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Consumer-Driven Healthcare Debate

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[…]prior to reading Ungar’s article I wasn’t aware of the agreement between the Independent Physicians Association and Rocky Mountain Health Plans with regard to Medicare and Medicaid reimbursement. The doctors in the IPA were so determined to treat every patient equally that they worked out an arrangement with RMHP to have the insurance carrier accept payment directly from Medicare and Medicaid and then pool that money together with premiums collected from RMHP insureds.
[…] Hixon argues that patients with more financial responsibility for their own care do indeed make better decisions regarding efficient use of healthcare dollars. Furthermore, he cites a study that found that patients with high deductible health insurance policies (eg, HSA qualified plans) had more preventive care, lower rates of hospitalization, and were more compliant in terms of following their doctors’ recommendations. They were also more likely to question their medical bills and had overall lower medical costs than people with traditional low-deductible policies.

[…] In addition to probably being above average in terms of financial savvy, I would assume that the demographic that opts for high deductible health insurance is also probably healthier than average. It makes sense that the more health problems a person has, the more likely he’ll be to choose a lower-deductible policy, since he knows he’s likely to be using the policy at least somewhat regularly. On the other hand, a person with no health conditions at all is probably making a good gamble to select a high deductible policy, since there’s a decent chance he’ll be able to go for several years without having a major claim. So the fact that people with HDHPs have lower medical costs isn’t really surprising. It’s largely a self-selected group (employers who offer an HDHP usually offer another plan as well, and everyone shopping for individual health insurance who picks an HDHP has other options from which to choose). I’m not sure that medical costs would still be lower for people with HDHPs if they policy designs were assigned randomly across the entire population.

Access To Healthcare In Colorado Worsening

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The Colorado Health Access Survey results were released earlier this month, and the results aren’t particularly surprising given the state of the economy for the past few years. The total number of uninsured Colorado residents is now 829,000 – up from 678,000 in 2009. The survey also counts the number of “underinsured” residents (those who aren’t able to afford their out-of-pocket expenses that total more than 10% of their income, or 5% for those below the poverty line). The two categories – uninsured and underinsured – amount to 1.5 million people, which is about a third of the Colorado population.

The 22% increase in the number of uninsured residents came despite strong efforts in Colorado to expand access to Medicaid and CHP+ over the past few years. Without the expansion of those programs, the numbers would undoubtedly be even more bleak. […]

Employer Funding Of Individual Health Insurance Varies By State

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Over the past several months, I’ve written a few articles about the legality of employer reimbursement of individual health insurance premiums in Colorado. Our friend and fellow blogger Hank Stern (writing at InsureBlog) found the changes interesting, and noted that the laws surrounding employer reimbursement of premiums vary quite a bit from one state to another (he’s in OH).

Hank and I wrote a joint post about the topic, which he published last week on InsureBlog. Here’s Hank’s description of how the law works in OH (regular readers will note that it’s similar to how things used to be here in Colorado, before HRAs became a major issue, and of course before SB19 passed earlier this year). […]

Photo Session for the Colorado Health Foundation

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IMG_3109 A few weeks ago, the Colorado Health Foundation interviewed Jay for an article in an upcoming edition of their magazine due to come out in January. Yesterday, photojournalist Barry Staver came up to Wellington from Denver to take pictures of us to accompany the article. We were honored to be photographed by him, and impressed with his unassuming, friendly personality. And we were thrilled when he offered to take pictures of our family with our little pocket camera so that we could have our own copies. (with a baby and a three-year-old, we have to make the most of moments when everybody is clean at the same time!) So here we are, in front of our backyard office, in a family photo taken by Barry Staver […]

Combining Patient Satisfaction With Clinical Outcomes And Cost Efficiency

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[…] Particularly in the current era of spiraling healthcare costs, it’s a bit troubling to hear that hospitals are doing things like putting in extra elevators so that people don’t have to wait as long for an elevator… all for the sake of boosting their patient satisfaction rankings. Yes, it might increase patient satisfaction by a small margin, but somebody has to pay for it. Renovation projects like that add to the hospital’s overhead expenses, and that leads to increased charges for care at the hospital. Ultimately, health insurance carriers end up paying more for their insureds’ claims, and that translates directly to increased health insurance premiums […]

Cholesterol Testing For Kids, With An Extra Serving Of Fries

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[…] Congress released a spending bill this week that would do away with the steps the government has made recently to improve the nutritional content of school lunches. The winners? The potato industry and the makers of frozen pizzas. The losers? Children all across the country and the future of our already over-burdened healthcare system.

