We just got a little bit of wet, sticky snow in Colorado last night; just enough for a little snowman in the morning. Matt made the snowman all by himself! Most of the snow in the yard has melted this evening, but not the snowman!
Blog
Healthcare Overutilization And General Physical Exams
[…] perhaps we need to consider at least some general physical exams to be overutilization of care. I know – that sounds blasphemous and counter-intuitive. But sometimes we have to abandon our preconceived ideas and look at what the evidence is telling us rather than just accepting what we assume we know to be true. I would say that further and more extensive studies need to be conducted before we make any radical changes as far as general physical exams and well-checks. But we definitely need to be taking a much closer look at healthcare over-utilization. Maybe that’s where we can do our “rationing”, and end up with a win-win for everyone: lower healthcare spending and better patient outcomes.
Health Insurance Premiums And The ACA
[…] We wrote a couple years ago about the Colorado Division of Insurance bulletin that laid out the reasons for rate increases in 2010 – almost all of them were the same factors that had been driving health insurance premiums for the previous decade; only 5% of the total premiums could be attributed to the ACA. […] The predicted long-term cost savings from the ACA are definitely not a sure thing. But we need to keep in mind that many of the substantial changes included in the law have not yet taken effect. And many of the changes that have been implemented are those that tend to increase short-term costs and/or utilization of care. […]
Individual Health Insurance Mandate From A Perspective Of Compassion
[…] I’ve usually addressed the issue of the individual health insurance mandate in terms of how guaranteed issue health insurance would impact premiums in the absence of an individual mandate. The mandate – regardless of its popularity – just seems like the most practical way to go if we’re in agreement that individual health insurance should be guaranteed issue.
Maybe we should also be looking at the individual health insurance mandate from a more compassionate, human angle too. There has long been a bit of a harsh undertone in the healthcare reform discussions when it comes to people who are […]
ACA Electronic Medical Records – Opposing Views
[…]Dr. Plested believes that the ACA will lead to rationing (it’s hard to say with certainty that this isn’t true, but Dr. Plested believes with certainty that it is true) and that the Obama Administration wants doctors to adopt the ACA electronic medical records so that treatment specifics can be sent to the Internal Revenue Service and federal health officials. He believes that doctors will then be instructed to pursue a treatment plan “that is preferred by the government.”
Dr. Bender notes that in his own practice, computerized medical records have alerted his office to the fact that less than half of their diabetic patients were being tested at least once every three months (standard of care, and a good way to lower costs since it reduces the number of patients with complications stemming from uncontrolled diabetes), Prior to the introduction of electronic medical records he had no idea that the number was so low. It’s now up to 85%. As far as records being transmitted to the IRS and other government officials, Dr. Bender notes that the IRS would need a subpoena to get his patients medical records, which are locked securely behind several firewalls. […]
Healthy Weekend Fun – Mocha Chip Banana Soft Serve
The idea of freezing bananas and then blending them into “ice cream” is not my own. I discovered it online a few years ago, and it has since become so popular that I’ve noticed bananas in the grocery store with little stickers on them letting people know that they can be blended into soft-serve style desserts. But the recipe I’m sharing here is my own creation that came about when I started tinkering with the basic blended bananas idea.
It’s quick, easy, and the sweetness in it comes almost entirely from the bananas. What’s not to love?!
