, CMS and RAND. It found the number of Medicaid enrollees will increase by 11 to 25 million, and the number of uninsured will decrease by 24 to 28 million, by 2019.
According to the report, “Of all the reforms, the requirement for all citizens to have insurance by 2014 will have the greatest impact—an increase in utilization. Other elements of the law that are expected to prompt increases in utilization include: creating Medicaid medical homes for patients with multiple conditions, funding of $11 billion for community health centers and other community clinics, increasing Medicaid payments to PCPs in 2013 and 2014, and establishing minimum coverage for all plans.”
“Several elements of the legislation are expected to decrease utilization, primarily those items around pay for performance, including the reduction in annual Medicare market basket payments; reduced Medicare payments for preventable hospital readmissions; financial rewards for efficient quality care provided by Medicare Accountable Care Organizations (ACOs); and, the proposed hospital value-based purchasing program that links payments to outcomes.”
Few would argue that the public health will benefit. However, this impact seems lost on many voters who are angered by the increase in government spending and the fact that the new law has done nothing to stem the rise in healthcare insurance premiums.
September 7, 2010
Health plans are opening retail stores where they sell individual and group insurance coverage.
Last month Highmark opened its fifth Highmark Direct store in a Pittsburgh suburb. Now Anthem BCBS of Colorado will open a retail store in the Southwest Plaza Mall in Littleton, CO near Denver.
Anthem’s store in Littleton will feature a juice bar, and the company plans to host yoga classes and other wellness activities to make the space friendly
The HMOs are trying to get a head start on healthcare reform provisions that take effect in 2014. By then, U.S. residents will be required to have health insurance and it is expected many individuals will purchase coverage.
In the 1980s Charles Schwab & Co. opened its first retail stores. Although they did not generate substantial foot traffic, the company found the “brick and mortar” locations instilled a sense of confidence in customers and led to increased business online.
September 1, 2010
The latest issue of Forbes reports that some American hospitals “make 25 cents or more for every $1 in patient revenue they take in.
.. That kind of profit margin compares favorably to drug giants like Pfizer, who are often vilified for charging too much for their drugs. It easily beats the operating profit margin that General Electric reported last year.”
The article adds that 15 of 25 hospitals on the magazine’s list were part of for-profit chains. HCA had 10 hospitals in the top 25.
The article doesn’t mention this but here are some other “industry secrets” that produce higher profits: 1) don’t accept Medicaid patients; 2) have well advertised cardiac surgery and cancer treatment programs and 3) don’t have a pediatrics wing (many children are uninsured).