I find it a bit ironic that the spending bill was released almost simultaneously with the recommendation that we begin screening all children for elevated cholesterol levels starting between the ages of 9 and 11.

Instead of asking the frozen food makers, who supply our schools’ cafeterias, to come up with a pizza that has whole wheat crust and a few more veggies on top, Congress would rather define the tiny amount of tomato paste on the current slices as a serving of vegetables. And instead of limiting starchy vegetables (including the french fries that are served almost daily in many schools), the new bill would allow fried spuds to continue to be served without limitations.

Cleaner Hospitals Spread Fewer Infections

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[…] What is shocking is the fact that hospitals aren’t already at the top of the cleanliness scale. Although we’ve known for more than a century that germs cause disease, there is still a surprising lack of compliance with basic hygiene in the medical profession – even something as simple as hand washing between patients. Jessica’s post describes a study at the Mayo Clinic that involved cleaning high-touch surfaces with bleach wipes twice a day for six months. Their incidence of Clostridium difficile (C. diff) went from one case every few days to one case every three months. Pretty impressive results, and a very easy solution. Sterilizing high-touch surfaces in hospitals should be a matter of routine, but obviously that isn’t yet the case. Maybe the Mayo Clinic study will help to get other hospitals on board in order to reduce the incidence of hospital-acquired infections across the country.

You Don’t Want To Come Out Ahead With Health Insurance

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Browsing around Reddit this morning, we came across this thread (there is profanity). The initial sentiment in the title is no doubt one that has been expressed by a lot of people over the last few years, and the thousands of comments are testament to the fact that healthcare debate tends to get people fired up […] Another way to think about it: Health insurance is designed to spread risk. We all pay in (ideally, anyway) and then the carriers pay out when someone has a claim. The premiums from those of us who have been fortunate enough to not have health problems are used to cover the healthcare costs of people who have serious illnesses or injuries. And we never know when we might find ourselves in that second category. If you’re complaining because you’ve paid $13,000 in premiums over six years and have have very little paid out in claims, would you take a similar position if you suddenly had a $500,000 claim? Would you want the carrier to say that you have to pay in what you get out? Reversing the scenario like that highlights the lack of logic on the part of people who get annoyed because they haven’t gotten as much out of their health insurance as they’ve paid in. And yet that sentiment is one that is constantly tossed around when people talk about their health insurance.

To summarize: It will be a very bad day if and when you actually come out ahead financially with your health insurance. Please don’t wish for that day. Remind yourself that your health insurance is in place to protect you in the event of a medical catastrophe. Don’t buy a mini-med or a discount plan or any other type of coverage that won’t actually be there for you if you have a major health crisis. Get a policy that you’re confident will protect you if you have a major claim, and then be grateful if you’re one of the people who remains healthy enough to get less back in benefits than you pay in premiums.

Being A Savvy Healthcare Consumer Is Tougher Than It Sounds

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[…] I’ve long been a fan of high deductible, HSA qualified health insurance policies (our family had one until very recently when we switched to a high deductible plan that isn’t HSA qualified but has much lower premiums). But I’ve also always been aware that we’re fortunate to be able to utilize a high deductible health insurance policy – both in terms of being healthy and not needing much in the way of healthcare, and also in our ability to make contributions to our HSA to cover the cost of care we might need in the future. People who have serious health conditions and/or those with very limited funds […] When it comes to actually being a savvy consumer of healthcare, the vast majority of us wouldn’t even know where to begin. Google? Asking friends? Maybe, but chances are, we’re going to go to a doctor and follow (at least roughly) the recommendations the doctor makes. Most of the time, providers are the ones who control how much care a patient receives ie, it’s the supply that’s driving things, rather than the demand. We might know that something’s not right and take the initial step of going to the doctor. But what happens next (surgery? PT? wait and see? Medication? etc.) is generally up to the doctor. As Michelle pointed out, the patient’s number one priority is going to be getting better, especially if the problem being treated is a serious one. Shopping around for the best price and poring over comparative effectiveness research data probably isn’t going to be high on most patients’ lists.

