Welcome to the Healthcare Social Media Review! We’re honored to be hosting this edition. Social media use continues to increase at a dizzying pace, and the healthcare world faces unique opportunities and challenges in utilizing it. There is tremendous potential for improved health, better medical awareness, and increased patient satisfaction if social media is used… Read more about Health Care Social Media Review – New Year, New Opportunities, New Challenges
David Williams did an excellent job with the most recent edition of the Health Wonk Review – be sure to check it out. One post that everyone should read comes from Health Affairs Blog, and was written by Joel Ario, Adam Block and Ian Spatz. They dig into the details of Silver plan premiums in four major US cities, finding lots of variation in pricing in some areas, and surprisingly little variation in others. As premiums have been slowly publicized over the last several weeks, I’ve seen numerous articles describing rates for ACA-compliant plans and how they vary from one plan to another within the same metal designation. But the Health Affairs article is the most thorough and helpful that I’ve read. The authors not only explain the details, but they also provide five very well-reasoned explanations for rate variation. If you’re confused about premiums for ACA-compliant plans, this article is a must-read. It’s also helpful in terms of helping people understand how plans can differ – even at the same metal level – beyond the basic deductible/copay amounts.
Wide variation in health insurance rates is nothing new. When I run current quotes (not yet 2014 ACA-compliant) for my own family, I get 11 pages of results, with prices ranging from $238/month to $1889/month. Much of that is explained by the vast differences in deductibles ($10,000 for the lowest priced plan, $500 for the highest), but even if I focus on plans that all have the same deductible ($5000, just to pick a middle-of-the-road number), I still get rates that range from $325/month to $924/month. Plan designs can vary greatly from one carrier to another, and provider networks make a big difference in terms of explaining premium variation from one area to another within a state (as an example here in Colorado, the carriers that offer the best rates in the Denver metro area and along the front range are typically not the same carriers that offer the best rates in the mountains or even in nearby Boulder, and much of the variation has to do with provider networks).
So it’s not at all surprising that rates will be significantly different from one carrier to another next year, both in and out of the exchanges. In most states […]
We recently heard from one of our clients who is dealing with a balance billing issue resulting from a NICU stay. For her baby’s birth, she chose a large hospital in Denver that was on her Humana health insurance network. Her OB/GYN was also on the Humana plan, and she figured she had all of her ducks in a row. But complications necessitated an emergency transfer to the NICU, where her new baby was cared for by doctors who are contracted with the hospital, but are not part of the Humana network.
When patients are treated by out-of network providers, there’s no contractual obligation between the doctors and the health insurance carrier. The patient will usually be responsible for a higher deductible when using a non-network provider (although this is not typically enforced for emergency care), but even after the deductible is met, the provider is not obligated to accept the “reasonable and customary” payment from the health insurance carrier. The provider can choose to bill the patient the shortfall between what was originally billed and what was paid by insurance.
Our client has been balance billed over $5,000 by the NICU doctors. Humana paid the doctors their in-network amounts for the NICU stay and counted it as an in-network expense (ie, no additional out-of-network deductible was charged) because it was an emergency situation. But the doctors refused to accept the insurance reimbursement as payment in full, and billed the family for an additional $5,000+. I suppose it could be worse – this family ended up with a $50,000 balance bill from their baby’s NICU stay.
But it could also be better. People who are recovering from an illness or injury don’t need to also be finding out that an in-network facility where they were treated also has providers who are not […]
You probably already knew that a Caucasian in Colorado has a life expectancy of almost 80 years. But did you know that an American Indian’s life expectancy is 45 years? This article from the Colorado Health Foundation, written by Sandy Graham, is a must-read for anyone interested in healthcare for minorities, specifically American Indians. The article focuses on the work that Marguerite Salazar is doing as Region VIII director of HHS, based in Denver (In addition to Colorado, Region VIII encompasses UT, WY, MT, SD and ND). Prior to working with HHS, Salazar was President and CEO of Valley-Wide Health Systems, a rural community-based healthcare program that served 40,000 people in Southern Colorado, including many migrant farm workers.
I particularly liked the focus on “culturally competent” healthcare – a concept that can be vital for the health of any minority group that doesn’t have the same heritage and traditions as the majority of healthcare providers in an area. And I liked this description from the article of work that Salazar did at Valley-Wide:
“…she [Salazar] and her staff had to explain to non-Hispanic providers that, yes, this person could not afford care, but had a cell phone – because he had to be able to hear from the field boss when agricultural work was available. And yes, the family drove a new truck – because they needed dependable transportation to get to the next farm job and that was most likely all they owned.”
