MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'HPHC' source. Mon, 17 Nov 2008 22:46:13 +0100 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/445575474/ For the past four years, the National Committee for Quality Assurance (NCQA) has teamed with U.S.News & World Report to prepare a national ranking on health plans using member satisfaction and clinical effectiveness information compiled by NCQA to build individual scorecards for each participating carrier.  This is the equivalent of the U.S.News forays into colleges, hospitals, and other elite services. For the past three years, Harvard Pilgrim has managed to secure the top spot in the U.S.News / NCQA national rankings.  Well, it happened again.  For the fourth year in a row, Harvard Pilgrim sits atop the U.S.News  & World Report  national ranking of health plans.  We didn’t win by much.  Our friends at Tufts Health Plan finished just behind us (think Michael Ph... HPHC blogs http://www.medworm.com/rss/comments.php?id=1943395 Fri, 07 Nov 2008 15:29:54 +0100 1943395 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/443761882/ I’m pretty sure that most public policy types believe they are doing the right kinds of things to encourage a greener and more resource sustainable economy.  And in many cases, I’m sure that translates into a set of initiatives, laws and regulations that put the arm on private sector organizations to do “better.”  I was thinking about this yesterday as I was looking at the massive, paper, perfect bound provider directories Harvard Pilgrim is required by MA state law to produce. I then started to think about all the paper we are required to produce under various state and federal statutes and regulations, and all the mailings and letters we are required to send out to various constituents - providers, employers, members - under other state and federal statutes. ... HPHC blogs http://www.medworm.com/rss/comments.php?id=1939166 Wed, 05 Nov 2008 23:15:24 +0100 1939166 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/434938420/ There was a front page story in the Boston Globe the other day with the following headline:  “Errors Test Openness At Beth Israel Deaconess.”  The story was about the decision made some time ago by BIDMC CEO Paul Levy to be totally transparent with his own team - and with the public at large - concerning the hospital’s success - or lack of it - in eliminating medical errors.  No one disputes the fact that Beth Israel puts far more of its successes and failures in reducing medical errors right out there for all to see - either through its own public reporting, or through Levy’s blog at www.runningahospital.blogspot.com.  But this has led to public disclosure of some embarrassing moments over the past year, as the hospital has fessed up to a number of tragic in... HPHC blogs http://www.medworm.com/rss/comments.php?id=1918038 Tue, 28 Oct 2008 17:34:50 +0100 1918038 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/433596558/ Alex Drane (Alex is short for Alexandra) is the CEO of Eliza Corporation, which is an interactive voice recognition company that Harvard Pilgrim works with to do outreach and education with our members on a variety of items, such as reminders about preventive screenings and plan designs.  But that’s not what I’m writing about today. Alex also has a former sister-in-law who died a few years ago after a long bout with a terrible illness, and it prompted her to consider whether or not we, as individuals and as a society, have thought as hard as we should about the end of our lives.  This was followed by a series of conversations with many others in the health care field, including Matthew Holt, the author of www.thehealthcareblog.com and the founder of Health 2.0. Earlier this ... HPHC blogs http://www.medworm.com/rss/comments.php?id=1914694 Mon, 27 Oct 2008 13:50:54 +0100 1914694 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/428825136/ The show is pretty much the same - every time.  Public sector entity gets in budget trouble, cuts have to be made, and providers who do business with the public sector get hammered - hard.  It’s happened with Medicare at the federal level for years, and it happens with Medicaid at the state level with some frequency as well. Well, the show is back in town, as state governments face declining revenues.  In Massachusetts, the state is not only cutting Medicaid payments prospectively - it’s cutting Medicaid payments for some providers retrospectively - simply choosing not to make payments to them they had planned on and expected. I must say, each time this happens, I can’t help but wonder if the hospital operators and physician leaders who think a single payor like Medi... HPHC blogs http://www.medworm.com/rss/comments.php?id=1901582 Wed, 22 Oct 2008 18:15:45 +0100 1901582 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/427611478/ I’ve been banging away on the transparency drum for almost four years now - and while the progress has been slow, it seems to be directionally correct.  More and more people in the health care and public policy community seem to be saying that public disclosure of payment and outcome information would be a good thing.  Recent events simply amplify the importance of moving in this direction. As the economy continues to sour, the pressure on employers and governments to do “something” about the rising cost of health care will intensify.  For employers, the choice will be between plan designs that have lower premiums and more consumer cost-sharing, or narrow network products that trade efficiency - and lower prices - for broad network access.  For either option ... HPHC blogs http://www.medworm.com/rss/comments.php?id=1895039 Tue, 21 Oct 2008 16:11:43 +0100 1895039 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/416889304/ I do call-in radio shows every once in a while just to hear what people want to chew the fat about.  