Comparing Wall Street And Healthcare

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[…] Should hospital, insurance, and pharmaceutical executives be earning millions of dollars while millions of Americans have no health insurance and no realistic access to healthcare? Should those executives earn their millions regardless of how their company has performed? Or regardless of the overall state of healthcare in this country? Should decision-making at healthcare companies (hospitals, pharmaceutical companies, insurance carriers, device makers, etc.) be based more on the best interests of shareholders and executives, or on what is best for the health of Americans? Do healthcare companies need to be held to a different standard than other corporations, simply because of the importance of the product they provide? […]

More Flexibility With An Individual Health Insurance Plan

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[…] For the average person who has had an individual policy for a decade and is late 50s-ish, keeping that individual policy (even though a group plan may become available) might be the ticket to being able to have some flexibility in terms of when to retire. The group plan is guaranteed issue – health conditions won’t be a barrier to getting coverage. But the group plan is also tied to the current employer, and the policy will only be available for a maximum of 18 months after you leave that job (via COBRA). […] Linda’s article is an excellent reminder about the importance of looking at the specifics of your own situation – including long term issues that might outweigh short-term benefits – rather than following conventional wisdom or doing what everyone else is doing.

Colorado’s Average 2012 Premium Increase Is The Smallest Since 2000

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[…] I’m sure there will still be people who falsely claim that Colorado’s maternity mandate and federal reform are the reason for any increase. But when we place the 2012 increase in context with the increases we’ve seen over the past decade, it becomes harder to blame recent reform laws for the 2012 premium increases. I’m glad to see that after a year of having guaranteed issue coverage for children, no lifetime maximums, more comprehensive preventive care, and maternity benefits on all new and renewed individual policies, we are seeing the lowest average rate increase in over a decade.

Employer Reimbursement Of Premiums Causing Applicants To Be Declined

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[…] I know that the law was written with good intentions, but we’re noticing that it’s the employees – the applicants who are trying to get individual health insurance policies – who get the short end of the stick. It’s the employees who end up getting their health insurance application declined. It’s the employees who end up having to pay for their own premiums in order to obtain coverage, even if they thought that they were going to be able to rely on some level of reimbursement from their employer.

Millions Of Uninsured Children Are Eligible For Public Health Insurance

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[…] The first sentence of Jason’s article is the most striking: The fact that there are 4.3 million uninsured children in the US who are eligible for Medicaid or CHIP (Children’s Health Insurance Program). Obviously, not all states are pushing hard to enroll all (or even most) Medicaid/CHIP eligible children in those programs. And although Colorado received a $13.7 million grant last year thanks to the increased enrollment in the state’s Medicaid program, the expansion of public health insurance programs in Colorado has not been without criticism. Especially in the current economic climate, it’s hard to see how government health insurance programs could afford to insure an additional 4.3 million children. […]

Kaiser Permanente Colorado Gets Top NCOA Ranking

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Kaiser Permanente Colorado is the highest-rated private health insurance plan in Colorado and one of the top-ranked private health plans (#6) in the nation for clinical performance and effectiveness, as well as member satisfaction, according to new rankings by the independent, non-profit National Committee for Quality Assurance (NCQA).
Kaiser is one of the top 10 plans in the nation in 36 of the 40 health outcome measures, recognizing high quality clinical care

Walgreens Leaving Express Scripts Network

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If you’re insured through Anthem Blue Cross Blue Shield or another carrier using the Express Scripts network, Walgreens will be leaving the network on January 1, 2012. Express Scripts just posted on their website:
“At Express Scripts, we’re committed to keeping your prescription drugs affordable and accessible. That’s why we negotiate cost-competitive agreements […]”
Express Scripts is sorry that Walgreens did what they did and has expressed sincere regret about the situation:
“We regret any inconvenience that Walgreens’ actions have caused you. If you have any questions, please call us at 1.877.885.3409.”