Mocha Chip Banana Soft Serve
Ingredients:
2 cups frozen banana chunks
3 Tbsp cocoa
1 scoop chocolate protein powder (try to stick with a brand that doesn’t […]
ACA Alternative Has Some Logistical Limitations
[…] But if we’re looking at an ACA alternative, I would say that the major issue that causes health insurance to be dramatically more expensive in some states has more to do with health insurance being guaranteed issue (without a mandate that everyone purchase health insurance) and less to do with specific laws regarding coverage details. I’ve written in the past about some of the problems that could go along with selling health insurance across state lines, but Bob and Joe’s point about no state having truly affordable health insurance is really the crux of the issue. In order to make health insurance more affordable, we have to get a handle on the cost of care, since that’s what drives health insurance […]
How To Better Serve Emergency Room “Frequent Flyers”
The American College of Emergency Physicians had their annual meeting in Denver, Colorado this week, and presentations involved several new studies pertaining to people who are the most frequent users of emergency room care. I found that article to be fascinating, in part because it dispels so many myths about emergency room “frequent flyers.” We’ve written before about the fact that most emergency room patients do have health insurance and that emergency room overcrowding cannot be blamed on uninsured patients (as is often cited in casual conversation). Although most emergency room visitors do have health insurance, many of them have public health insurance via Medicare or Medicaid. And since the Medicaid rolls are expected to grow significantly over the next several years, it’s likely that ER overcrowding will grow to become more of a problem as some of those Medicaid patients are unable to access primary care outside the emergency room. […]
Healthcare Fact Checking the Presidential Debate in Denver
I think that political debates would be a lot more fun (and educational) to watch if non-partisan fact checkers were allowed to sit off to the side and hold up “pants on fire” signs when appropriate. But the next best option is the plethora of online fact-checkers who can help us sift through the statements. It’s generally been acknowledged that there were more than a few half-truths and outright lies in last night’s 1st Presidential debate here in Colorado at the University of Denver.
Specifically regarding healthcare and health insurance reform, there are a couple of PPACA-related points that need further comment. First, we have the comment from Romney regarding the “unelected board, appointed board, who are going to decide what kind of treatment you ought to have.” He’s referring to the Independent Payments Advisory Board (IPAB), whose job is to oversee general Medicare spending. They are allowed to reduce Medicare payments to hospitals with high re-admission rates and recommend ways to reduce wasteful Medicare spending through new innovations. But they cannot restrict benefits, alter Medicare eligibility, or make any decisions regarding treatment options. […]
CORHIO Continues To Make Progress On Colorado Health Information Exchange
There are 110 hospitals in Colorado, and so far CORHIO has connected 27 of them to the health information exchange, and they are actively working on connecting two more. They are also currently working to add 800 more medical offices to the health information exchange, to join the 290 who are already connected.
Health IT has been a major talking point throughout the healthcare reform process, and the steps that CORHIO is taking will no doubt make for a more efficient healthcare system throughout Colorado once the entire state is linked through the HIE. Patients who see multiple doctors or who are treated at more than one hospital […]
Colorado Health Exchange Gets $43 Million Federal Grant
Throughout the entire healthcare reform process, Colorado has been one of the states working hardest to make healthcare for everyone a priority. Even before healthcare reform became a national issue, the Colorado Blue Ribbon Commission was actively working on the problem (and many of the recommendations that the Blue Ribbon Commission recommended ended up being quite similar to reforms that subsequently were included in the PPACA). So it’s not surprising that the Colorado health exchange is moving ahead on schedule to meet the target of being able to start enrolling people and small businesses in the exchange as of October 2013 (January 2014[…]
How Does Health Care Reform Impact HDHPs and HSAs?
Will HSA qualified health insurance plans and Health Savings Accounts (HSA) still exist after the majority of the remaining PPACA changes are implemented in 2014? That’s a question that we often hear from Colorado health insurance clients who are concerned about their existing HSA qualified high deductible health plan (HDHP)/HSA, as well as people who are considering an HDHP but uncertain about the future of that type of health insurance.
In terms of direct impact, the PPACA changes very little about HDHPs and HSAs. There are only two […]
Playoff Health Wonk Review, And The Other Side Of The ACO Coin
An excellent baseball-playoff themed edition of the Health Wonk Review is at Wing of Zock, hosted by Jennifer Salopek – be sure to head over and check it out. This article by Jason Shafrin should be of interest to anyone who has been paying attention to all the talk about ACOs lately. I have been generally impressed with what I’ve read regarding the potential cost savings and improved efficiency that ACOs will hopefully provide. However, although health care reform has focused quite a bit of energy on the creation of ACOs, it is far […]
Colorado Kaiser Permanente Recognized By HHS For Hypertension Control
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[…]
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.