I did one about a month ago and got asked by three different people on three different calls why Harvard Pilgrim didn’t offer a certain kind of plan.  One called about a “two person plan” instead of a family plan for herself and her son.  Another person called about chiro coverage as a part of the plan design.  And a third caller asked me why we didn’t offer high deductible plans attached to a Health Reimbursement Account.  I found this all kind of interesting, because we sell all three of these plan designs - in both the individual and group markets - and as the calls went on, I realized the callers just assumed that Harvard Pilgrim had chosen the plan d... HPHC blogs http://www.medworm.com/rss/comments.php?id=1870863 Fri, 10 Oct 2008 15:33:22 +0100 1870863 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/412905718/ As CEO of Harvard Pilgrim, I find I do a fair amount of public speaking.  Over the past ten days or so, I’ve been on several panels with a variety of public policy, health policy and industry types.  We also represented a pretty broad collection of political philosophies - some Democrats, some Republicans, some liberals, some moderates and some conservatives. What really struck me, though, was the amount of cross-over support several policy ideas had in the “what do we need to do about health care” arena.  To listen to the media, one would conclude there is no common ground between the parties on this issue - and, frankly, a lot of the stuff the people I was with were talking about hasn’t really showed up on the national debate scene at all. So - at the risk of... HPHC blogs http://www.medworm.com/rss/comments.php?id=1856090 Mon, 06 Oct 2008 15:37:02 +0100 1856090 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/409344486/ The other day, the Mass. Hospital Association published a report on health plan performance.  The report was based on a member survey that asked hospital executives how they thought the plans were performing across a wide range of administrative operations.  I’m pleased to say that Harvard Pilgrim did quite well on the survey - finishing in the top three (of around 12 plans being rated) on 19 of the 23 measures.  We also finished first on more measures than any other carrier.  This will be well received by our team, most of whom work hard to deliver reliable and predictable experiences to our business partners and key constituents every single day. BIDMC CEO Paul Levy wrote a post on his blog following up on the MHA survey, and asked his readership if plans or provi... HPHC blogs http://www.medworm.com/rss/comments.php?id=1851043 Thu, 02 Oct 2008 15:32:04 +0100 1851043 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/408324727/ I wrote a blog a few weeks ago on the interplay between Emergency Room traffic and elective surgeries, in response to a story in the Boston Globe about new DPH guidelines concerning ER diversions.  I won’t repeat what I said then, but thought I should highlight one of the comments I got for that post from Brad Prenney at Boston University.  It pretty much speaks for itself. Take it away Brad… “Boston Medical Center is not the only hospital that has been able to address problems of patient flow, including timely access to emergency care, using the methodology developed by Boston University’s Management of Variability Program (MVP), which Eugene Litvak heads. Cincinnati Children’s Hospital Medical Center (CCHMC) achieved comparable benefits when they separated OR res... HPHC blogs http://www.medworm.com/rss/comments.php?id=1844778 Wed, 01 Oct 2008 14:59:39 +0100 1844778 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/406476381/ This study also analyzed medical cost ratios to determine what percent of each dollar of premium goes to pay for health care costs at each health plan.  There was more variation here than there was on administrative expenses.  Harvard Pilgrim, for example, averaged 11 cents on the dollar for administration, 87 cents on the dollar for medical claims costs, and a 2 cent margin.  Aetna averaged 13 cents for administration, 80 cents for medical claims costs, and a 7 cent margin.  Pretty big difference. Overall, MA health plans spent almost 87 cents of every premium dollar on medical claims costs - again, consistent with earlier reports published by the Mass. Association of Health Plans - while the Northeast and national plans spent 85 cents, on average, on medical claims costs. As I’... HPHC blogs http://www.medworm.com/rss/comments.php?id=1841076 Mon, 29 Sep 2008 18:13:28 +0100 1841076 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/401900652/ A few days ago, Doug Brown wrote a an opinion piece in the Boston Globe about UMass Memorial Health Care’s experience with public reporting of cardiac surgery outcomes.  The article speaks for itself, but the short story is this - when Massachusetts expanded the number of hospitals who could do cardiac surgery in 2000, the state established a public reporting mechanism, so that the state would be able to determine if the expansion had affected the quality of cardiac care.  UMass’s risk adjusted mortality when the results were first released was twice the statewide average.  They did the right thing - suspended the program - figured out what was wrong, re-structured it, and did quite well in recent rankings. The first conclusion Doug drew from the turnaround was that &#8... HPHC blogs http://www.medworm.com/rss/comments.php?id=1825789 Wed, 24 Sep 2008 15:30:16 +0100 1825789 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/401107046/ It’s an eye-catching cover, that’s for sure.  How many times does one see “brand names” from The Heritage Foundation, The Brookings Institution, The Urban Institute, The American Enterprise Institute, and the The Progressive Policy Institute all on the same letterhead?  