Nationally, more than half of hypertension cases are not under control (36 million uncontrolled cases out of 67 million total cases). In 2008, Kaiser Permanente members in Colorado had a 61% control rate, and that number has climbed to 82.6% thanks to an intensive effort on the part of Kaiser Permanente to continually work with patients to control hypertension. Sebelius said that Kaiser Permanente’s efforts have proven that “… by making high blood pressure[…]
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An Idea That Beats “Skin In The Game”
David points out that healthcare isn’t like a shopping spree at the mall. He believes “… that patients actually just want to get better and that they will be willing to forego expensive services and products when it makes sense to do so.” I agree. And David links to a study that found evidence-based decision aids can indeed […]
Health Wonk Review – Football Is Here Edition
Welcome to the Health Wonk Review Football edition because, well, it’s September and that means football season is here! And… we’ve got Peyton Manning!!!
Every time I read a post by Amy Berman on the John A. Hartford Foundation’s blog, I’m blown away[…]
AG Announces Settlement With Colorado Discount Medical Benefits Plan
Last spring I wrote about the lawsuit that was filed by the Colorado Attorney General against Consolidated Medical Services, LLC. Consolidated Medical Services was a discount plan (ie, not health insurance but a cheaper substitute that wouldn’t provide much in the way of benefits if a person needed medical care) run by Joseph Benedetto. The Colorado discount medical benefits plans were, according to Colorado Attorney General John Suthers, “… fraudulent, frequently failing to pay patients’ claims as promised.” However, the focus of the lawsuit was the manner in which Benedetto and his LLC went about recruiting affiliate salespeople. According to the AG press release, “Consolidated Medical Services recruited individuals, many of whom are elderly, to market “medical benefits programs” that were advertised as valid substitutes for traditional health insurance.” Salespeople were charged start-up fees and monthly hosting fees in order to sell the discount medical benefits, and virtually none of them made enough money selling the product to recoup the fees they had paid. Only about three percent of the 12,800 affiliates who were recruited between 2008 and 2011 made any money at all selling the discount plan, and most of the few who did make money earned less than they had paid in fees.
Attorney General Suthers’ office announced today that a settlement has been reached with Joseph Benedetto and Consolidated Medical Services, LLC. Benedetto must […]
More About Colorado’s Kaiser Permanente Benchmark Health Insurance Plan
Yesterday’s article about Colorado selecting a benchmark health insurance plan for individual and small group policies sold starting in 2014 has raised a few more questions and I wanted to clarify some details.
This publication from the Colorado Division of Insurance, the Health Benefit Exchange and the Governor’s office is an excellent resource and answers a lot of frequently asked questions. It was released earlier this summer, before the Kaiser small group plan was selected, so it includes details about all nine options that were considered as possible benchmark plans. The Kaiser small group plan that was ultimately picked as the benchmark is listed on page 11 as option A, under “one of the three largest small group plans in the state”.
The 2011 Colorado health insurance plan description for the Kaiser policy is here if you’re interested in the plan specifics. We had a question from a reader who wondered whether chiropractic care would be covered, but it’s listed as “not covered” on the plan description form (item number 30). It’s important to note that cost sharing details like deductible, coinsurance and copays are not part of the benchmark program. The concept of benchmark here only applies to the benefits provided by the Kaiser Permanente health insurance plan. The deductible on the Kaiser health insurance plan is $1200, but that DOES NOT mean that all policies will have to have a $1200 deductible in 2014. In order to be sold in the exchanges, health insurance plans will have to cover at least 60% of costs in order to qualify for a “bronze” designation. And there will also be silver, gold and platinum ratings, so there will still be plenty of variation in terms of cost sharing.
If Colorado had not selected a benchmark plan, HHS would have picked one for us. HHS would have […]
Colorado Selects Kaiser Permanente As Its Benchmark Health Insurance Plan
Last December, HHS made it clear that they were giving states a lot of flexibility in determining what plan would serve as the benchmark for the state’s “essential benefits” for individual and small group health insurance policies that would be sold starting in 2014.
After months of consideration, Colorado has selected Kaiser Permanente’s small group plan as a benchmark. This is the largest small group plan in the state, with almost fourteen thousand members, and was selected by a group of officials from the Colorado Division of Insurance, the Governor’s office, and the health benefits exchange. The Division of Insurance will be taking comments until next Monday before making a final announcement, and you can contact them by email ([email protected]) if you’d like your comments to be considered.
