Have you scrolled through the latest Health Wonk Review yet? Billy Wynne hosted this week over at Healthcare Lighthouse, and his “Thank God It’s Recess” edition is excellent.
A few articles were particularly interesting to me. At the National Center for Policy Analysis, John R. Graham wrote about how the second open enrollment is going to be awful. I always enjoy reading perspectives that are different from my own (I think open enrollment will be a lot better this time around), because it helps me to clarify my own thoughts and I usually learn something new as well. Graham focuses on the fact that total enrollment in exchange plans has been dropping over the summer (although unfortunately we won’t have an official update on exchange enrollment in the federally facilitated marketplace until November). But our 12 years of experience in the individual health insurance market has taught us that attrition is very common. Historically, the average individual health insurance policy has only remained in force for eight months. Although the ACA makes it easier to obtain individual health insurance regardless of medical history – and also subsidizes the cost for most enrollees – it doesn’t change anything about the various life circumstances that cause people to need – or not need – individual health insurance in the first place. Most people get their health insurance from an employer-sponsored plan or from the government (Medicaid, Medicare, VA, CHIP). The individual health insurance market has always been a small segment of the overall total, and that remains the case. It’s also a very dynamic market – people should not be surprised to see attrition following the surge of enrollments last spring. We can expect to see another surge this winter, followed most likely by more attrition next summer. This is not a reflection on the ACA – it’s just how it is in the individual health insurance market.
Writing at Health Affairs, Ari Friedman and Siyabonga Ndwandwe analyze different approaches to value-oriented reform that focuses on the insurer rather than the provider. Debates about how providers should be paid (per service, per patient, bundled, outcome based, etc.) are frequent in the healthcare reform world. But discussions about how insurers should pay – or not pay – for services based on the value they provide are less common. This might be because the topic probably isn’t all that popular. In essence, it’s all about creating a structured framework for health insurance carriers to deny payment. And while that may be perfectly justified under evidence-based medicine standards, it’s usually the sort of thing that ends up on the evening news with people using not-polite terms to describe the insurer. This is a tricky tightrope to walk, but you’ve got to establish value-based standards against which claims and potential claims should be judged. Ultimately, Friedman and Ndwandwe reach the conclusion that “No plan … has a clear advantage over the others. Combining several proposals may have substantial benefits.” As with many aspects of healthcare reform, there’s no one solution that is better than all the others, and a combination approach is probably the best solution.
And writing at Managed Care Matters, Joe Paduda reminds us that more technology is not always better. His article looks at the negative impacts of MRIs that are performed soon after the onset of pain or without any specific medical condition that warranted them. For these “early and often” MRIs, the results for the patients include higher healthcare costs and a “cascade of medical services” in the subsequent six months.
There are lots of other great articles in this edition of the HWR – enjoy some weekend reading! And many thanks to Billy for hosting.