November 2011

Consumer-Driven Healthcare Debate

by Louise November 30, 2011

[...]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.

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Access To Healthcare In Colorado Worsening

by Louise November 26, 2011

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. [...]

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Employer Funding Of Individual Health Insurance Varies By State

by Louise November 20, 2011

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). [...]

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Photo Session for the Colorado Health Foundation

by Louise November 18, 2011

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 [...]

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Combining Patient Satisfaction With Clinical Outcomes And Cost Efficiency

by Louise November 18, 2011

[...] 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 [...]

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Cholesterol Testing For Kids, With An Extra Serving Of Fries

by Louise November 16, 2011

[...] 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.

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Cleaner Hospitals Spread Fewer Infections

by Louise November 15, 2011

[...] 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.

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

by Louise November 15, 2011

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.

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Being A Savvy Healthcare Consumer Is Tougher Than It Sounds

by Louise November 13, 2011

[...] 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.

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