The Kaiser plan covers services in the ten areas that are required by the PPACA (ambulatory patient services, emergency care, hospitalization, maternity and newborn care, mental health and substance abuse services, prescription medications, rehabilitative services, lab work, preventive care/disease management, and pediatric care), which means that it will serve as a benchmark for services in those areas without the DOI having to add additional coverage minimums. In addition, the Kaiser plan was generally considered to be a good balance between comprehensive coverage and affordable coverage. It’s not the most comprehensive policy out there (the much maligned “Cadillac plans” offer more benefits), but it provides […]
Most Colorado Residents Have Health Insurance
This article about the state of healthcare and health insurance in Colorado is an interesting one, and it provides plenty of good, factual information. However, I was a bit perplexed by a quote from Dr. Ned Calonge, president and CEO of The Colorado Trust, who says “We’re reaching a tipping point where there will be more people who are uninsured than are insured.” This comes after some statistics that highlighted the decline in the number of Colorado residents who get health insurance from their employers: currently 57.8% of employers, compared with 63.7% two years ago.
I’m not really clear about the meaning of Dr. Calonge’s quote about a “tipping point”. I am not in any way minimizing the importance of increasing the number of people in Colorado who have health insurance and improving access to healthcare for everyone. Those are certainly the goals we should be working towards. But we are in no way close to a point where Colorado will have more uninsured people than insured people. The state currently has a population of 5.1 million people. Although the number of uninsured people in Colorado is quite high (829,000), it’s nowhere near half of the population. We are not close to having more uninsured people than insured people.
I wonder if the distinction was regarding the number of people who get their health insurance from an employer? If the current trends continue, we could indeed see a point in the near future when the number of people who get their health insurance from an employer will be lower than the number who don’t. But it’s important to keep in mind that the people who don’t get health insurance from an employer are not necessarily uninsured. In fact, most of them have health insurance. Some get it from the government (eg. Medicare, Medicaid, CHP+) and some purchase individual policies. The article I linked to above includes a graph that shows where people in Colorado get their health insurance, and although it’s true that the percentage of uninsured residents increased while the percentage of people who get their health insurance from an employer decreased, we should also note that the percentage of people with individual health insurance, Medicare and Medicaid all increased in that same time frame (2009 to 2011).
So although Colorado has a long way to go in terms of getting everyone in the state insured, we’re not close to a point where the uninsureds outnumber the insureds.
Low Deductible Still Required To Waive CSU Student Health Insurance
I’ve been getting a lot of questions from CSU graduate and international students. I just confirmed with the Colorado State University (CSU) Health Network that they’re not budging (much) on the requirement that graduate and international students have a $500 deductible if they want to waive the CSU Student Health Insurance. The person I talked to did mention they might allow a $1000 deductible if the student can prove sufficient financial resources to pay such a large bill.
Meanwhile, the CSU Student Health Insurance Plan has a policy year limit of $250,000 per accident/illness. It’s much better than a mini-med, but they still have a reputation for getting maxed out. I asked if they’ve ever had a student hit the limit (like has happened at other schools), and she said she could only think of one minor case when the student was able to wait until the next calendar year when the benefits started over.
The CSU Health Network is a really great organization though, if it weren’t for the low cap on benefits. They have top notch providers and are very friendly and helpful. And on January 1, 2014, even university health insurance plans will be required to not have a cap on benefits because of the Affordable Care Act.
Primary Care Practices In Colorado Chosen As Part Of CMS Pilot Program
The Centers for Medicare & Medicaid Services (CMS) announced this week the start of a pilot program to enhance primary care via collaboration among CMS, private health insurance carriers and 500 primary care practices in seven regions across the US. 73 of those practices are in Colorado, with 335 participating physicians, and several of the top health insurance carriers in Colorado are participating too: Anthem Blue Cross Blue Shield, Cigna, Humana, Rocky Mountain Health Plans, and United Healthcare, in addition to Colorado Medicaid, Colorado Choice Health Plans, and Colorado Access (a health plan specifically designed for underserved populations).
CMS will be paying participating providers a “care management fee” which is estimated to be about $20 per month per beneficiary, in addition to the usual fee-for-service reimbursements. The private health insurance carriers that are participating have worked out their own reimbursement schedules, but one would assume that the setup will be similar to the one that CMS has devised. […]
I Thought Insurance Companies Couldn’t Decline Due To Pre-Existing Health Conditions Anymore?
