Kaiser is the Future of Health Care?

Interesting article on Kaiser's efforts to control the costs of health care. It has spent $30B the past 10 yrs. on its electronic medical records capability. It employs all of its doctors and tracks each one for employing best treatment practices. Yet even in places such as California where it controls all forms of delivery its cost savings is only 10%.

http://www.nytimes.com/2013/03/21/business/kaiser-permanente-is-seen-as-face-of-future-health-care.html?ref=business

Not For Profits Best For Profit Health Plans in Customer Satisfaction

No particularly reason given for not for profits doing better here. Overall though health plans have very low customer satisfaction scores.

http://www.healthleadersmedia.com/print/HEP-290331/Nonprofit-Health-Plans-Edge-ForProfits-in-Customer-Satisfaction

Great Results When Hospitals Share Best Practices

Former CMS head Donald Berwick has good news to report on a national initiative to improve hospital performance. Most eye popping number--over 92,000 lives saved as a result of reduced infections and better care. Amazing.  Plus these hospitals provided this better care at lower costs.


http://www.healthleadersmedia.com/print/QUA-290313/Berwick-Quest-Program-Results-A-Breakthrough

Best Analysis of the two Medicare Proposals by Far

This article by Jonathan Cohn of the New Republic easily does the best job I have seen of comparing the two Medicare reform  initiatives of the two presidential candidates:

http://www.tnr.com/blog/plank/106298/guide-to-medicare-debate-romney-ryan-obama-voucher-premium-support#comment-377242

Supplemental Policies Sales Increase

With high deductible coverage becoing increasing popular due to its lower costs for employees, it appears that employees are buying supplemental policies to fill in the gap:

http://www.reuters.com/article/2012/08/02/us-insurance-supplementary-gaps-idUSBRE87111K20120802t

Maasachusetts Legislature Passes Bill to Rein in Health Care Costs

The Legislature in MA yesterday passed a bill that limits the cost of health care to the rate of economic growth in the state. This will be a challenge for providers and insurers as medical costs increased 6-7% in 2010 while the state economy grew by only 3.6%. More details in this Boston Globe article:

http://www.bostonglobe.com/lifestyle/health-wellness/2012/07/30/legislative-leaders-reach-compromise-plan-control-health-care-spending/nVM0gPAYznIo4Vc9YYlgyH/story.html?

Will this work? Hard to say but MA s the first state in the country to set such a target. More details to follow.

HCCI Report: Rising HC Costs Due to Children

According to a report from the Health Care Cost Institute, a Washington, DC-based research group, spending on healthcare costs for commercially insured children under age 18 grew faster than spending for adults from 2007 to 2010. HCCI had access to three billion health insurance claims from Aetna, Humana, and UnitedHealthcare.

Insurers and consumers spent nearly $88 billion on healthcare for children in 2010, up by 12% percent from 2007, according to the HCCI. Spending increased even though the number of children covered by employer-sponsored insurance dropped from 44 million in 2007 to 41.4 million in 2010.

By comparison, healthcare costs for adults increased by 8%. For  the full report please clink on the link below.
http://www.healthcostinstitute.org/childrensreport

Good Summary of What the SC Ruling Means for Medicaid Expansion

One of the key ways of expanding coverage in the ACA was raising Medicaid eligibility to 133% of the poverty level. 29 states opposed being compelled by the feds to do so and now given yesterday's ruling they now have the option not to do so. What does this mean?

If some states do reject the Medicaid expansion, consumers between 100% of poverty and 133% of poverty would become eligible for the private federally subsidized insurance in the exchanges since the subsidies start at 100% of poverty. That would mean more business for those offering private insurance in the exchanges.

It also means that the federal government’s cost of covering these people would increase—covering them under Medicaid would be cheaper than under the private plans in the exchanges.

For those between 100% of poverty and 133% of poverty, it would be a mixed bag. Instead of a Medicaid plan, they would get a mainstream private insurance plan from the exchange that could gain them access to the health care system beyond only the providers who accept Medicaid patients. But they would have to pay 2% of their income in premiums—$600 a year if they make $30,000 a year. And, unlike Medicaid, they would be subject to standard deductibles and copays—perhaps an upfront $1,000 deductible per person. The cheapest plan, the bronze plan, is intended to only cover about 60% of health care costs.

Governors even end up having an incentive to dump Medicaid people onto the exchange—the state has to pay 10% of any Medicaid extension starting in 2017 but none of the cost of subsidies in the private exchanges.

And, some states don't now provide Medicaid coverage for some poor people making less than 100% of the poverty level--leaving them caught in a gap before federal coverage starts at 100%.

So, it’s not an open and shut case for the states on what they should do.