The answer to that question is “never.”  So - what did this collection of Washington DC think tank/egg head types all decide to agree on?  They came together to publish a paper that says, “Unsustainable deficits in the federal budget threaten the health and vigor of the American economy,” and, “The first step toward establishing budget responsibility is to reform the budget decision process so that the major drivers of escalating deficits - Social Security, Medicare... HPHC blogs http://www.medworm.com/rss/comments.php?id=1825790 Tue, 23 Sep 2008 19:57:52 +0100 1825790 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/395507274/ A few months ago, the MA Division of Health Care Finance and Policy (DHCFP) released a study that showed that mandated health insurance benefits cost insurance purchasers about $1.3 billion - or 12% of their premiums - each year. Thanks to DHCFP for publishing the study. This issue is always the source of heated debate, and it’s nice to have a piece included on it that tries to inform the discussion. Business people read the study and said, “Ah ha! Mandates cost a lot of money!” That would be correct. Health care advocates read the study and said, “Ah ha! Mandates don’t cost that much money!” That’s correct too - sort of.  As usual, where you stand depends on where you sit, how much twelve percent is worth to you for what you’re getting, and who pays the bi... HPHC blogs http://www.medworm.com/rss/comments.php?id=1806333 Wed, 17 Sep 2008 19:45:05 +0100 1806333 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/393359954/ There was a story in the Boston Globe the other day about the Massachusetts Department of Public Health’s decision to order hospitals to stop temporarily closing their Emergency Rooms, effective January 1, 2009. This is good news. I first heard about the practice of temporarily turning away ambulances from the ER — commonly called “diversion” — about ten years ago. The Globe did a series of articles on temporary ER closures, and while I can’t recall for sure, I think the culprit was “managed care.” Those stories then, like this story now, focused almost exclusively on ERs, ER personnel, ER administrators and ER clinicians. I’m not sure that’s the best way to frame this issue. In fact, many people think ER overcrowding usually has... HPHC blogs http://www.medworm.com/rss/comments.php?id=1798192 Mon, 15 Sep 2008 16:46:39 +0100 1798192 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/386860503/ A new study - a big one ($50 MM) - was recently released that compared the short and long term effects of drug eluding stents to bypass surgery for patients with serious heart disease.  The headlines - “Heart Surgery Bests Stents” - pretty much told the story.  In this particular case, 18% of those patients who had stents installed to treat their disease ended up either dying or needing another treatment over the next twelve months.  Only 12% of bypass patients ended up with complications or passing on.  The death rate in both instances was the same - 8%. Stents - the tool of choice for interventional cardiologists - and bypass surgery - the technique of choice for cardiothoracic surgeons - have been playing this “which is better” game for almost ten years.�... HPHC blogs http://www.medworm.com/rss/comments.php?id=1779289 Mon, 08 Sep 2008 17:16:32 +0100 1779289 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/382345746/ I don’t pretend to be an expert on patient compliance, and have found most of the studies I’ve read on how often and how well patients follow their doctor’s orders to be confusing and inconclusive. I’m sure others do, too. It’s a tough subject. In a world where many people — including me — believe the system tends to over-treat people to begin with, some non-compliance is probably not a bad thing. In addition, defining non-compliance — versus poor communication, wrong clinician/wrong situation or four or five other issues that might impede care delivery and/or recovery — is no easy task. But as I recover from my idiotic vacation accident, in which I tore ligaments in my right foot, bruised bones in my ankle and damaged a boatload of cartilage, I&#8217... HPHC blogs http://www.medworm.com/rss/comments.php?id=1763962 Wed, 03 Sep 2008 13:42:32 +0100 1763962 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/378143772/ There was a story in the Wall Street Journal last week-end about how “a growing number of health plans offer specially trained case managers to help patients during a major illness…”  The story goes on to say that these people “take our very fragmented health-care system and put some glue on it to ensure that a patient with a complex condition does not fall through the cracks.” Umm…Harvard Pilgrim has been providing these kinds of services to our members for about THIRTY YEARS — and I know that many other carriers have been doing it for more than ten. In fact, if I wanted to, I could post a blog on this site almost every day about a letter or an email or a phone call I’ve gotten from one of our members about how one of our case managers has lit... HPHC blogs http://www.medworm.com/rss/comments.php?id=1742781 Fri, 29 Aug 2008 14:52:41 +0100 1742781 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/376201403/ For the past year or so, I’ve been listening to and participating in a conversation in New England and nationally about the rising cost of health care. It’s a sticky wicket, to be sure, with no obvious, simple solutions. But I must say, I’ve been surprised that at least one pretty good idea hasn’t generated more traction. Intensive Care Unit checklists — which I’ve written about before — have already demonstrated that they can save lives, money and time, reduce variation, and improve quality, but they remain the exception instead of the rule in ICU care. In June, the World Health Organization