Comparative Effectiveness Research Fee To Be Added To Premiums In 2012

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[…] This fee is similar to the one that is assessed to pay for CoverColorado (except that it’s a much smaller amount). Basically, carriers will collect the fee from members and then pass the money on to the Patient-Centered Outcomes Research Institute, much the way carriers pass on the CoverColorado fee. The fee will not be counted as premiums for the purpose of calculating medical loss ratio numbers, and should not be confused as being part of the premium that we pay for our health insurance.

Possible Solutions For Long Term Care Funding Problems

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[…] As long as we’re looking at a fragmented public/private hodge podge of long term care funding that includes Medicaid, private long term care insurance, private assets, and help from family and friends, I think it’s important that we look for ways to make things as fair as possible and also keep Medicaid financially afloat. The CLASS Act got nixed from the ACA, but the problem of funding long term care isn’t going away, and is only going to grow as the baby boomer generation ages. John’s article is a good one to read if you’re interested in possible solutions.

World Insurance And American Republic Leaving Individual Market

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[…] The rep I spoke with at World Insurance said that it wasn’t clear yet which states will be in the November round of notifications, so we aren’t sure when World/American Republic policyholders in Colorado will be officially notified that their carrier is leaving the market. But I confirmed with both World Insurance and Celtic that the change is happening and that the initial stage of it will begin next month. Colorado residents who are currently covered by either World Insurance or American Republic would be wise to begin looking for other health insurance options. […]

Real-Time Tracking Of Healthcare Costs

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[…] Obviously we have to avoid cutting corners just for the sake of lowering costs at the expense of patient outcomes (again, including patient outcomes when we compare the cost data would help to prevent this problem). But I have no doubt that there are other healthcare expenses that could be eliminated without compromising patient outcomes. In many cases, the providers might just be unaware of the actual costs that are being incurred – Dr. Fogelson’s idea for a real-time digital tracker would help to keep cost in the front of everyone’s mind.

Health Insurance Exchange Payroll and Admin Expenses

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[…] One of the comments on the post was from Dede de Percin, the Executive Director of the Colorado Consumer Health Initiative (CCHI). […] Dede’s comment on my article referenced the point I made about consumers not having to pay additional fees to have a broker. Basically, health insurance is priced the same whether you go directly through a health insurance carrier (calling Anthem Blue Cross Blue Shield directly, for example) or through a broker (who will compare options from multiple carriers for you). Dede made this point:
“While a consumer or business doesn’t not pay a health insurance broker directly, broker fees and commissions are paid by the insurance companies – and rolled into […]”

Why People Don’t Buy Life, Disability, and LTC Insurance

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[…] Insurance just isn’t that much fun to buy, period. It’s a product that we purchase while hoping we never have to use it, and if we ever do have to use it, things aren’t going so great. Having insurance does contribute to our peace of mind though, and that’s valuable in and of itself.

Does The Pink Ribbon Trivialize Breast Cancer Deaths?

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[…] I can see how awareness is a good thing if it encourages people (men and women) to be in tune with their health and current on the screening exams that they and their doctor feel they need. And it’s a reminder to all of us to do whatever we can to provide support to those who have cancer. But what about the people who know that their cancer is terminal? What about those with metastatic breast cancer? Or with another form of advanced cancer like my friend? The people who know that there is almost no chance they will beat the disease, and that their life will almost certainly be cut short by it? Do all the pink ribbons trivialize their deaths? […]

Conflicting Data Regarding Medical Costs

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[…] These numbers are much more in line with the rise in health insurance premiums that we’ve seen over the past few years. I have no explanation for why the data from the two sources is so dramatically different in terms of medical trend in 2010, but if the trend was really closer to 7.5% rather than 1.7%, the health insurance premium increases would be a lot easier to understand. […] In addition to the MLR rules, some states (including Colorado) have implemented strict review processes for rate hikes. The ACA now calls for insurers who propose a rate hike of 10% or more […]

The Opposite Of Transparent

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[…] David also points out that the amounts allowed by his Blue Cross Blue Shield carrier don’t seem to have anything to do with the amounts billed by his physical therapies – the lowest allowed amount on his EOB was for the service that was billed with the highest price tag. We’ve also seen little rhyme or reason (that we can detect, anyway) in terms of how billed amounts and allowed amount correlate. […]