One of the most common questions lately: I was declined for health insurance due to a pre-existing health condition. I thought insurance companies couldn’t look at our pre-existing health conditions anymore because of [the PPACA] ObamaCare?”
Will Tax Credits Be Available In Federally-Run Exchanges?
[…] Both arguments are interesting, and very convincing. I read Jost’s first, and found myself nodding in agreement all the way through. But then when I read Cannon and Adler’s response, I also found their points to be compelling and hard to refute. This could be the sort of issue that many people would see as splitting hairs, but on an issue as contentious as the PPACA, I can see this debate getting quite a bit of traction over the next year as the exchange implementation process churns along. And it makes me glad that Colorado took the initiative early on (despite a lot of political wrangling) to begin the process of creating our own exchange. I know there are many flaws in the PPACA, and that the yet-unanswered question about how the exchanges will be funded starting in 2015 is a valid concern. But it still seems like a better solution than sitting back and waiting for the federal government to set up an exchange for us that 1) would not be tailored to our state’s specific needs and 2) might make Colorado residents ineligible for much-needed tax credits to help pay for health insurance.
Program Encourages Rural Students To Pursue Careers In Medicine
[…] I’ve written before about the PCP shortage, which exists even though many patients in well-served areas (and those with good private health insurance) may be unaware of it. Compounding the problem is the often lower median income in many rural communities. There are some exceptions of course, but in general the metropolitan areas of the state have higher average incomes than the rural areas. That means that it’s likely that a higher percentage of rural families – living in areas that are already underserved in terms of healthcare providers – qualify for state and federal health insurance programs that might further limit the options in terms of healthcare providers they can see.
All of this serves to highlight the importance of programs like CREATE Health Scholars. The program is relatively new and its first group of students is now moving on to post-graduate studies in medicine, pharmacy, dentistry and research. It will be interesting to look at the distribution of healthcare providers in rural areas of Colorado a decade from now. Hopefully the CREATE Health Scholars and other programs like it will have helped to close the gap between medically well-served and under-served areas of the state.
Colorado Health Benefits Exchange Allowed To Submit Grant Application – But It’s Still Controversial
[…] But Lundberg’s concerns are still quite valid. The problem of long-term funding – and the question of how many people will utilize the exchange – is something that will have to be solved in order to keep the exchange functional after the federal money is used up. There was a big push to create high risk pool health insurance programs in all 50 states as soon as the ink dried on the PPACA (no doubt this was a very good thing for people in states that previously had no high risk pool option at all), but enrollment was a lot slower than expected. The exchange has to be prepared for enrollment numbers that may be lower (or higher?) than anticipated, and make sure that financially the exchange is able to sustain itself regardless of the level of initial participation.
Although the long-term funding question is unresolved at this point, it would seem that the only viable option is to move ahead with the creation of the exchange. They have less than 18 months now to get everything ready to go for January 1, 2014, and it makes sense that the funding problem has to be worked out in tandem with all of the other administrative questions. If they try to fix the funding issues first, they may not be able to get everything else done in the time they have left. If the federal government is giving out grants to states working on setting up their own exchanges, it seems to be in Colorado’s best interest to take advantage of that and at least submit an application for the grant money.
Success In Reducing Overutilization Of Medical Imaging
[…] Similar strategies – that utilize a variety of tactics introduced together – could likely be helpful in reducing healthcare spending in other areas, like pharmaceuticals for example. Health insurance carriers could be involved in the solution (with more prior authorizations or computer systems that prompt doctors to always start with the lowest-cost drug and then work up, etc.) but with buy-in and cooperation from medical providers, the public and the pharmaceutical industry itself, the impact would likely be far more impressive.
Colorado Health Insurance CO-OP Receives Loan From HHS
At the end of July, the first of Colorado’s health insurance CO-OP plans got a $69 million loan from HHS as part of a push by the ACA to develop consumer-owned-and-operated health insurance plans (“CO-OP” is short for Consumer Oriented and Operated Plans). The CO-OP is sponsored by Rocky Mountain Farmers Union and the bulk of the loan from HHS will be put in reserve to fund claims expenses for initial enrollees. As premium dollars are collected, the loan will be paid back to HHS.
Colorado Senator Irene Aguilar introduced a bill last year to create a state-wide Colorado health insurance co-op, but the bill was tabled in May 2011 after passing its second reading in the Senate.