shared preliminary data on a demonstration it’s running using a “Safe Surgery Checklist” that showed reductions in deaths, complications and ... HPHC blogs http://www.medworm.com/rss/comments.php?id=1739217 Wed, 27 Aug 2008 13:44:02 +0100 1739217 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/370217291/ Some people with long memories may recall that Harvard Pilgrim dedicated its 2004 annual report to explaining how we were going to “Eat At Our Own Restaurant” by changing the way we offered and managed our health plan benefits AS AN EMPLOYER to reduce the increase in our health care costs over time. It’s now 2008, and we’ve got five years under our belt with this real life experiment. And I must say, it’s worked out much better than I thought it would. Get this — since 2004, the first year we changed our contribution policy and plan designs, Harvard Pilgrim’s medical expense trend has averaged 8 percent per year. Our medical expense trend since 2005 is 6 percent per year. And that’s with only minor changes in benefit plan design since 2004. This ... HPHC blogs http://www.medworm.com/rss/comments.php?id=1720378 Wed, 20 Aug 2008 18:50:40 +0100 1720378 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/364071007/ A few months ago, the New England Healthcare Institute (NEHI) issued a report on non-urgent use of Emergency Departments. It didn’t get that much public attention, which is too bad. It offered some interesting insights. First of all, inappropriate — or non-urgent — use of the Emergency Room was not limited to uninsured populations. It showed up across the board. People covered by private insurance, Medicaid and Medicare were just as likely to use the ER for non-urgent care as people without health insurance. About 20% of all ER visits by privately insured and Medicare patients were for non-urgent purposes. About 24% of all ER visits by Medicaid beneficiaries and people without any insurance were for non-urgent purposes. Second, another 25% of all ER visits for each group were for pri... HPHC blogs http://www.medworm.com/rss/comments.php?id=1704749 Wed, 13 Aug 2008 17:21:26 +0100 1704749 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/358453048/ There was a story in the Boston Business Journal last week about the delays incurred by the MA Health Care Quality and Cost Council in trying to put up a web site that would show — for the first time — what the private sector actually pays providers for health care services in Massachusetts. The story says, and I quote, “The system insurers use to pay hospitals is extraordinarily complex.” True — but as a member of the Council, as the CEO of one of the insurers, and as the head of an insurance company that submits similar data in NH and ME — both of which have operations in place — I would offer a more complex answer. This delay is mostly of our own collective making. Pinning it on the plans is easy, but it’s inaccurate. And I say that as someone who likes an... HPHC blogs http://www.medworm.com/rss/comments.php?id=1689046 Thu, 07 Aug 2008 14:18:25 +0100 1689046 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/356674126/ For the past few years, Harvard Pilgrim has published an annual report that focuses on some issue — or set of issues — in health care. Most of the time, the report is a little late — usually because I’ve been slow to get around to writing about something that gets past the plan’s PR and Marketing honchos. This year is no exception. I was late, blah, blah, blah — and here it is August — and the report’s finally out in the public domain. Let’s hope it’s not old news. This year, I wrote about how the high cost of living in New England is driving young people away — at the same time the Baby Boomers are entering their 40s, 50s and 60s. As a result, this region will have an aging workforce going forward, even as its health care costs are already abo... HPHC blogs http://www.medworm.com/rss/comments.php?id=1683070 Tue, 05 Aug 2008 19:43:40 +0100 1683070 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/352799881/ A few weeks ago, the federal government’s Government Accountability Office (GAO) issued a report on the rapid rise in the cost and use of high-end radiology services (CT Scans, PET Scans, MRIs and the like). In a nutshell, the report said three things: first, the use and cost of imaging services to Medicare beneficiaries went up dramatically from 2000 through 2006, second, the use patterns suggest wide variation in treatment protocols and the possibility of inappropriate utilization. And finally, that CMS and Medicare should implement some kind of front-end prior approval process to deal with the potential overuse and misuse of these services that came through in their data. Well, well, well. If it isn’t deja vu all over again. Several years ago, Harvard Pilgrim noticed a si... HPHC blogs http://www.medworm.com/rss/comments.php?id=1674904 Fri, 01 Aug 2008 16:57:08 +0100 1674904 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/348777111/ I was in a meeting the other day when someone said - mostly in exasperation - ”Everyone’s for affordable health care for everyone, but no one cares very much about dealing with the cost of health care.”  I’m sure that truer words have been spoken, but I can’t think of any off the top of my head.  It’s too bad.  Somehow, we’ve divorced the coverage/affordability question from the cost question, and we pay for it - everyday.  In a recent article in the Journal of the American Medical Association (JAMA), bio-ethicist Zeke Emanuel from the National Institutes of Health, put it pretty well - “Without controlling health care cost, any attempt at universal coverage will be transient.  