It’s a perfect anecdote for anyone who has ever been frustrated by the internet meme describing how a patient in the ER has a cell phone (with a fancy ring tone!) and various other bling – and is on Medicaid. It seems to be circulated in an effort to show righteous indignation towards people who would dare to have anything more than a cardboard box and a blanket if they’re using “entitlements” to pay for things like food or healthcare. Salazar’s understanding of the healthcare needs of low-income families and cultural minorities comes[…]
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. […]
Four years ago, we wrote an article about recycling prescription drugs to be used by patients who don’t have health insurance or cannot afford their medications. This has remained a popular post on our blog, and people frequently search our site for information about prescription recycling and/or disposal programs in Colorado. So I wanted to write an updated post with information that we’ve come across in the years since we published that first article. […]
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 […]
[…] The merger is expected to provide numerous benefits for both hospital systems, and will presumably make for lower total operating/administrative costs than they would have if they weren’t working together. As health care costs continue to climb, this should help both hospitals continue to provide quality care to their patients. It’s also reasonable to assume that the merger will be beneficial for UCH and PVHS patients, since access to both hospital system’s strengths will likely be available to patients in both Denver and Northern Colorado. […]
[…] I understand that each hospital needs to bring in enough money to pay staff, maintain the facilities, and – in the case of for-profit hospitals – make a profit for shareholders. But overall healthcare costs aren’t helped by duplication of facilities and high-tech medical gadgets. There has to be a balance between providing the excellent medical care, keeping things at least somewhat convenient for patients, and keeping medical costs under control. […]
[…] And that means that Medicaid claims submitted over the last couple weeks won’t be paid until July 9th – providers will miss out on payments that were scheduled for last week and later this week. The 2011 fiscal year begins in July, and the state is planning to push Medicaid reimbursements out in order to contain the budget for this year. The money will eventually be paid to the providers, but for book-keeping purposes it will be in a different fiscal year, and it also amounts to an interest-free short term loan from the providers to the state. […]
A new state law that imposes fees on hospitals went into effect this week. Over the next few years, it’s expected to allow Colorado to expand access to health insurance to about 150,000 of the state’s 800,000 uninsured residents. The funds generated from the hospital fees will allow Colorado to expand access to Medicaid for adults, increase the income limit to qualify for Medicaid, and expand access to Child Health Plan Plus (CHP+) for children and pregnant women. […]
[…] But these numbers would seem to indicate that while Anthem’s rate increase may have been large, it seems to be in line with what other carriers are charging in Colorado. For the little test I conducted, Anthem’s premium was the second-lowest I found, and the only one with a lower premium had an additional thousand dollars in out of pocket exposure.
[…] The decision to not carry health insurance (despite being able to afford it) is one that has ramifications for more than just the person who opts to be uninsured. In addition, there is no way to keep health insurance premiums affordable unless a large number of healthy people are paying premiums to offset the cost of care for those who are not as healthy.
[…] It’s hard to have an effective dialog about costs and cost-control when the average person has no idea what the costs actually are, and no realistic way of finding out. EOBs are great, but they only come after a person has received treatment, and thus aren’t particularly useful in terms of comparison shopping. Kefalas’ bill would be a good step towards transparency in health care costs, and I hope it is well received.
[…] In order to truly provide quality care, a doctor is likely going to have to spend more time with sicker patients. This should be reflected in how the doctor is compensated, along with the outcome-based incentives. There are ways to implement an outcome-based incentive system for doctors while at the same time making sure that they aren’t encouraged to avoid the sickest patients.
[…] It’s laudable that the clinics are offering free health care at all; they have to structure this in such a way that they don’t end up driving themselves out of business in the process. By requiring that a patient (who might think that a job/health insurance loss is on the horizon) come in for a paid visit first, the clinics will likely boost their revenue in the early phase of this program.
[…] But some students have done their own research and found an individual health insurance policy that better fits their needs and/or budget, and they would prefer to be given the option of keeping that policy. For those students, we feel that colleges should reconsider their waiver requirements and treat their students as adults who are capable of making their own decisions.
[…] the big disease advocacy groups that are focused on finding cures do provide an important service. But Duncan’s article serves as a reminder that just donating money to a disease advocacy organization isn’t all that is needed. And there are plenty of smaller, lesser-known organizations that are working to address other, more tangible needs that sick people face. […]
[…] Increasing the income limits and enrolling more people doesn’t require additional infrastructure or administrative changes. Working within our current framework, but with expanded enrollment, seems to be an efficient way of going about this process. It’s also probably the quickest way to actually get health insurance coverage to Colorado residents who need it.
Thanks to Alvaro Fernandez at Sharp Brains, the Huffington Post has cross posted the latest Grand Rounds. And the neat thing is that a Colorado Health Insurance Insider article is the first one mentioned (about the cost of treating the uninsured at Denver Health). Check it out.
[…] just providing health insurance to the uninsured would still leave us with a pretty big mess. We don’t have enough primary care docs, our drugs are too expensive, our hospitals are too focused on turning a profit, we spent more than any other country on our healthcare, and yet our results are mediocre at best. […]
[…] while some hospitals are adding beautiful atriums, Denver Health is struggling to stay afloat. Adding non-essential services in hospitals that cater to well-to-do clients may make the hospital experience more enjoyable for those who can afford it. But the unintended consequence is that as time goes on, fewer people will be able to afford health care at all.
Here in Colorado, Denver Health Medical Center treats a large number of patients without health insurance, and the cost is staggering. Last year, it cost the hospital $275 million to treat uninsured patients. That number rose to $300 million this year, and is projected to increase to […]
Today’s Guest Blogger is J.A., an RN, who submitted via our “Be A Guest Blogger” page:
I am paying COBRA, health and dental at $640. per month. I am a nurse, recently diagnosed with cystic fibrosis (CF) at age 50, this year. Cobra is 18 months with 11 month extension. I was informed I have to exhaust COBRA timeline before being eligible for Cover Colorado […]
[…] The problem of drugs in our water supply in Colorado and throughout the US is scary and formidable. Drug companies should be required to implement safe systems for re-distribution of unused medications. Health insurance carriers should put pressure on pharmaceutical companies in this regard, since drugs that are getting flushed down the toilet aren’t free.