The new CO-OP being created with the loan money will be especially focused on rural areas of Colorado – which are generally underserved in terms of health insurance options. In addition, residents in rural areas are often already familiar with the concept of co-ops for other services like utilities. So a Colorado health insurance plan that is owned and operated by its members should be an especially good fit.
The CO-OP will begin marketing plans next fall with policy effective dates starting January 1, 2014, and is hoping to enroll 10,000 Colorado residents in its first year. Unlike most commercial health insurance plans available in Colorado, the CO-OP will be able to direct profits back into the plan in the form of lower premiums and/or higher quality service rather than sending profits to shareholders. And while most health insurance carriers that do business in Colorado are multi-state organizations, the CO-OP will be a local plan based here in Colorado (Rocky Mountain Health Plans is another example of a local, non-profit health insurance option for people in Colorado).
The CO-OP expects to be available both through the Colorado Health Benefits Exchange (aka “the exchange”) and also via independent health insurance brokers and agents. An innovative new health insurance product – especially one that strives to serve populations that are underserved by our current health insurance industry – is good news for Colorado, as it should foster more competition among the existing health insurance carriers in the market. Congratulations to Rocky Mountain Farmers Union for the approval from HHS for the loan to get the CO-OP going!
Colorado Hospital Payment Assistance Act Takes Effect Next Week
[…] To sum up the new law, hospitals will be required to charge uninsured patients earning less than 250% of FPL (and who are not covered by the Colorado Indigent Care Program) no more than the lowest negotiated price the hospital has with a private health insurance carrier. In addition, hospitals will have to clearly post their financial assistance, charity care and payment plan information so that patients will be aware of the financial options that are available.
In an article I wrote last week about the shooting victims in Aurora, I noted that although highly publicized tragedies tend to generate a lot of financial support (and in this case some of the hospitals treating the victims have offered to waive charges), there are many other people suffering from all sorts of injuries and illnesses whose cases do not receive media attention and who are crippled by the cost of their care. The Hospital Payment Assistance Program will hopefully provide some measure of relief for uninsured Coloradans who find themselves in need of hospital care in the future.
Colorado Judge Rules Against Contraceptive Mandate
A US District judge in Colorado issued a ruling earlier this month which allows an HVAC company – Hercules Industries, owned by a Catholic family – to temporarily avoid having to provide contraceptive services to female employees with no cost sharing. The PPACA requirements for contraceptive care take effect this week, and Hercules Industries would have had to start covering contraceptives on their group health insurance plan as soon as the next plan year started. The PPACA allows religious institutions an exemption from the contraceptive mandate, and also provides a one year “safe harbor” period during which non-profits that don’t meet all of the requirements for an exemption are permitted to delay the introduction of contraceptive coverage. And most of the lawsuits that have been introduced so far with regards to the mandatory contraceptive coverage have been by employers that qualify for the safe harbor and thus don’t have to start offering the coverage until their plan renewal following August 1, 2013.
The lawsuit involving Hercules Industries was unique in that the company is private and for-profit. It’s also unique in that the judge in the case ruled in favor of the company and against the mandate, siding with the idea that compelling the Catholic-owned company to cover contraceptives in their health insurance plan would violate their religious rights. I think we can assume that similar cases will crop up, and that this PPACA provision – much like the individual mandate – will eventually make its way to the Supreme Court, which is never a quick process.
The issue of contraceptive coverage is one that has highlighted the potential problems that arise by having health insurance provided by employers. Other than the fact that we’ve become accustomed to it, does it really make sense to have our health insurance be tied to our employment? Employers don’t have anything to do with our home or auto insurance, or to what schools we send our children. Mortgages, cell phone service, liability umbrella policies – all of these contracts are maintained between individuals and the companies that issue them. What if employers were […]
5280 Magazine Needs Denver Area Self-Employed for Health Insurance Article
Are you a Denver area resident who’s self-employed and had to navigate getting individual health insurance? Or do you fall somewhere in this description—“the self-employed, freelancers or ‘accidental entrepreneurs’ who started their own business or began doing freelance/contract work after being laid off from full-time positions during the economic turmoil of recent years”?
I’m writing a short article for 5280 magazine and would like to talk to about your experience. I would ask a few questions and potentially use a few short quotes. It should take about 10-15 minutes. I would be glad to speak at your convenience, but it will need to be during the week of July 30. You may contact me at [email protected] or 719-649-3634.
Hospital Bills Waived For Many Aurora Shooting Victims. But What About Victims Of Less-Publicized Violence?