Sustainable expansion of coverage to all Americans requ... HPHC blogs http://www.medworm.com/rss/comments.php?id=1660813 Mon, 28 Jul 2008 21:37:38 +0100 1660813 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/338456133/ I usually spend some time throughout the year visiting with accounts, physicians, hospitals, and brokers (among others), just to hear what’s up and what’s going on.  Earlier this week, I was out visiting the leadership at a community hospital in Massachusetts, and asked them if they appreciated the Department of Public Health’s (DPH) decision to require Academic Medical Centers to prove they weren’t duplicating existing clinical services in the community when they opened new operations in the suburbs around Boston. For the uninitiated, this issue’s been percolating in Massachusetts for the past couple of years, as a number of well known teaching hospitals have broken ground on some pretty big outpatient facilities in the suburbs around Boston.  The servic... HPHC blogs http://www.medworm.com/rss/comments.php?id=1634954 Thu, 17 Jul 2008 22:24:21 +0100 1634954 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/336421823/ A few weeks ago, the Baker family did something we’d never done before. We took a two-week vacation, and we went to France. While there are many fun places to visit in the U.S., my wife and I decided a couple of years ago that before our oldest went off to college, we thought the kids should see something, somewhere, in Europe. France is small enough to travel around, they have a great train system, it’s a relatively easy place to get to, etc. So imagine my dismay when, on our second day there, I stepped off of a bluff on the beach and into water I thought was three inches deep — but turned out to be four feet deep — and jammed my right foot into my right leg. It hurt — a lot — but I figured it would work itself out over the next couple of days. Hah! After walk... HPHC blogs http://www.medworm.com/rss/comments.php?id=1625653 Tue, 15 Jul 2008 20:40:51 +0100 1625653 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/329907798/ For The Record — I am a member of the Board of Trustees of Beth Israel Deaconess Medical Center (BIDMC). The Board of Trustees is NOT the same as the Board of Directors. The Board of Directors is the governing body that has fundamental oversight responsibility for the hospital. The Trustees serve as an ancillary board to the main board, and serve as members on various sub-committees of the Board. That makes me, I suppose, an “interested party.” Nonetheless, I thought it worthwhile to comment on the big story in our health care marketplace these days — which is the wrong side surgery at BIDMC. The Boston Globe pretty much covered the incident, and BIDMC CEO Paul Levy has blogged on it several times in the past couple of days, so I won’t spend a lot of time re-hashing t... HPHC blogs http://www.medworm.com/rss/comments.php?id=1596471 Tue, 08 Jul 2008 15:26:01 +0100 1596471 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/324300827/ Earlier this year, the Deloitte Center for Health Solutions published a survey of health care consumers that covers a lot of ground. In fact, I would recommend it to anyone who’s interested in learning about what’s on consumers’ minds these days. The report itself is quite long, so I won’t try to capture everything it says here, but it does make some important points that are worth repeating. First, the health care consumer is not monolithic. He or she is a bunch of different types of people - with very different views of the system, and how to approach it. Deloitte breaks the consumer up into six categories… 1) Content and Compliant (29%) - While not regular users of the system, these folks do what they’re told by their physician, have a traditional vie... HPHC blogs http://www.medworm.com/rss/comments.php?id=1560904 Tue, 01 Jul 2008 19:50:22 +0100 1560904 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/320652053/ At the risk of overstaying my welcome on this subject, I thought I might comment on a recent story in the New York Times concerning practice pattern variation and the Wennberg guys at Dartmouth. The Times article — published on May 30th — focused on the fact that the resource use for elderly patients during the last two years of life in some New York City hospitals varied enormously from the resource use in other New York City hospitals. Private teaching hospitals, like NYU, landed in the 99th percentile nationally in terms of resource use during the last two years of life for patients living with at least one of nine chronic conditions, while Bellevue Hospital Center ended up in the 60th percentile. This was still above the national average (50th percentile), but much lower than NYU. ... HPHC blogs http://www.medworm.com/rss/comments.php?id=1546718 Thu, 26 Jun 2008 16:43:09 +0100 1546718 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/316318118/ There’s a big debate going on right now in Massachusetts about whether or not physicians should be allowed to accept gifts of any kind from pharmaceutical and medical device company representatives. In fact, the Massachusetts Senate passed legislation — currently before the House — that prohibits all kinds of gift giving — travel, honorarium, subscription services, and entertainment, to name a few. It also requires the MA Department of Public Health to license and register pharmaceutical sales representatives. This proposal, one of many in a comprehensive bill designed to reduce the rate of increase in health care spending, has received an enormous amount of public attention, and will remain a major focal point for debate when the larger bill comes up in the House later this mo... HPHC blogs http://www.medworm.com/rss/comments.php?id=1535794 Fri, 20 Jun 2008 16:19:22 +0100 1535794 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/315631857/ One of the reasons the operating model in health care doesn’t change much over time is pretty simple: most of the people who think about it, write about it, work