Many States Will Not Have Their HIX Ready 2014

It made little sense to me to invent the wheel 50 times throughout the country but to appease conservatives and lessen the concern about the federal government takeover of health care, the ACA gave the power to the states to create their own HIXs. But in a true irony, given how few states will be ready come 2014, the feds will have to step in and play a minor to major role in approximately 40 states or more come 2014.

http://www.politico.com/news/stories/0512/76596.html

Under 65 HC Claims Data Study Reveals Interesting Results

The first report based on claims data for the under 65 insurance market was released last week. Some of the findings include:
--Prices for care outside the hospital grew faster (10.1%) than care for patients admitted to the hospital (5.5%), though the average price for outpatient care was a fraction of inpatient care. The average price for care provided to patients admitted to the hospital was $14,662, compared with $2,224 for outpatient care.

The researchers found that price was still the major driver of costs even after adjusting for intensity of service

Read more: Rising prices drove higher spending among commercially insured: study - Healthcare business news and research | Modern Healthcare http://www.modernhealthcare.com/article/20120521/NEWS/305219978#ixzz1vWFR0KUN
?trk=tynt

State HIXs Should Limit Plan Choices

Each state has the flexibility to create the HIX that it believes best serves its market. Right now only two states, Utah and Massachusetts, have established HIXs. Utah allows any insurer to market its product(s) while Massachusetts limits the number of products offered. My experience shows that the MA model makes the most sense. Health insurance is very confusing to the average consumer so limiting the amount of choices is best. Research has shown that the more choices a consumer has the more difficult it is for them to make a purchase decision. This is particularly true for health insurance.

http://thehill.com/blogs/healthwatch/health-reform-implementation/226085-study-states-should-limit-number-of-plans-in-exchanges

HHS Regulatory Review: All Bark No Bite

It is nice that HHS can call out insurers for "unreasonable" rate increases on their individual products but in the end the feds cannot stop them from doing it.
http://www.politico.com/news/stories/0512/76066.html

Commonwealth Study On US HC Costs Compared to 12 Other Countries

Good review of the topic. Same old story: we spend much more than anybody else with no improvement in quality and in some ways are way worse.

http://www.commonwealthfund.org/Publications/Issue-Briefs/2012/May/High-Health-Care-Spending.aspx

Good Review of the Promise of ACOs

I think this is a fair treatment of the ACO concept. But is the risk worth it? I think most providers will still say no.
http://www.kaiserhealthnews.org/Stories/2012/May/02/millenson-ACOs-muscle-to-transform-system.aspx

Aetna CEO: HIs are Dinosaurs

Aetna CEO says in a speech that health insurers need to shift to becoming  technology guides for future consumers that will make it more convenient for consumers to access health care:
http://www.healthdatamanagement.com/news/HIMSS12-Aetna-CEO-insurers-face-extinction-44041-1.html?zkPrintable=true&goback=.gde_3264333_member_97073975

So What is the Latest on Payment Reform in MA?

Interesting presentation on payment reform by Dr. Robert Galvin on what could go wrong in payment reform. Two of his biggest concerns: providers fighting the loss of their income and consumers being told they can no longer have it all.

http://commonhealth.wbur.org/2012/04/10-ways-payment-reform

Good Summary of the SC and the Mandate

I have read many accounts now of Tuesday's SC hearings. Many said that the mandate is likely to lose 5-4 based on what they heard during the oral arguments. This summary takes a more reasoned view:

http://healthaffairs.org/blog/2012/03/28/william-sage-on-the-supreme-court-aca-arguments-day-two-where-no-law-has-gone-before/

Employer Sponsored HI Coverage Drop

In 2001 it was at 69.8%. By 2010 it had dropped to 54%. Wow.

http://motherjones.com/kevin-drum/2012/03/employer-based-health-insurance-going-way-dodo

Consumers Still Not Satisfied w/ Health Insurers

JD Power's new survey shows that consumers still are not happy with their health insurers. Interesting to note that 41% of people who have coverage through their employers would be interested in using an exchange to obtain coverage. I think this speaks to their desire to have multiple options for coverage.

http://www.fiercehealthpayer.com/story/insurance-exchanges-entice-dissatisfied-consumers/2012-03-16?utm_medium=nl&utm_source=internal

CBO Analysis of ACA Impact on Employer Coverage

Estimates range from 3M more covered by employers to 20M less. But even if the 20M less happens the net cost to the federal gov't will be minimal as additional cost for subsidies will be offset by higher tax revenues from higher salaries paid in lieu of HI coverage.

http://www.cbo.gov/publication/43090?utm_source=feedblitz&utm_medium=FeedBlitzEmail&utm_content=812526&utm_campaign=On-Demand_2012-03-15%2016%3a08