The tragic shooting at a movie theater in Aurora last week has horrified all of us in Colorado and across the country. In addition to the 12 people who were killed, 58 more were shot and have required medical care that ranged from relatively minor to very major. And while we don’t know the health insurance status of the victims (to my knowledge that information hasn’t been released), we do know that The Dark Knight’s audience included a large number of young adults, which is the population most likely to be uninsured in Colorado.
Five years ago, when the Lewin Group was preparing data for the Colorado Blue Ribbon Commission, they found that 38.7% of 19 – 24 year olds in Colorado were uninsured, as were 27.1% of 25 – 34 year olds (see the graph on page 6). Those two age groups were significantly more likely to be uninsured than any other age group. More recent data from the Colorado Health Institute found that 27.7% of 19 – 34 year olds in Colorado had no health insurance in 2011, up from 22.7% in 2009 (the increase comes despite the fact that starting in 2010 the PPACA allowed young adults to remain on their parents’ health insurance policies up to age 26). As with the earlier Lewin Group study, that age group is far more likely to be uninsured than any other age group in Colorado.
So now the 58 surviving victims of the theater massacre will need medical care that ranges from relatively minor to very major. Some have already been discharged from the hospital, while others will likely remain there for a while. Three of the five hospitals in the Denver metro area that are treating the shooting victims have agreed to waive most or all of the hospital bills incurred by the victims. The other two hospitals – University of Colorado Hospital and Denver Health – haven’t said what their specific policy will be with regards to medical bills for the shooting victims in their care, but those are Colorado’s top two safety net hospitals and they provide hundreds of millions of dollars worth of free care to uninsured patients each year.
It’s reassuring to know that the theater shooting victims – quite a few of whom likely have no health insurance – will have at least some help with their immediate hospital bills. What’s less clear is the financial implications for the more gravely injured victims as they move forward with their treatment after being discharged from the hospital. Physical and occupational therapy, outpatient follow ups, mental health treatment to cope with the trauma – these expensive services are likely to be a big part of some of the victims’ lives for the foreseeable future. Individual health insurance is still medically underwritten (until January 2014), so it would be difficult or impossible for uninsured victims to obtain health insurance now to cover future medical bills related to the shooting (CoverColorado and GettingUSCovered – the state’s high risk pools – are an option available to people with pre-existing conditions). They may be able to obtain health insurance through an employer group plan, but the ones who are uninsured likely didn’t […]
Walgreens, Anthem Blue Cross Express Scripts Agreement Reached
Express Scripts and Walgreens have come to a multi-year agreement for Walgreens to participate as an in-network retail pharmacy. Anthem Blue Cross Blue Shield of Colorado members will be able to use their prescription drug benefits at Walgreens locations beginning Sept. 15, 2012.
Walgreens was in a situation where it needed to get this deal figured out. They were losing millions, not just in prescription drug sales, but the people who weren’t in the store filling their prescriptions also weren’t in the store to buy juice, toilet paper, grills, etc…
Healthcare Reform Progress In Colorado
[…] Although I frequently read and write about Colorado’s healthcare reform progress, I wasn’t aware of the work being done by the Colorado Regional Health Information Organization (CORHIO) before I read Anne’s article. Although the PPACA has put a lot more emphasis on electronic health records and healthcare IT, Colorado has been working on its own system with CORHIO. The program is working with healthcare providers to implement health information exchange between providers – saving time and money in the process – and improve the overall quality of care for Colorado patients. CORHIO goal is to have health information exchange implemented in every community in Colorado by 2015, with at least 85% of providers in the state enrolled in meaningful use EHRs by that time.
Anne also writes about the Colorado Health Benefits Exchange (which has received high marks for its progress so far) and notes that it “…will enable up to 960,000 Coloradans to purchase health insurance at a discounted rate.” The exchange has a lot of excellent features, and will no doubt be a solid resource for individuals and small businesses in Colorado. But in order to avoid confusion I think we should point out that the “discounted rate” likely refers to the government subsidies that will be provided to help people pay their health insurance premiums. Subsidies will be available for people earning up to 400% of the federal poverty level, which is roughly $92,000 in 2012 for a family of four. This means that the majority of the population will qualify for subsidies, and that will indeed amount to a lower premium in terms of what the individual will have to pay out of pocket for health insurance. But I think that there could be widespread misunderstanding in terms of what the exchange will be and what it can provide.