in it and study it have trouble seeing the model any differently than they see it today. I was struck, therefore, by Hebrew Senior Life’s Len Fishman the other day when he and I served on a panel at the 30th annual meeting of the Massachusetts Health Data Consortium. We were told to discuss health care 30 years from now — me from the plan perspective, and Len from the long term care perspective. I went pretty far out there in my remarks, imagining, among other things, a world in which there were no health plans at all(!). Len did too. His presentation on the future of long term care could not have looked more differe... HPHC blogs http://www.medworm.com/rss/comments.php?id=1531340 Thu, 19 Jun 2008 18:59:33 +0100 1531340 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/315417328/ Ten years ago, the term “medical tourism” referred to non-U.S. citizens seeking health care in the United States, because the health care systems in their own countries either couldn’t give them what they needed in a timely way, or couldn’t give it to them at all. What a difference a decade makes. Today, more often than not, medical tourism refers to people leaving the United States to access care that’s every bit as high quality as it is in the United States — but much, much cheaper — in foreign countries. According to a study by the Deloitte Center for Health Solutions — which I first saw referenced in the May 5th edition of Modern Healthcare — the number of people leaving the US to access care in other countries is now growing at a faster rate than ... HPHC blogs http://www.medworm.com/rss/comments.php?id=1531341 Wed, 11 Jun 2008 18:41:45 +0100 1531341 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/315417330/ Boston Globe reporter Jeff Krasner does a great job covering business issues for the Globe and was kind enough to attend the seventh — and most recent — public meeting of the Coalition for Affordable Health Care. The Coalition is a group of Massachusetts businesses and health plans (including Harvard Pilgrim) who’ve joined together to promote state policies that reduce the increase in health care costs and improve quality. The Coalition is focused on several issues: 1) Leveraging the Commonwealth’s Health Care Quality and Cost Council (of which I’m a member) to collect and make public understandable information on health care cost and quality — by provider and by procedure — in Massachusetts. The group believes that to do something about health care cost and quality, the pub... HPHC blogs http://www.medworm.com/rss/comments.php?id=1531342 Mon, 09 Jun 2008 18:43:26 +0100 1531342 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/315417333/ I got a letter the other day from a friend of mine who happens to be a Harvard Pilgrim member. She was annoyed by the size of the bill she received from a Boston teaching hospital for a colonoscopy. She said the amount due — both the total and the amount she had to pay — couldn’t possibly be right, given the simplicity of the procedure. I looked into it, concluded that the payment rates were, in fact, correct, and let her know that while it was a big bill, it was, in fact, for the right amount. I also told her that her experience — her shock and surprise over the size of her bill — was a great example of why I’ve spent so much time working on making what health plans pay for services more publicly available. I told her that if all goes according to plan, the Massachusetts Healt... HPHC blogs http://www.medworm.com/rss/comments.php?id=1531343 Wed, 04 Jun 2008 18:07:31 +0100 1531343 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/296074973/ A few weeks ago, I wrote a post about a recent study by the folks at Dartmouth concerning variation in resource utilization at various providers in Massachusetts during the last six months and two years of life. The study showed that the variation in practice patterns and resource utilization in health care, even for fairly standard procedures, during the period of time studied was gigantic — sometimes as much as 300-500%. Practice pattern variation. It’s like a bad penny. Activists and advocates — and many others — prefer to talk about the money that’s wasted on administrative inefficiencies — and if we could just get everyone covered by one payer, everything would be fine. But then Jack Wennberg and Co. at Dartmouth keeps publishing these studies that show that the bi... HPHC blogs http://www.medworm.com/rss/comments.php?id=1463834 Wed, 21 May 2008 15:00:59 +0100 1463834 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/290384941/ I have a book sitting on my desk at home called, “Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer,” by Shannon Brownlee, a journalist who’s been writing about health care policy issues for quite some time. I’m going to read it — soon — maybe in between my kids’ games and my day job. I don’t know her — and I’m sure in her mind, my industry — and guys like me — are a big part of the problem. I’ll take my lumps. That’s okay. Because someday, somehow, we need to get over this “more” thing that dominates the way we think about health care. Three quick examples… 1) A few years ago, Harvard Pilgrim began requiring physicians’ offices to notify us when they ordered non-emergency high end radio... HPHC blogs http://www.medworm.com/rss/comments.php?id=1442933 Wed, 14 May 2008 16:01:18 +0100 1442933 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/286896968/ I was one of several local (aka, “Boston area”) health care participants who had a chance to hear Dr. Steve Pearson, President of the Institute for Clinical and Economic Review and Senior Fellow at America’s Health Insurance Plans in Washington, DC speak recently about “CER” (Comparative Effectiveness Research). I’m proud to say that Dr. Pearson is a member of the faculty at the Department of Ambulatory Care and Prevention at the Harvard Medical School — and is, therefore, supported in part by the folks at Harvard Pilgrim Health Care — who support the DACP at HMS as a joint venture with the medical school. Dr. Pearson is the Vice-Chair of the Medicare Evidence Development and Coverage Advisory Committee, serves as a member of the AcademyHealth Methods Co... HPHC blogs http://www.medworm.com/rss/comments.php?id=1432535 Thu, 08 May 2008 15:43:31 +0100 1432535 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/283059207/ Regular readers of this blog should know by now that I spend a lot of time thinking about Medicare — the 800 pound gorilla in health care in this country. Apparently, I’m not the only one. As previously posted, Peter Orszag, the director of the Congressional Budget Office, is thinking about it a lot. So did David Walker, the former comptroller general of the United States and the head of the Government Accountability Office. As the federal government’s chief accountant (no jokes please), he barnstormed the country, talking to pretty much anyone who would listen about the financial disaster that is and will be Medicare ten or twenty years from now if nothing’s done to change its current revenue and spending trajectory. Last week, the American Enterprise Institute tossed ... HPHC blogs http://www.medworm.com/rss/comments.php?id=1419098 Fri, 02 May 2008 15:43:22 +0100 1419098 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/281052354/ It was an inside story in the Wall Street Journal, which meant it wasn’t THAT important. But as someone who pays attention to the cost of health care generally — and the cost of Medicare and Medicaid in particular — it caught my attention. Peter Orszag, the director of the Congressional Budget Office, is making health care costs — and especially the future growth in Medicare and Medicaid spending — the primary focus of his operation. Orszag is quoted in the story as saying, “This (health care) actually is our fiscal future, and policy makers do not have as much analysis and options as they would need to make sound, long-term decisions.” He even has a chart over his desk that projects what he calls the “unsustainable” growth rates of Medicare and Medica... HPHC blogs http://www.medworm.com/rss/comments.php?id=1411781 Wed, 30 Apr 2008 21:10:08 +0100 1411781 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/272249986/ Most observers of the Massachusetts health care marketplace would probably agree that the two most influential players in this space are Partners HealthCare System and Blue Cross/Blue Shield of Massachusetts. They are, respectively, the wealthiest and biggest health care delivery system and health insurance plan, and each can move the market in pretty much any direction they wish to. Therefore, those of us who live in the Bay State always pay attention when the leaders of either of these organizations speak publicly on health care. Last week, some of the leaders of Partners HealthCare published an article in the New England Journal of Medicine on health care costs, and what might be done about them. The article was co-authored by Partners CEO Jim Mongan, PCHI CEO Tom Lee and MGPO Medical D... HPHC blogs http://www.medworm.com/rss/comments.php?id=1379424 Thu, 17 Apr 2008 15:44:06 +0100 1379424 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/268556164/ Last week, economist/columnist Paul Krugman wrote an op-ed for the New York Times about Republican Presidential candidate John McCain’s positions on health care. Suffice it to say that Krugman sees things a bit differently than McCain. I’ll leave it up to Senator McCain to fight his own fight with Krugman over what works and doesn’t in health care policy, but I do feel compelled to respond to at least one of Krugman’s comments about health insurance plans. Krugman states that, “They (health insurance companies) also deny as many claims as possible, forcing doctors and hospitals to spend large sums fighting to get paid.” For me, this statement of “fact” is right up there with the one about how 40% of health insurance premiums funds health plan... HPHC blogs http://www.medworm.com/rss/comments.php?id=1366711 Fri, 11 Apr 2008 18:57:07 +0100 1366711 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/265962012/ This report, like the many that have been issued before it, illustrates, in typical Wennbergian fashion, the extraordinary differences in resource use associated with health care that’s provided by health care organizations during the last two years and last six months of a patient’s life. For the past forty years or so, Wennberg and his colleagues have been publishing study after study after study on the enormous differences in practice patterns and practice styles that exist across the health care system. More importantly, I think they’ve proven beyond any reasonable doubt that these differences don’t translate into better health care. To quote one of the Project’s Policy Briefs, “Regions and academic medical centers with greater overall spending rates... HPHC blogs http://www.medworm.com/rss/comments.php?id=1356163 Mon, 07 Apr 2008 23:13:27 +0100 1356163 http://www.letstalkhealthcare.org/employer/small-large-business-health-insurance-costs/ It’s not news that small employers have a harder time getting and holding onto health insurance coverage than larger employers. But in many cases, the rationale for this problem is predicated on the idea that small employers — because of their size — pay far more for health insurance than larger groups do. I wondered about this, and asked our finance people to separate average claims expenses for smaller employers (those with less than 50 employees) from the claims expenses for those employers with more than 50 employees. I also asked them to do the same thing with health insurance premiums. I expected to discover that small business, on