To illustrate the point, we can look at a common misperception that exists with regards to the current health insurance market. It’s widely believed that group coverage is less expensive than individual health insurance thanks to the “group discount”. In fact, individual health insurance is quite a bit less expensive because of medical underwriting: group policies have to accept all eligible employees and dependents, regardless of medical history. This drives up the claims expenses for group coverage and results in higher premiums than medically underwritten individual policies. That’s just one example, but I can imagine that the health benefits exchanges might be erroneously viewed as a marketplace where customers can get “special deals” on the health insurance. People shopping in the exchange will be able to know that they’re getting a certain minimum level of coverage and they’ll be able to compare numerous plans side-by-side (in many ways this is similar to what brokers like us already provide). The subsidy system is also expected to be tied in with the exchange’s policy shopping platform so that any applicable subsidy and the purchase of health insurance can be lumped together in one transaction. But beyond the subsidy and the inherent competition that will exist among the carriers participating in the exchange, I’m not aware of any other discounted rates for policies that will be sold in the health benefits exchanges that the states are currently creating.
HWR and Malpractice Reform
[…] Republicans in congress have long argued that the PPACA needs to be “repealed and replaced”, and many Americans are indeed unhappy with the law as it currently stands. A recent NPR poll found that a slight majority of the population favors amending the law rather than repealing it, but either way I wouldn’t be surprised if we see at least some changes to the law between now and 2014 when the bulk of it is set to take effect.
Malpractice reform sounds great in theory. So it’s the sort of thing that people grab onto as a solution, even if it might not really end up having a significant impact on healthcare costs. Huge malpractice cases – especially the ones that the public deem frivolous or ridiculous – tend to get news coverage and stir up all sorts of online commentary and water cooler discussion. We do live in a litigious society, but I would say that substantial malpractice lawsuits get more than their fair share of media discussion. The result is that everyone has heard of someone who was awarded millions in a malpractice case. My family once lived in a small town where the only obstetric practice closed down after the doctors were the defendants in a $23 million malpractice suit. Stories like that end up on the news, and people tend to think that if we could just reform that system, our healthcare costs (and thus our health insurance premiums) would go way down since doctors wouldn’t have to practice as much defensive medicine. But numerous studies have found that malpractice reform wouldn’t have much of an impact on healthcare costs. David’s article delves into a few of the reasons for this. There’s no doubt that the malpractice system could use some reform, but if that approach is used as a cornerstone of a “repeal and replace” strategy, it’s likely to come up short.
FEHB Health Insurance Now Available For Seasonal Firefighters
[…] The federal Office of Personnel Management (OPM) issued a ruling yesterday – effective immediately – that grants seasonal firefighters access to health insurance through the Federal Employees Health Benefits Program (FEHB), which allows federal employees to select from among several private health insurance policies. Normally, eligibility for FEHB requires an employee to have completed a full year of service. This is not possible for seasonal firefighters, since they are employed for temporary positions during the fire season, usually for only six months at a time. So until OPM issued the new rules, seasonal firefighters were never eligible for health insurance through FEHB. Their only real options were to obtain health insurance as a dependent on a spouse’s plan, or to apply for coverage in the individual market – which is subject to underwriting (and some individual carriers won’t accept applicants who have high risk jobs).
[…]
Laws That Protect Young Workers
[…] Teens working their first summer job might not have the knowledge or ability to speak up and refuse to put themselves in harm’s way or work more hours than they should. So laws have been crafted to protect them, and it’s up to the employer to understand the rules and follow them. The penalties for not doing so can be steep. This post is a good reminder at this time of year, when many businesses hire teens for part-time work during summer vacation. Especially if you’re an employer who hires young workers for part-time or temporary positions, Julie’s article is well worth the few minutes it takes to read.
Does GSK Case Show A Need For Profit And Admin Caps In the Rest Of the Healthcare Industry?
[…] The fine against GSK is addressing transgressions that occurred several years ago, and the company notes that they have taken steps to remedy the problems and make sure that similar problems won’t happen again. But it still sheds light on the tremendous marketing machine that is Big Pharma, and the huge sum of money that is earned every year by the pharmaceutical industry. I’m reminded of an article I wrote on the Colorado Health Insurance Insider in the fall of 2010, when the Medical Loss Ratio rules were issued and scheduled to go into effect the following January. I wrote about how the MLR rules (requiring health insurance carriers to spend at least 80% of premiums on healthcare services, with admin costs capped at 20%) would surely drive health insurance carriers to be more innovative and efficient. But I also lamented the fact that the rest of the healthcare industry wasn’t being held to similar standards.