average, had higher medical costs on a per member basis, and therefore, paid higher premiums. I figured small businesses would have less “... HPHC blogs http://www.medworm.com/rss/comments.php?id=1347414 Mon, 24 Mar 2008 21:33:15 +0100 1347414 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/254510632/ It’s not news that small employers have a harder time getting and holding onto health insurance coverage than larger employers. But in many cases, the rationale for this problem is predicated on the idea that small employers — because of their size — pay far more for health insurance than larger groups do. I wondered about this, and asked our finance people to separate average claims expenses for smaller employers (those with less than 50 employees) from the claims expenses for those employers with more than 50 employees. I also asked them to do the same thing with health insurance premiums. I expected to discover that small business, on average, had higher medical costs on a per member basis, and therefore, paid higher premiums. I figured small businesses would have less “... HPHC blogs http://www.medworm.com/rss/comments.php?id=1315392 Wed, 19 Mar 2008 20:40:24 +0100 1315392 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/250352409/ Well, sometimes the federal government can surprise us all. Many of you probably know by now that the Office of Human Research Protections (OHRP) — which is part of the U.S. Department of Health and Human Services — has reversed its position prohibiting the use of health care checklists unless every patient signed a waiver permitting their use. Since the primary use of these lists to date had been in ensuring safe and effective use of C-lines in ICUs, that seemed like kind of a high standard. And more importantly, they appear to improve safety, save lives and reduce costs — a triple play that’s often hard to find in today’s health care world. I wrote about this hoo-hah in two previous blogs (part I and part II). I’m happy to report that the feds not only permit the ... HPHC blogs http://www.medworm.com/rss/comments.php?id=1298758 Wed, 12 Mar 2008 21:02:56 +0100 1298758 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/249624106/ Pretty interesting article in my local paper recently. Turns out that the bid the town of Swampscott got from BC/BS of MA and the Mass. Municipal Association through the so-called MIIA Trust was the lowest in years. Maybe decades. In fact, the proposed increase in health insurance premiums for the town of Swampscott through MIIA in FY 2009 (starting in July, 2008) was…ZERO. That’s right — the big goose egg. That, of course, is really good news for my hometown — which can use all the financial help it can get these days. Now here’s the rub. Swampscott was one of a handful of towns in Massachusetts last fall to pursue the coalition bargaining option for enrolling in the state of Massachusetts’ Group Insurance Commission (GIC) made available under a new state law l... HPHC blogs http://www.medworm.com/rss/comments.php?id=1294435 Tue, 11 Mar 2008 17:19:50 +0100 1294435 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/246217622/ The Massachusetts health plans submitted their 2007 filings at the end of last week, and amidst all the hub-bub were some interesting facts. If I read the numbers right, the large plans in MA (BC/BS of MA, Harvard Pilgrim, Tufts and Fallon) all paid out at least 87 cents on the dollar in medical expenses, and kept 13 cents, or less, for their own administrative overhead and profit. I’ll know more about the details once we have a chance to review the filings in more detail, but as far as I can tell, the plans continue to live within the framework established by the Massachusetts Association of Health Plans a month or so ago. FYI — the information on the MA plans can be found on the MAHP web site and information about BC/BS of MA’s administrative expenses can be found on their ... HPHC blogs http://www.medworm.com/rss/comments.php?id=1280778 Wed, 05 Mar 2008 16:41:07 +0100 1280778 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/245234566/ In case you haven’t heard, today is a big day for the health care industry in Massachusetts. MA Senate President Therese Murray unveiled a much-anticipated plan to reduce the growth rate in health care costs earlier today.  While some of what she’s proposing makes me nervous, I applaud her efforts, and look forward to the discussion her proposals will most certainly jump start.  Senator Murray talked about some of these issues in a speech before the Greater Boston Chamber of Commerce last year.  Back then, she proposed public hearings to justify premium rate increases in excess of 7 percent in any given year.  While the incrementalist in me says, “Yikes!  This road is fraught with peril!” the realist in me says, “Anyone who thinks we can change the... HPHC blogs http://www.medworm.com/rss/comments.php?id=1276038 Tue, 04 Mar 2008 03:00:55 +0100 1276038 http://feeds.feedburner.com/~r/letstalkhealthcare/~3/233935359/ So — for those of you who pay attention to my occasional musings and confessions, I apologize for the time away. I do have a day job, and I’m expected to do it. And for the past few weeks, it’s been pretty hectic. If I’m going to take a few weeks off in the future, I’ll try to post a “Gone Fishin’” sign, or something like that. Okay? Anyway, I saw a letter to the editor in the Wall Street Journal earlier this week that prompted me to get back on my (high) horse. It was a letter from a physician taking a few shots at the health insurance industry, and among other things, it said, “The current insurance companies operate with a profit margin of 14% and other overhead expenses that total 20-40% of total premium dollars spent.” I honestly... HPHC blogs http://www.medworm.com/rss/comments.php?id=1225346 Tue, 12 Feb 2008 20:02:48 +0100 1225346