MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'health plans'. Sat, 03 Sep 2011 02:07:31 +0100 http://www.medworm.com/index.php?rid=5182049&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2F9bNH8gYAQvI%2F My Blue Cross Blue Shield of Massachusetts card has a “Blue Care Line” phone number on the back. I’d never used it until recently but in the past couple weeks have had the occasion to call it twice. It’s a good service, which connects fairly quickly to an RN, who then uses a protocol driven system to help identify whether the patient needs to go to an ER, doctor’s office, or can perform self-care. I found it more convenient and systematic than calling the PCP’s office, and more considerate than calling my physician relatives and friends. And of course it’s easier and cheaper than heading to the emergency room. I don’t know whether they still refer to these lines as “demand management,” but in the 1990s when co-pays were $5 the sal... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=5182049 Thu, 01 Sep 2011 21:12:49 +0100 5182049 http://www.medworm.com/index.php?rid=5159422&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FXE8ROHqjA7E%2F I’m taking a break from blogging this week so am rerunning some favorite posts from 2010. Please visit the original post to comment. This is the transcript of my recent podcast interview with Castlight Health Chief Medical Officer Dr. Dena Bravata. David E. Williams: This is David Williams, cofounder of MedPharma Partners and author of the Health Business Blog.  I’m speaking today with Dr. Dena Bravata.  She is Chief Medical Officer of Castlight Health. Dena, thanks for joining me today. Dr. Dena Bravata:            David, thank you so much.  It’s a pleasure to be here. Williams:            What is Castlight Health and why is it needed? Bravata:            Castlight Health is dedicated to making health care cost and quality information publicly ava... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=5159422 Thu, 25 Aug 2011 12:10:18 +0100 5159422 http://www.medworm.com/index.php?rid=5159423&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FmW47YCkM4-w%2F I’m taking a break from blogging this week so am rerunning some favorite posts from 2010. Please visit the original post to comment. In Health care’s dilemma: Competition or collaboration? the Washington Post’s Steven Pearlstein points out that health care reformers tend to favor integrated care providers like the Mayo Clinic, which deliver affordable, quality care. But, as he says: Here’s the dilemma: The only way for the health-care industry to move toward accountable care is to further accelerate a process of consolidation that has already reduced competition and increased market power. Hospitals are once again busily buying up physician practices and outside laboratories that used to compete with them, incorporating them into their “systems.” And independent physicians who ... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=5159423 Wed, 24 Aug 2011 12:03:53 +0100 5159423 http://www.medworm.com/index.php?rid=5159424&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FLoT9TklsCeA%2F I’m taking a break from blogging this week so am rerunning some favorite posts from 2010. Please visit the original post to comment. In Health Insurers Get Tough on Hospital Prices, the Wall Street Journal reports that health plans and employers are using narrower provider networks to negotiate lower prices with hospitals. The idea is that hospitals should be willing to make concessions when that gives them the opportunity to exclude their competitors from a health plan’s network. No doubt this approach works, at least up to a point. Aetna is excited enough about the idea to brag about it at a recent conference. Apparently the company is even bringing its employer customers along to hospital negotiations to show it isn’t bluffing. But the approach isn’t as productive or sustainable... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=5159424 Tue, 23 Aug 2011 12:00:59 +0100 5159424 http://www.medworm.com/index.php?rid=5159425&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2F7GaQm8ngCxA%2F I’m taking a break from blogging this week so am rerunning some favorite posts from 2010. Please visit the original post to comment. A major reason US health care costs are so much higher than anywhere else while outcomes lag is that we waste so much money is wasted on end-of-life care. An article by Angela Maas in Health Plan Week (no longer available, unfortunately) provides a cogent, concise treatment of the topic. Some takeaways: Health plans cover palliative and hospice care but it is underutilized Although palliative care discussions have a role early on, MDs don’t want patients to think they’re giving up on them When terminal cancer patients come into hospice they may improve for a while –because they’re not coping with chemo effects– and such improvement may make them... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=5159425 Mon, 22 Aug 2011 11:56:04 +0100 5159425 http://www.medworm.com/index.php?rid=5140011&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2F0gjcipOm9yg%2F Johns Goodman’s Three Simple Ways Medicare Can Save Money sparked ample debate on this blog and John’s. Now the Wall Street Journal has printed letters in response. Three of the four point out ways in which the simple solutions aren’t quite as promising as they seem. I won’t dwell on those. But one adds a fourth “simple” one. Alas, that simple one suggested by Ronald Horwitz of Farmington Hills, MI won’t work too well either. His idea: Do away with all dollar-based deductibles and co-payments and replace them with percentage co-pays. Horwitz thinks this would give patients the incentive to seek out the lowest price for their care. Alas, once again a simple, elegant solution isn’t going to get us where we need to go. Here are a few problems wi... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=5140011 Thu, 18 Aug 2011 18:30:19 +0100 5140011 http://www.medworm.com/index.php?rid=5096674&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FODlH1oxrUbI%2F The editor of Drug Benefit News, Anthony Vecchione asserts (Copay Cards Could Be Win-Win If All Sides Work Together). I really don’t think so. In fact, my home state of Massachusetts is the only one that’s got things right. Here the cards are banned outright. Vecchione’s argument: When it comes to the topic of drug companies’ copayment cards, the consensus among PBMs and health insurers is pretty clear. The discount cards, issued by pharmaceutical companies to defray patients’ out-of-pocket costs, interfere with payers’ ability to manage trend and the formulary process. But because it’s unlikely that copay cards will disappear anytime soon, some industry analysts are calling on PBMs, payers and employers to look at copay cards as a multi-dimensional issue where th... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=5096674 Tue, 02 Aug 2011 19:24:56 +0100 5096674 http://www.medworm.com/index.php?rid=5086351&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FOccMw7J7r1U%2F The normally sage CEO of the Kaiser Family Foundation, Drew Altman isn’t as persuasive in his latest Pulling it Together column (Are We Headed for a Government Takeover of Health Care?). His essential argument is that since the government’s share of health care spending is projected to rise only modestly –from 45 percent to 49 percent– from 2010 to 2020, that no such takeover is occurring. As he puts it,”our health care system has been, and will remain, a mixed public-private one.” In my view, this mixed system of financing is one reason the US health care system is in a tough spot. Since the government is the single biggest customer for most provider organizations, that’s where providers place the bulk of their attention. Add on all the regulatory... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=5086351 Mon, 01 Aug 2011 17:03:52 +0100 5086351 http://www.medworm.com/index.php?rid=5050461&cid=t_92177_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F07%2Fhealth-care-for-very-rich-is-different.html Another glimpse of health care for the very rich comes by way of a BNet post by Jim Edwards about the beleaguered CEO of Forest Laboratories.The background is that:The CEO is fighting to retain his place atop the company against both investor Carl Icahn, who wants his own directors on Forest’s board, and the Department of Health & Human Services, which wants to exclude Solomon from the drug business as a punishment for the company settling a $313 million investigation by the Department of Justice over its illegal marketing of Levothroid and other drugs.We had posted about the government threat to disbar him from government business after his company here. Edwards noted that despite these setbacks, Solomon's total compensation actually increased:Forest Labs (FRX) reported that CEO How... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=5050461 Tue, 19 Jul 2011 21:16:00 +0100 5050461 http://www.medworm.com/index.php?rid=5036332&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FlQ3Ne9JFs_w%2F Just returned from an eye exam with my pupils dilated wide enough that I can’t read. Luckily, I’m able to crank the font size way up on my computer monitor so that I can see well enough to write this. When I left the eye doctor I commented to the receptionist that my $25 co-pay was kind of a lot, but that next time I saw her it would probably be up to $50. She said she saw quite a few at $50 and the highest she’d personally dealt with was $60. Once I got back to my office I found the dreaded annual renewal letter from Blue Cross Blue Shield of Massachusetts for my small business. I recognized the envelope but had to have someone else read it to me. The current premium for fairly dumbed down family HMO coverage is right around $18,000 per year (more than a minimum wage wor... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=5036332 Thu, 14 Jul 2011 22:06:37 +0100 5036332 http://www.medworm.com/index.php?rid=5036338&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FX3rKd-glp-A%2F Recently I sat down with Harvard Pilgrim Health Care (HPHC) CEO, Eric Schultz for a wide-ranging discussion on the health care business. In this last of four segments Eric and I discuss how health plans can leverage social media and mobile apps, and how –like with most revolutions– health care reform requires the middle classes to rise up against the status quo. HPHC has been named the top health plan in the US seven years in a row by the National Committee for Quality Assurance (NCQA), so a lot of people in the industry are keeping a close watch on what Eric and his team are doing. You can also view the other segments of this interview: Part 1, Part 2, Part 3. Share (Source: Health Business Blog) Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=5036338 Thu, 07 Jul 2011 00:01:41 +0100 5036338 http://www.medworm.com/index.php?rid=5036339&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FEnT6sseBK7g%2F Recently I sat down with Harvard Pilgrim Health Care (HPHC) CEO, Eric Schultz for a wide-ranging discussion on the health care business. In this third of four segments Eric and I discuss the practicality of narrow networks in a supply-constrained environment, transparency on cost, quality, service and safety, and how health plans can engage with consumers and referring physicians. HPHC has been named the top health plan in the US seven years in a row by the National Committee for Quality Assurance (NCQA), so a lot of people in the industry are keeping a close watch on what Eric and his team are doing. Share (Source: Health Business Blog) Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=5036339 Tue, 05 Jul 2011 23:24:22 +0100 5036339 http://www.medworm.com/index.php?rid=5036341&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2Ffwc8hHGMmtY%2F Recently I sat down with Harvard Pilgrim Health Care (HPHC) CEO, Eric Schultz for a wide-ranging discussion on the health care business. In this second of four segments Eric and I discuss consumer engagement in health and the implications of physicians moving from independent practice to an employed model. HPHC has been named the top health plan in the US seven years in a row by the National Committee for Quality Assurance (NCQA), so a lot of people in the industry are keeping a close watch on what Eric and his team are doing. Share (Source: Health Business Blog) Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=5036341 Fri, 01 Jul 2011 12:40:45 +0100 5036341 http://www.medworm.com/index.php?rid=5036342&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FZ0eI0Ijpz0U%2F Recently I sat down with Harvard Pilgrim Health Care (HPHC) CEO, Eric Schultz for a wide-ranging discussion on the health care business. In this first of four segments I ask Eric to share his thoughts on the role of health plans in influencing cost and quality, what HPHC brings to Accountable Care Organizations (ACOs), and whether there’s any difference between the current shift toward global payments and what we witnessed in the 1990s. HPHC has been named the top health plan in the US seven years in a row by the National Committee for Quality Assurance (NCQA), so a lot of people in the industry are keeping a close watch on what Eric and his team are doing. Share (Source: Health Business Blog) Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=5036342 Wed, 29 Jun 2011 20:39:39 +0100 5036342 http://www.medworm.com/index.php?rid=5036346&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FhgPKwz4er1M%2F This is the transcript of my recent podcast interview with Michael Ross, Chief Medical Officer of NaviNet. David Williams: This is David Williams, co-founder of MedPharma Partners and author of the Health Business Blog.  I’m speaking today with Dr. Michael Ross, Chief Medical Officer of NaviNet.  Dr. Ross, thanks for being with me today. Michael Ross:            You bet David. Williams:            Tell me about NaviNet. In particular, what is the core challenge that your company addresses? Ross:            NaviNet is an 11 year old company focused on real-time health care communications. We provide core customers, which are largely health plans –but also governmental entities and — with a linkage that enables administrative simplification. I... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=5036346 Sat, 25 Jun 2011 03:10:26 +0100 5036346 http://www.medworm.com/index.php?rid=4953122&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2Fwp-content%2Fuploads%2Fnaviross.mp3 NaviNet supplies health plan-funded provider/patient communications tools to physician offices and has developed a large cadre of installed users over the past decade. In this podcast interview, Dr. Michael Ross, NaviNet’s Chief Medical Officer describes how the market is evolving and how NaviNet is serving its customer base with new solutions, especially its NaviNet Mobile Connect offering. Share (Source: Health Business Blog) Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4953122 Tue, 21 Jun 2011 11:46:20 +0100 4953122 http://www.medworm.com/index.php?rid=5036389&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FT1ewh6o7iTE%2F I first ran this post four years ago, but thought it worth re-running considering all the recent debate about mini-meds in the era of PPACA. I’m not enthusiastic about Mini-Med plans –the policies that offer limited coverage, often capped at $25,000 to $50,000 per year. In some ways they are the opposite of insurance because they pay for routine expenses but don’t cover catastrophic ones. In fact, I’ve come out repeatedly in favor of scrapping insurance for routine costs, like prescriptions. I have to admit there’s another side to the story, and admit that my personal perspective on this has been colored by the fact that I can afford traditional coverage. The Wall Street Journal ran a very informative piece on page 1, today (Covering the Uninsured, But Only up to $25,000). It foc... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=5036389 Tue, 03 May 2011 01:45:12 +0100 5036389 http://www.medworm.com/index.php?rid=5036397&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FkSD8fGN7hOw%2F A notable finding from a RAND study How Do Consumer-Directed Health Plans Affect Vulnerable Populations? is that members in high deductible plans receive fewer preventive services, such as mammography, after switching from traditional plans. That seems odd at first blush since preventive services aren’t subject to the deductible. The authors suggest a couple of plausible reasons: members aren’t familiar with the rules (so may think preventive services aren’t covered) and some people may miss out on other appointments (that are subject to the deductible) where the preventive services might be suggested. Those are reasonable explanation, which demonstrate real limitations of these plans. But I can think of a couple of other reasons: Screening tests often lead to more expen... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=5036397 Fri, 22 Apr 2011 16:39:10 +0100 5036397 http://www.medworm.com/index.php?rid=4512391&cid=t_92177_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fconsumer-driven-healthcare-why-it-will-fail%2F2011.02.23 With the creation of consumer-driven health plans and health insurance policies with high deductibles linked to a savings option, more financial responsibility shouldered by patients and employees and less by employers was completely inevitable. The American public likes to have everything, whether consumer electronics or other services, as cheap as possible. With escalating healthcare expenses rising far more rapidly than wages or inflation, it’s not surprising employers needed a way to manage this increasingly-costly business expense. In the past, companies faced a similar dilemma. It wasn’t about medical costs, but managing increasingly expensive retirement and pension plan obligations. Years ago, companies moved from these defined benefit plans to defined contribution plan... Better Health blogs http://www.medworm.com/rss/comments.php?id=4512391 Wed, 23 Feb 2011 22:00:00 +0100 4512391 http://www.medworm.com/index.php?rid=4512489&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FBVX5oa9XL84%2F This is the transcript of my recent podcast interview with HealthEdge COO Ray Desrochers. David Williams: This is David E. Williams, co-founder of MedPharma Partners and author of the Health Business Blog.  I’m speaking today with Ray Desrochers, he is Chief Operating Officer of HealthEdge.  Ray, thanks for your time today. Ray Desrochers:            Thanks for having me. Williams:            Let’s start off talking about ICD-10. First, Ray, can you explain what ICD-10 is? Desrochers:            ICD-10 is a coding standard that allows health care organizations of all types to communicate with each other about a number of important things. The most important are diagnosis codes and procedure codes. Those codes allow us to talk to each other about what ... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4512489 Wed, 23 Feb 2011 04:39:31 +0100 4512489 http://www.medworm.com/index.php?rid=4495320&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2F4Av_Oi2qi7A%2F As a kid learning about the US Civil War I remember being particularly moved by the fact that it divided a lot of families who had some members on one side and some on the other. It’s not as dramatic and isn’t violent, but the fight over public sector benefits, especially retirement health benefits, has some of the same characteristics. In Pension Issues Spice Dinner Debates the Wall Street Journal examines how those who enjoy generous government benefits are facing off against those who don’t. It would be a serious enough issue if it were simply a matter of jealousy, but those sounding the alarm are also upset that these obligations are sapping municipal and state finances. “I don’t expect guarantees from my employer,” says Ms. Izzarelli, 50 years old, ... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4495320 Sat, 19 Feb 2011 03:13:48 +0100 4495320 http://www.medworm.com/index.php?rid=4489805&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2Fwp-content%2Fuploads%2Fhealthedge.mp3 ICD-10 is a health care coding scheme that increases the number of diagnosis and procedure codes by an order of magnitude, permitting much more granularity for payers and providers. In this podcast interview, HealthEdge COO Ray Desrochers describes ICD-10 and why it’s taking plans so long to implement, and explains why ICD-10 implementation is the Y2K of health care. Ray’s optimistic that a combination of health care reform efforts, ICD-10 implementation and value based benefit design will finally begin to constrain the growth of health care costs. Share (Source: Health Business Blog) Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4489805 Fri, 18 Feb 2011 03:16:18 +0100 4489805 http://www.medworm.com/index.php?rid=4489806&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FdLu0Pfe5Xe4%2F In general I oppose the minimum Medical Loss Ratio (MLR) provision of the Affordable Care Act. If an insurer can help keep me healthy and out of the hospital and doctor’s office I’m happy to pay them to do so. But I have to admit I’m pleased that the new MLR rules are putting the squeeze on brokers. See Will health care law be a job-killer for insurance brokers? Brokers usually serve smaller companies and individuals; they often receive 10 or 15 or even 30 percent of the premium as commission. The commissions are paid by health plans, which have relied on brokers to deliver the business and have been scared to alienate them. But those commissions are part of a plan’s administrative expense. When the going gets tough –for example as the total administrative cos... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4489806 Thu, 17 Feb 2011 02:08:10 +0100 4489806 http://www.medworm.com/index.php?rid=4419111&cid=t_92177_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2F0fpYN8orlOk%2F By Michael F. CannonAn article at HealthPolicySolutions.org (“a project of the Buechner Institute for Governance at the School of Public Affairs at the University of Colorado Denver”), about how ObamaCare is causing Colorado’s child-only health insurance market to implode, contains this startling admission by the top lobbyist for Colorado’s health insurance companies: “Requiring all the carriers to sell this sort of plan creates a level playing field,’’ said Ben Price, executive director of the Colorado Association of Health Plans. “This is one of those unusual situations where we’re asking for more competition. If everyone else is in the market, the risk is spread across the entire market. Each company can afford to take on more risk.” Catch that?  A ... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=4419111 Mon, 31 Jan 2011 19:40:09 +0100 4419111 http://www.medworm.com/index.php?rid=4411610&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FTTTATVM80ek%2F A couple of related pieces caught my attention today: @HealthPlan: How insurers use social media and Insurers are scouring social media for evidence of fraud. Slowly but surely health plans and other insurers are stepping into the world of social media and it’s interesting to see how they are doing it. Health plans seem to be following along the lines of other big, bureaucratic organizations that cause customers a lot of frustration through poor customer service. Here’s an example of a Twitter exchange between Humana and a customer: Sept. 23, 2010 @MrAndrewDykstra: Dear Humana, you’ve ruined my day. Worse, my wife’s day. Way to CYA. I’m paying you to cover mine. #NotHappy Sept. 24, 2010 @HumanaHelp: @MrAndrewDykstra I’m sorry to hear about your frustrati... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4411610 Fri, 28 Jan 2011 22:32:27 +0100 4411610 http://www.medworm.com/index.php?rid=4377659&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2Fwp-content%2Fuploads%2FAdamson.mp3 In this podcast interview, MEDecision’s vice president of medical home initiatives Matt Adamson lays out his vision of patient centered medical homes and neighborhoods and Accountable Care Organizations. He argues that these new clinical care models are best served when health plans are closely involved. In his view, the new entities can benefit from the care coordination data and tools available from health plans through MEDecision. Adamson is convinced that medical homes and ACOs have important roles to play in bending the health care cost curve, and thus are unlikely to be threatened by the ongoing political wrangling in Washington, DC. Share (Source: Health Business Blog) Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4377659 Fri, 21 Jan 2011 01:29:26 +0100 4377659 http://www.medworm.com/index.php?rid=4330967&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2011%2F01%2Flimited-sympathy-for-the-blue-devils.html By Matthew Holt A year on from Wellpoint's ju-jistu move of announcing a 39% rate increase in California, therefore re-invigorating the health care bill and guaranteeing themselves billions in government subsidies, Blue Shield of California, the non-profit rival to Wellpoint's... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=4330967 Mon, 10 Jan 2011 00:00:00 +0100 4330967 http://www.medworm.com/index.php?rid=4309727&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FBR1KwbCVgLs%2F This is the transcript of my recent podcast interview with Dr. Ted Eytan of Kaiser Permanente. David E. Williams:            This is David Williams, co-founder of MedPharma Partners and author of the Health Business Blog.  I’m speaking today with Dr. Ted Eytan of Kaiser Permanente.  Ted, what’s your role at Kaiser and how did you get there? Dr. Ted Eytan:            I work for the medical groups in a part of the organization called the Permanente Federation.  I’ve been there since 2008. Formerly I worked at Group Health Cooperative in Washington State, where I was a practicing physician and also supported the rollout of their electronic health record and their personal health record. Williams:            What are the main things you’re trying to ... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4309727 Wed, 05 Jan 2011 01:01:01 +0100 4309727 http://www.medworm.com/index.php?rid=4298715&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FsbVYCbUd0es%2F I’m taking a break from blogging this week so am rerunning some favorite posts from 2010. Please visit the original post to comment. Sara Rosenbaum’s has an informative Perspective (Can States Pick up the Health Reform Torch?) in the current New England Journal of Medicine. She argues that reforming health care at the state level is not a realistic alternative to national health care reform. I agree with her conclusion but don’t find all of her arguments  persuasive. Rosenbaum highlights four hurdles: Fiscal reality Practical considerations The law The “reality of health care today” In number 1, fiscal reality, Rosenbaum cites the high costs of subsidizing health insurance and says “an infusion of federal resources” is needed. I agree that the magnitude of spending is ... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4298715 Wed, 29 Dec 2010 14:00:17 +0100 4298715 http://www.medworm.com/index.php?rid=4285258&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2Fwp-content%2Fuploads%2Feytan.mp3 Kaiser Permanante’s Dr. Ted Eytan is a passionate advocate of patient centered care, supported by health information technology. I first encountered him last month at a Robert Wood Johnson Foundation meeting where he gave an inspiring talk about Kaiser’s success in engaging patients and families. In this podcast interview, Ted speaks about his role at Kaiser Permanente and how he got there, the ways life is changing for patients and their families as electronic health records and personal health records roll out, and the potential for mobile health and social media. We then turn to the topic of walking meetings (Ted is a major proponent and practitioner), innovation within large organizations, and what’s ahead for 2011. If you want to hear more from Ted, check out his blo... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4285258 Thu, 23 Dec 2010 21:39:35 +0100 4285258 http://www.medworm.com/index.php?rid=4253138&cid=t_92177_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-heart-and-the-holidays%2F2010.12.12 The human heart resides in a lighltless 98.6-degree chest cavity. Its contracting muscles are further cushioned by the well-lubricated glistening smooth pericardial sac. One wouldn’t think that the heart could sense the time of year. The heart’s rhythm should remain independent of the holiday season. But then there is December in the EP lab. They are as busy as the malls. Is it the depressing weather? Or the short days? Or a post-Thanksgiving hangover? It’s hard to say, but every year for as many as I can remember, the EP lab rocks in November and December. And with the advent of deductible health plans, this holiday phenomenon has only intensified. The I-90 of the heart, the AV node, seems to give out more in the holidays. I’ll never forget the Saturday in Decembe... Better Health blogs http://www.medworm.com/rss/comments.php?id=4253138 Sun, 12 Dec 2010 21:00:00 +0100 4253138 http://www.medworm.com/index.php?rid=4233131&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F12%2Fthe-problem-with-free-market-healthcare.html By JOE FLOWER The right payment structure keeps patients healthy while saving money. We want healthcare to be abundant, effective, easy, and cheap; for too many of us too much of the time it is scarce, ineffective, and maddeningly difficult.... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=4233131 Mon, 06 Dec 2010 00:00:00 +0100 4233131 http://www.medworm.com/index.php?rid=4219864&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FmLG6ybjs0aA%2F The Senate Committee on Commerce, Science, and Transportation put McDonald’s on the hot seat today, challenging the company to justify the “limited benefits” aka “mini-med” plans it offers its hourly employees. Benefits in these policies generally top out at $2000 to $10,000 per year of coverage. From the perspective of some of the Senators, McDonald’s should offer plans with higher limits and pick up more of the tab. As reported in the Wall Street Journal (Senators Attack McDonald’s Health Plan), committee chairman, Sen. Jay Rockefeller (D, WV) asked McDonald’s about what happens to the 10 percent of employees who actually reach their caps. “Why can you let them go, let them suffer?” Sen. Barbara Boxer (D, CA) didn’t like h... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4219864 Thu, 02 Dec 2010 02:06:01 +0100 4219864 http://www.medworm.com/index.php?rid=4214035&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F11%2Fis-this-normal-1.html By PAUL LEVY This is a story about consumer choice using publicly available information. Unfortunately, it is also about the power of suggestion as used by an incumbent provider organization. The friend who sent me this note is a research... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=4214035 Mon, 29 Nov 2010 00:00:00 +0100 4214035 http://www.medworm.com/index.php?rid=4200631&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FWcuhMlAWcOw%2F In Health care’s dilemma: Competition or collaboration? the Washington Post’s Steven Pearlstein points out that health care reformers tend to favor integrated care providers like the Mayo Clinic, which deliver affordable, quality care. But, as he says: Here’s the dilemma: The only way for the health-care industry to move toward accountable care is to further accelerate a process of consolidation that has already reduced competition and increased market power. Hospitals are once again busily buying up physician practices and outside laboratories that used to compete with them, incorporating them into their “systems.” And independent physicians who used to compete with one another are quickly merging into multi-specialty practices, offering a full range of servi... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4200631 Thu, 25 Nov 2010 02:45:00 +0100 4200631 http://www.medworm.com/index.php?rid=4197206&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2Ft3IK-knyxwU%2F The government has decided to exempt limited benefits plans (also known as mini-med plans) from rules requiring minimum medical loss ratios. Under the Patient Protection and Affordable Care Act (PPACA), most plans will be required to pay out at least 80 or 85 percent of premiums on medical care. As I’ve written, I don’t think minimum MLR rules are a good idea. I’d rather my plan figure out a way to keep me healthy and spend as little as possible sending me to the doctor or hospital. I’m glad, though, to see that mini-med plans are off the hook. These plans are typically offered to low wage workers to provide access to the health care system and protection from unexpected medical expenses. The plans aren’t great, but then again neither is a career making minimu... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4197206 Wed, 24 Nov 2010 04:59:20 +0100 4197206 http://www.medworm.com/index.php?rid=4186963&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FXFP6VJoQdHM%2F The Wall Street Journal reports (Private Medicare Plans Are Retrenching) that senior citizens enrolling in private Medicare policies, known as Medicare Advantage plans, are facing fewer choices as insurers stop offering certain plans –mainly Private Fee-for-Service (PFFS) plans. However, those who remain insured through Medicare Advantage will generally pay about the same in premiums and have richer benefits. I’d like to see Medicare costs brought under control and so I applaud the reduction in PFFS plans, which are a big waste of taxpayer money. I only wish the cutbacks went further. Medicare Advantage is a complex topic, and I won’t try to explain it all in this post. Here are some basics, though. About three-quarters of beneficiaries are enrolled in traditional Medicare indemnity ... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4186963 Sat, 20 Nov 2010 03:15:57 +0100 4186963 http://www.medworm.com/index.php?rid=4172187&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2F5h-yRvoY7DM%2F This is the transcript of my recent podcast interview with Castlight Health Chief Medical Officer Dr. Dena Bravata. David E. Williams: This is David Williams, cofounder of MedPharma Partners and author of the Health Business Blog.  I’m speaking today with Dr. Dena Bravata.  She is Chief Medical Officer of Castlight Health. Dena, thanks for joining me today. Dr. Dena Bravata:            David, thank you so much.  It’s a pleasure to be here. Williams:            What is Castlight Health and why is it needed? Bravata:            Castlight Health is dedicated to making health care cost and quality information publicly available. It’s needed because that kind of information is not readily available today. One of the things we do that is not publicly ava... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4172187 Tue, 16 Nov 2010 13:00:18 +0100 4172187 http://www.medworm.com/index.php?rid=4168076&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2Fwp-content%2Fuploads%2Fbravata.mp3 The growth and impact of consumer directed health care has been hobbled by a dearth of real price information. Imagine shopping at a regular retailer, where neither the shopper nor the cashier knows the price of anything and where prices vary five-fold from one store to the next. That pretty well describes the current situation in health care. Castlight Health seeks to correct this problem. The company’s web-based tools provide personalized price information to consumers, giving them their actual out-of-pocket price levels for different services and providers based on their specific benefit plan. For example, a consumer scheduling a colonoscopy can compare out-of-pocket costs at various locations. Castlight also provides quality information and explains insurance jargon in plain lang... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4168076 Mon, 15 Nov 2010 13:00:18 +0100 4168076 http://www.medworm.com/index.php?rid=4162980&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2Fwp-content%2Fuploads%2Fusablenet.mp3 Usablenet extends consumer facing websites to mobile platforms. The company got its start 10 years ago with mobile applications for business travelers. Since then it’s expanded into other industries including health care. The new CIGNA Mobile application, powered by Usablenet, enables members to find in-network providers (such as urgent care clinics) while they’re on the road, and provides a variety of other self-service functionality. In the podcast interview Usablenet’s VP of Global Product Strategy discusses the Usablenet approach overall and CIGNA Mobile specifically. Share (Source: Health Business Blog) Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4162980 Fri, 12 Nov 2010 21:39:41 +0100 4162980 http://www.medworm.com/index.php?rid=4119267&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FurB_kjS9Www%2F A major reason US health care costs are so much higher than anywhere else while outcomes lag is that we waste so much money is wasted on end-of-life care. An article by Angela Maas in Health Plan Week provides a cogent, concise treatment of the topic. Some takeaways: Health plans cover palliative and hospice care but it is underutilized Although palliative care discussions have a role early on, MDs don’t want patients to think they’re giving up on them When terminal cancer patients come into hospice they may improve for a while –because they’re not coping with chemo effects– and such improvement may make them ineligible for reimbursement Patients receiving palliative care for non-small cell lung cancer from shortly after their diagnosis enjoy better qualit... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4119267 Fri, 29 Oct 2010 20:32:32 +0100 4119267 http://www.medworm.com/index.php?rid=4053289&cid=t_92177_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-to-pick-good-health-insurance%2F2010.10.10 Unless your doctor is a policy expert, in healthcare administration, a researcher, an author or blogger, I seriously doubt he will be reviewing an important report card that helps you pick the best health insurance plan that keeps you healthy. Published annually by the National Committee for Quality Assurance (NCQA), this year’s report card ranks 227 health plans across the country on their ability to keep you healthy and well, treat you quickly, and how patients feel about their insurance coverage. Because unlike banking or airlines where there is not much difference in ATM machines or planes, there is a big difference in whether a health insurance plan helps in keeping its enrollees healthy. Do children get their vaccinations? Do healthy mothers get screened for breast cancer or ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4053289 Sun, 10 Oct 2010 14:00:00 +0100 4053289 http://www.medworm.com/index.php?rid=4119287&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FjKfmoZBwDSg%2F Last week the Wall Street Journal reported that health reform might compel McDonald’s to drop the health insurance plan it offers it restaurant employees. Why? Because the plan doesn’t pay out a minimum of 85 percent of premiums in medical costs and has annual benefits caps under $750,000. McDonald’s denied the report but it has the ring of truth. Republicans quickly grabbed the issue an another cudgel to beat over the head of PPACA proponents. Some Democrats, including Senator Jay Rockefeller, want to investigate McDonald’s and its health insurer to see whether workers are getting value from such plans. In my view, McDonald’s is smart to offer the plans it does, and both Democrats and Republicans are going off in the wrong direction with their criticisms. McD... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4119287 Tue, 05 Oct 2010 00:26:35 +0100 4119287 http://www.medworm.com/index.php?rid=4119291&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FFxN8_azZHJs%2F The Boston Globe has a lengthy front page story on Charlie Baker today, focusing on his decision as CEO of Harvard Pilgrim to pull out of the Rhode Island market (To Baker, R.I. pullout was right move). It’s a pretty thorough and balanced piece and definitely worth a read if you’re a Massachusetts voter trying to decide who our next Governor should be. In December 1999, an ailing Harvard Pilgrim Health Care pulled out of Rhode Island with two months’ notice, shuttering the company’s three health centers there and forcing 1,200 physicians and other employees to search for new jobs. Thousands of patients suddenly had to find new doctors, and about 128,000 subscribers scrambled for other health insurance. The Ocean State accounted for about 10 percent of Harvard Pilgrim’s cu... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4119291 Wed, 29 Sep 2010 19:42:27 +0100 4119291 http://www.medworm.com/index.php?rid=4119304&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FC3DHgq05Wjk%2F In Health Insurers Get Tough on Hospital Prices, the Wall Street Journal reports that health plans and employers are using narrower provider networks to negotiate lower prices with hospitals. The idea is that hospitals should be willing to make concessions when that gives them the opportunity to exclude their competitors from a health plan’s network. No doubt this approach works, at least up to a point. Aetna is excited enough about the idea to brag about it at a recent conference. Apparently the company is even bringing its employer customers along to hospital negotiations to show it isn’t bluffing. But the approach isn’t as productive or sustainable as it sounds. First of all, we’ve been here before. There were plenty of narrow network HMO products offered in the early 1990s. Pat... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4119304 Wed, 15 Sep 2010 20:19:52 +0100 4119304 http://www.medworm.com/index.php?rid=4119305&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FWyrCiu49xZY%2F Blue Cross Blue Shield of Massachusetts is implementing an interesting method to highlight out-of-network costs and to reduce them. Here’s what BCBS says in a letter sent to employers and posted online: In an effort to deliver more affordable products, Blue Cross Blue Shield of Massachusetts is implementing a change in the way we reimburse Massachusetts based providers who do not participate in our network. Effective October 1, 2010, we will reimburse members directly for covered services provided by most non-participating providers and it will be the member’s responsibility to reimburse the provider. The payment to the member will reflect the provider’s billed charge, or in some cases the usual and customary charge based on the Massachusetts indemnity fee schedule, less ... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4119305 Tue, 14 Sep 2010 20:34:30 +0100 4119305 http://www.medworm.com/index.php?rid=3961800&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F09%2Finterview-highmark-introduces-private-labeled-adam-iphone-app.html By Matthew Holt A few weeks back Highmark, the big Pennsylvania Blues plan, became one of the first major US insurers to introduce a local navigational iPhone app—a white labeled version of the ADAM tool formerly known as Medzio. I... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=3961800 Sun, 12 Sep 2010 23:00:00 +0100 3961800 http://www.medworm.com/index.php?rid=3965365&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F09%2Finterview-highmark-introduces-private-labeled-adam-iphone-app.html By Matthew Holt A few weeks back Highmark, the big Pennsylvania Blues plan, became one of the first major US insurers to introduce a local navigational iPhone app—a white labeled version of the ADAM tool formerly known as Medzio. I... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=3965365 Sat, 11 Sep 2010 23:00:00 +0100 3965365 http://www.medworm.com/index.php?rid=4119312&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FA2QFEC5MtOM%2F Wall Street Journal’s Health Blog reports some findings from a Kaiser Family Foundation/Health Research and Educational Trust  survey: Just 34% of firms employing at least 200 people and 5% of firms employing between 3 and 199 people reported reviewing performance indicators of plans’ clinical and service quality. I can think of a few reasons: Coverage is so costly that the decision is really mainly about what’s affordable and palatable. More emphasis is given to total cost and how to split the cost with employees than to plan quality The plan quality measures are not that well developed or clearly reported Differences among plans are fairly modest and not necessarily captured by the measures There is a bigger interest in provider quality than plan quality Share (Source: H... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4119312 Wed, 08 Sep 2010 00:25:26 +0100 4119312 http://www.medworm.com/index.php?rid=4119317&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FMOUlkU2tGbs%2F The Health Business Blog is on summer vacation until Labor Day, and will be re-running some classic posts from now till then. This item originally ran on April 18, 2007.  Mini-meds look dead due to health reform, but depending on how things goe they may come back. If you’d like to comment, please do so on the original post. I’m not enthusiastic about Mini-Med plans –the policies that offer limited coverage, often capped at $25,000 to $50,000 per year. In some ways they are the opposite of insurance because they pay for routine expenses but don’t cover catastrophic ones. In fact, I’ve come out repeatedly in favor of scrapping insurance for routine costs, like prescriptions. I have to admit there’s another side to the story, and admit that my personal perspective on this has... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4119317 Tue, 31 Aug 2010 12:00:45 +0100 4119317 http://www.medworm.com/index.php?rid=4119329&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FvVu07PGEWY4%2F Although I’m upset at continued inflation of health insurance premiums in Massachusetts, I’m proud that the state has brought many more people into coverage since health reform was passed in 2006. We have the lowest rate of uninsurance in the US and have made strong progress in enrolling even hard-to-reach people. Two new reports sponsored by the Robert Wood Johnson Foundation assess the characteristics of the remaining uninsured and evaluate the role of special provisions in bringing young adults into coverage. Massachusetts Health Reform in 2008: Who are the Remaining Uninsured Adults? identifies the groups that are more likely to lack coverage. They are: Male, young, and single Racial/ethnic minorities and non-citizens Unable to speak English well or very well Living in a h... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4119329 Tue, 17 Aug 2010 18:04:04 +0100 4119329 http://www.medworm.com/index.php?rid=4119330&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2F_CALnem_u6E%2F Late last month, like clockwork the dreaded thick white envelope arrived from Blue Cross Blue Shield of Massachusetts, announcing the health insurance rate increases for the year starting September 1, 2010 for my small business. I took a deep breath and opened the envelope, looking for the inevitable double digit premium increase. So I was surprised to see that the proposed increase was just 3.4 percent –well over the rate of inflation but the smallest increase we’ve ever seen, by a long shot. My lucky day, I thought. But then I read the cover letter: IMPORTANT: Except for some PPO plans, these are interim rates in effect until the Division of Insurance has completed its review of our 2010 rate requests. Final rates may be higher than interim rates. Finally I remembered. My fir... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4119330 Tue, 17 Aug 2010 01:32:55 +0100 4119330 http://www.medworm.com/index.php?rid=4119339&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2Fg06g1ebbrwk%2F Value based insurance design (VBID) is sometimes mocked as merely “free maintenance drugs for diabetics.” Although in concept it’s a lot more than that, in practice most VBID programs encourage the use of high value services but don’t discourage the use of low value services. A paper in the American Journal of Managed Care (Low-Value Services in Value-Based Insurance Design) by Peter Neumann of the Center for the Evaluation of Value and Risk in Health (where I am an Executive Advisory Board Member) et al. lays out the challenges in identifying low-value services and incorporating information about them into VBID. Although at an aggregate level it’s clear that a lot of low-value services are being delivered, it’s hard to pin down the specifics.  The auth... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4119339 Thu, 05 Aug 2010 01:25:37 +0100 4119339 http://www.medworm.com/index.php?rid=3805918&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2Fwp-content%2Fuploads%2F2010%2F7%2Fsubrogation%25202.mp3 Often when a dependent or I have a claim we get a letter asking us to call Healthcare Recoveries who works on behalf of our insurer, Blue Cross Blue Shield of MA. I know what they want: they are trying to figure out if someone else is at fault for an injury, whether the claim should be for workers comp instead of medical and whether I have other insurance beyond Blue Cross that might pay some or all. I usually try to ignore these requests because I know the claims are legitimate as billed and I don’t want to deal with the hassle. But today, after getting a second request letter with a lot of bold print I decided to go ahead and make the call, which I’ve recorded in its entirety for your listening pleasure. I’m not sure how much Blue Cross pays for this service but my gues... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=3805918 Fri, 30 Jul 2010 19:30:06 +0100 3805918 http://www.medworm.com/index.php?rid=4119343&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2F0ltO6AAS-6I%2F When I mention the new Center for Medicare and Medicaid Innovation to my business-oriented friends, they often sneer at the idea. “Medicare and innovation,” the say. “That’s an oxymoron.” And while it’s true that in general innovation thrives in small, private, entrepreneurial organizations rather than big government bureaucracies, the only real hope to bend the health care cost curve in this country lies with CMS. Some Medicare Demonstration Projects, notably the Medicare Health Support Program for chronic illness that was part of the 2003 Medicare reform bill, have been big failures. Thankfully the Innovation Center has been freed of many of the restrictions that have prevented success. As described by Barr et al. in a subscribers-only Health Affairs a... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4119343 Wed, 28 Jul 2010 22:15:53 +0100 4119343 http://www.medworm.com/index.php?rid=4119349&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2F7XEsfme0DEA%2F The Wall Street Journal’s Health Blog asks (Is Your Spouse Really Your Spouse? A Dependent Audit Wants to Know). Companies that offer benefits to their employees and dependents don’t want to pay health care costs for husbands and wives who aren’t the real thing. So they hire companies to check up on people to make sure they’re legit. I haven’t experienced this particular kind of checking myself (perhaps because I own my own business) but it seems like just about every time a dependent or I have a claim we get a letter from some kind of auditor working for Blue Cross Blue Shield of MA wanting to make sure the charge is appropriate. Usually the instruction is to call a “recovery service” –typically done via interactive voice response– and... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=4119349 Thu, 22 Jul 2010 01:02:46 +0100 4119349 http://www.medworm.com/index.php?rid=3776334&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F07%2Fmicrosoft-talks-health-plans.html By Ida Strom Seljeseth At the AHIP conference in Las Vegas in June 2010, Matthew Holt sat down with two leaders in Microsoft's health plan practice: Dennis Schmuland, Director οf U.S. Health Plans Industry Solutions and Hector Rodriguez, Industry Technology... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=3776334 Tue, 20 Jul 2010 23:00:00 +0100 3776334 http://www.medworm.com/index.php?rid=3767033&cid=t_92177_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F07%2Fnot-your-average-joes-health-plan.html A Denver Post article offered a brief glimpse into the health benefits of corporate leaders, on the unusual occasion of a former CEO now in legal fight for the health benefits in the style to which he had become accustomed:Poor Joe. He's not getting the health-care benefits he was promised.His former employer merged with another company, and then another, and then another. And, you know how it goes after a slew of mergers. Suddenly the new, conglomerated monster just doesn't care about retirees any more.Joe isn't going to sit back and take it like an average Joe. He's suing his former employer in U.S. District Court in Manhattan for breach of contract, breach of faith, breach of fiduciary duty and even promissory estoppel.The Joe in question was really:Lord & Taylor's CEO.Joseph E. Bro... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3767033 Mon, 19 Jul 2010 20:37:00 +0100 3767033 http://www.medworm.com/index.php?rid=3757852&cid=t_92177_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FsaYXyH9Fags%2F By Michael F. CannonChristopher Weaver of Kaiser Health News has an excellent article in today’s Washington Post on the various government agencies that will now be deciding what health insurance coverage you must purchase, and how many of those decisions will ultimately fall to lobbyists and politicians: For years, an obscure federal task force sifted through medical literature on colonoscopies, prostate-cancer screening and fluoride treatments, ferreting out the best evidence for doctors to use in caring for their patients. But now its recommendations have financial implications, raising the stakes for patients, doctors and others in the health-care industry. Under the new health-care overhaul law, health insurers will be required to pay fully for services that get an A or B recomm... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=3757852 Thu, 15 Jul 2010 15:32:20 +0100 3757852 http://www.medworm.com/index.php?rid=3746680&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F07%2Fwellcare-yes-theres-more-even-without-regi.html By Matthew Holt A few weeks back we welcomed John Goodman as a contributor at THCB. His first column was more than a tad critical of me for impugning the ethics of Harvard Business School Prof Regina Herzlinger. Herzlinger, you... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=3746680 Sun, 11 Jul 2010 23:00:00 +0100 3746680 http://www.medworm.com/index.php?rid=3737003&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F07%2Fdurenberger-health-insurance-chickens-come-home-to-roost.html Former Republican Senator Dave Durenberger was always the sensible Republican on health care. He now hangs out in a small institute called the National Institute of Health Policy at a small Minnesota college called the University of St. Thomas. Every... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=3737003 Wed, 07 Jul 2010 23:00:00 +0100 3737003 http://www.medworm.com/index.php?rid=3729831&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F07%2Fbizarre-pr-pitch-of-the-year-so-far.html By Matthew Holt I get emails from PR companies all the time pimping this or that client, but they don't get a lot stranger than this one. (I‘ve hidden the names to protect the guilty): Subject: Top 3 Reasons Why... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=3729831 Mon, 05 Jul 2010 23:00:00 +0100 3729831 http://www.medworm.com/index.php?rid=3714309&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2Fwp-content%2Fuploads%2F2010%2F6%2Fpantos.mp3 The Healthcare Performance Management Institute is a new think tank dedicated to the use of technology and management principles to deliver more cost-effective health care benefits for employers. The idea is to use the same techniques in health care cost and quality management that the private sector successfully deploys in core business processes such as customer service, supply chain management and enterprise resource planning. In this podcast interview, the Institute’s Executive Director George Pantos and board member Keith Lemer discuss their ambitions for the Institute. Share (Source: Health Business Blog) Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=3714309 Wed, 30 Jun 2010 12:45:44 +0100 3714309 http://www.medworm.com/index.php?rid=3662789&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2F%3Fp%3D3491 One of the big complaints about the recently enacted health care reform law is that it does little to control costs. There is some truth to that because the major focus is on increasing access to insurance. And yet there is reason for optimism on a couple of fronts: First, with many of the access issues settled, stakeholders can focus directly on cost matters rather than cost-shifting and finger pointing Second, health reform actually does provide Medicare with opportunities to make significant payment reforms The first issue is playing out in Massachusetts today. As the Wall Street Journal reports (Massachusetts Race Highlights Health Care), the three candidates for Governor are talking seriously about how to control health care costs. And these issues are being addressed with substanti... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=3662789 Tue, 15 Jun 2010 13:51:17 +0100 3662789 http://www.medworm.com/index.php?rid=3662790&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2F%3Fp%3D3487 I had a long flight today, which gave me the chance to catch up on some neglected reading. I was a little upset that my seatmate took my New York Times when I had stepped away, then gave it to the flight attendant as trash when he finished with it –and before I’d had a chance to read it! In any case it gave me more time to dig into the June issue of Health Affairs, which is all about the health care reform law and its implementation. One of the more interesting pieces is The Three Types of Reinsurance Created by Federal Health Reform, written by Mark A. Hall, a law professor at Wake Forest. He lays out three purposes for reinsurance (defined as “insurance for insurers or for self-insured employers”) To subsidize the cost of health care in order to lower premiums To... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=3662790 Tue, 15 Jun 2010 03:25:22 +0100 3662790 http://www.medworm.com/index.php?rid=3662653&cid=t_92177_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2F3ikrG5AMif4%2F By Michael F. CannonToday, the Obama administration issued new health insurance regulations as part of its effort to implement ObamaCare.  According to The New York Times: the rules appear to fall short of the sweeping commitments President Obama made while trying to reassure the public in the fight over health legislation. One of those commitments was that people who are satisfied with their health insurance will be able to keep their existing health plans. Of course, there is a tension between that goal and ObamaCare’s goal of requiring every American to purchase a minimum amount of health insurance coverage. The new regulations explain how the government will interpret ObamaCare’s “grandfather” clause, which allows some health plans to continue as they exist tod... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=3662653 Mon, 14 Jun 2010 20:47:27 +0100 3662653 http://www.medworm.com/index.php?rid=3644876&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2F%3Fp%3D3468 As you’ve probably heard, Walgreens announced yesterday it won’t fill prescriptions from patients who have CVS Caremark as their PBM. Although the decision is due to take effect gradually as contracts renew, it’s fairly dramatic news. The context for the move is that now that PBM Caremark has merged with retail chain CVS, Walgreens feels it’s being given the short end of the stick by the PBM. Considering that the Federal Trade Commission and some CVS Caremark customers are concerned about the same issue, Walgreens felt safe to make this move. Most analysts are treating this as a negative for CVS Caremark –whose PBM offering will become less compelling– and for Walgreen, which will lose CVS customers. It’s seen as a boost to the other big PBMs, Medc... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=3644876 Tue, 08 Jun 2010 23:02:24 +0100 3644876 http://www.medworm.com/index.php?rid=3629742&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2F%3Fp%3D3462 Mental health parity is a big deal. As I wrote recently (Will mental health parity accelerate adoption of evidence based medicine?) I think the implementation of mental health parity will ultimately lead to greater use of evidence based medicine in general –not just in mental health. But that’s the third stage. The first stage is insurers trying to pre-emptively control mental health costs through circa 1992 managed care tactics such as forcing providers to run an extensive prior authorization gauntlet. The second stage is providers successfully breaking through, and forcing insurers to place no more scrutiny on mental health services than they place on services for physical conditions. The truth is many services in physical medicine are not evidence based and under mental heal... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=3629742 Fri, 04 Jun 2010 14:04:52 +0100 3629742 http://www.medworm.com/index.php?rid=3629589&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F06%2Fthe-ny-times-dogs-sores-dartmouth-critics.html By Matthew Holt Today’s NY Times has a confused, woffly attack on Dartmouth from Reed Abelson & Gardiner Harris. This is a dreadful article. Period. That the NY Times printed it is remarkable given the turnaround in thinking by David... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=3629589 Wed, 02 Jun 2010 23:00:00 +0100 3629589 http://www.medworm.com/index.php?rid=3599326&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F05%2Falexandra-drane-fabulous-poacher.html By Matthew Holt One of my favorite people has the (first of) her (several) 15 minutes of fame in the NY Times today. Alex Drane tells all about growing a small business into a pretty big one (although it’s in... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=3599326 Mon, 24 May 2010 23:00:00 +0100 3599326 http://www.medworm.com/index.php?rid=3588955&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2F%3Fp%3D3423 The new health insurance reform law will generally require health plans to pay out at least 80 or 85 percent of premiums in medical expenses, depending on whether they are selling to individuals/small groups or to large groups. Intuitively it makes sense that purchasers would want the medical loss ratio to be as close to 100 percent as possible –since the purchaser doesn’t derive utility a plan’s administrative expenses and profits. But there is another way to look at it. From a personal perspective, I’d rather stay away from doctors, hospitals and pharmacies. If I get just my routine physical and recommended screening tests my medical cost will be very low. If everyone’s like that, then the insurance company will have a very low medical loss ratio. Maybe I&#8... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=3588955 Sat, 22 May 2010 01:15:13 +0100 3588955 http://www.medworm.com/index.php?rid=3577503&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2F%3Fp%3D3413 Under health care reform, insurers must pay at least 80 percent of premiums out in the form of medical expenses. The goal is to make insurance more affordable, reduce insurance company profits and improve value for consumers and individuals. Insurers are looking to trim administrative expenses to meet the requirements, and they have sales commissions in their sights. As the Wall Street Journal reports (Health Overhaul Hits Sales Commissions): Among the first to feel the effects of the nation’s health-care system overhaul are insurance salespeople, whose commissions for selling policies to individuals and small groups are themselves getting overhauled… The commissions typically run between 4% and 6% of a policy’s premium, but can be as high as 30% for the first year. Compa... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=3577503 Wed, 19 May 2010 00:39:47 +0100 3577503 http://www.medworm.com/index.php?rid=3573813&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2F%3Fp%3D3410 I was delighted to see the Boston Globe lead off its front page with an article on mental health parity (Firms put limits on mental therapy; New scrutiny may break federal law, opponents allege). It’s a fairly straightforward documentation of the squeeze being put on some providers by behavioral health companies, in particular United Behavioral Health, which is trying to hold down the soaring cost of mental health treatment. Left unsaid is the implications this squeeze may have for evidence based medicine throughout health care. At issue is the growing practice of requiring therapists to undergo lengthy and repeated phone interviews about their patients’ progress before the insurance company will approve further treatment. According to patients and therapists interviewed by the Glo... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=3573813 Mon, 17 May 2010 21:09:41 +0100 3573813 http://www.medworm.com/index.php?rid=3556224&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2F%3Fp%3D3392 Health care reform allows young adults to remain on their parents’ health insurance until age 26. The Department of Health and Human Services released an estimate showing that policy change will boost employer premiums by about 0.7 percent. See Costs will rise as young adults stay on policies in the Boston Globe. Obviously an employer’s health care bill will rise if more dependents are on the books, so the finding is not a surprise. From an employer’s standpoint it’s an added cost, which isn’t great. But from a societal standpoint we need to assess what would happen to these young adults otherwise. About 1.2 million young adults are projected to enroll in their parents’ plans. More than half of them would have been uninsured otherwise. Therefore the poli... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=3556224 Wed, 12 May 2010 01:34:51 +0100 3556224 http://www.medworm.com/index.php?rid=3545529&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2F%3Fp%3D3385 InsureBlog’s Bob Vineyard has quite a lot to say about student health insurance policies offered by Vanderbilt University and others, and not much of it is nice (Student Health Insurance Sucks). Having had two students in college already I knew that health insurance plans pushed by universities are usually inexpensive and fine until you really need them. If you are seriously injured or develop a severe illness you will be lucky if the student health insurance plan covers 30% of your medical bills. His complaints: Student is enrolled in a non-renewable, 1-year health plan. If their health status changes before year-end, e.g., they get seriously sick? Too bad. Vanderbilt will let you get your own insurance, as long as it meets a long list of criteria designed to make it impossible to ... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=3545529 Fri, 07 May 2010 19:34:08 +0100 3545529 http://www.medworm.com/index.php?rid=3515507&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2F%3Fp%3D3363 This is the transcript of my recent podcast interview with Cyndy Nayer of the Center for Health Value Innovation. David Williams: This is David E. Williams, co-founder of MedPharma Partners and author of the Health Business Blog.  I’m speaking today with Cyndy Nayer, President and CEO of the Center for Health Value Innovation. Cyndy, thanks for being with me today. Cyndy Nayer: It’s my pleasure David.  Thank you for inviting me. Williams: Tell me about the Center for Health Value Innovation.  What is it? Nayer: Our tag line is “the information resource for value-based benefit design.”  We identify value and share the innovation that is getting the value so that employers, purchasers, health plans and patients get the most for every dollar they spend on health care. Toda... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=3515507 Thu, 29 Apr 2010 01:59:59 +0100 3515507 http://www.medworm.com/index.php?rid=3511499&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F04%2Freg-strikes-back-apparently-wellcare-were-a-bunch-of-crooks-after-all-maybe.html By Matthew Holt Everyone's favorite Harvard Business School professor is back in the news. Those of you with long memories may remember that at THCB I’ve been a tad critical of Regina Herzlinger’s ideas, her presentation of said ideas and—resulting... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=3511499 Tue, 27 Apr 2010 23:00:00 +0100 3511499 http://www.medworm.com/index.php?rid=3508309&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2F%3Fp%3D3359 This is a transcript of my recent podcast interview with SeeChange Health CEO, Martin Watson. David E. Williams: This is David Williams, co-founder of MedPharma Partners and author of the Health Business Blog.  I’m speaking today with Martin Watson. He is CEO of SeeChange Health, a health insurance company that’s just launching today.  Martin, thanks for speaking with me. Martin Watson: Thanks David.  Pleasure to be here. Williams: Martin you describe SeeChange as a value-based health insurance company.  What do you mean by that? Watson: Value based is really the next iteration in benefit design within the health insurance world. Our definition of value-based is the delivery of benefits that enables somebody to change their behavior, help better manage any conditions or jus... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=3508309 Tue, 27 Apr 2010 18:31:34 +0100 3508309 http://www.medworm.com/index.php?rid=3499178&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2Fwp-content%2Fuploads%2F2010%2F4%2Fnayer.mp3 The Center for Health Value Innovation is a multi-stakeholder organization that disseminates evidence of improved outcomes achieved through value-based benefits design. In this podcast interview, the Center’s President and CEO Cyndy Nayer discusses the meaning of “value-based design” (hint: it’s more than just free drugs for diabetics), the role of health IT, and how population health and wellness are brought into the picture. She also describes the participants in the work of the Center, including TriZetto, and shares her thoughts on the role of value-based design within the context of health care reform. Share (Source: Health Business Blog) Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=3499178 Fri, 23 Apr 2010 14:49:05 +0100 3499178 http://www.medworm.com/index.php?rid=3501491&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F04%2Fwell-point-less.html By Matthew Holt OK, so it's a terrible and stolen pun but Wellpoint’s recent history is getting more and more bizarre. First they become the poster child for the recissions scandal (even if not the worst offender)—which eventually helped push... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=3501491 Thu, 22 Apr 2010 23:00:00 +0100 3501491 http://www.medworm.com/index.php?rid=3499179&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2Fwp-content%2Fuploads%2F2010%2F4%2Fseechange.mp3 SeeChange Health is a brand new health insurance company built on the concept of “value based design,” which provides incentives including lower co-pays and deductibles for patients who actively manage their health. For example, patients need to do three things (see their MD for a routine annual wellness visit, undergo a biometric session similar to a life insurance exam, and register with SeeChange’s online portal) in order to go from 80/20 coinsurance to 100/0,  see their out-of-pocket maximum drop from $3200 to $2200 and receive funding for their health incentives account of $200 for an individual or $400 for a family. The company is launching in Fresno, CA with $40 million in private equity backing. In this podcast interview, CEO Martin Watson describes the company&#... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=3499179 Thu, 22 Apr 2010 21:54:26 +0100 3499179 http://www.medworm.com/index.php?rid=3463704&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2F%3Fp%3D3294 As I’ve reported several times, insured patients use the emergency room more than uninsured patients. A new review of the literature confirms what I’ve been saying and adds a couple new points. From MedPage Today (Most ED ‘Frequent Fliers’ Insured) Most patients who visit the emergency department (ED) four or more times a year have health insurance and a primary care physician… Women and blacks were disproportionately associated with frequent ED use, but the data showed that, in absolute numbers, the majority of frequent ED users — 60% — were white. The mean age was around 40. LaCalle and Rabin noted that “many studies on frequent ED use have considered the influence of insurance status and have found this patient population to be predominant... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=3463704 Mon, 12 Apr 2010 16:28:03 +0100 3463704 http://www.medworm.com/index.php?rid=3399176&cid=t_92177_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2FHKZWxYiRh7Q%2F A federal courtroom in Boston is hosting a trial between Pfizer and Kaiser Foundation Health Plan and Kaiser Foundation Hospitals, which claim the drugmaker committed fraud by aggressively promoting off-label use for its Neurontin epilepsy drug. Warner-Lambert, which developed the pill and was bought by Pfizer a decade ago, pleaded guilty in 2004 and paid $430 million to resolve off-label marketing charges brought by the US Justice Department. Now, Pfizer faces a $270 million fraud claim. To defend the drugmaker, Pfizer attorney Raoul Kennedy made a curious admission to jurors in closing arguments. Neurontin, he said, is “a good drug that, at one time, at least in some parts of the country, may have been marketed by some bad people.” Hmm… Pfizer lawyers also argued that K... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=3399176 Wed, 24 Mar 2010 12:32:17 +0100 3399176 http://www.medworm.com/index.php?rid=3374080&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F03%2Fandy-wiesenthal-kaiser-permanente.html By Matthew Holt Those of you with really long memories may remember that Kaiser had a little kerfuffle with a guy named Justen Deal. As part of that incident, I did a rather unorthodox interview with Andy Wiesenthal from The... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=3374080 Wed, 17 Mar 2010 00:00:00 +0100 3374080 http://www.medworm.com/index.php?rid=3374249&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2F%3Fp%3D3202 As the Wall Street Journal (Bill Gives Insurers A Younger Market) points out, there is some upside in national health reform for commercial health plans. In particular, it should increase the number of young, healthy people with coverage. Health insurers have been trying to encourage the so-called ‘young invincibles’ to purchase plans, but it’s a tough sell. Coverage is pricey and puts a real dent in young adults’ lifestyles. Health insurance is not a product or service that’s enjoyable or status-raising either. Health reform will help by mandating coverage and providing subsidies to those with lower incomes. And it looks likely that reform will allow companies to sell low-cost plans that appeal to this age group. For example, some companies offer plans that c... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=3374249 Tue, 16 Mar 2010 21:18:32 +0100 3374249 http://www.medworm.com/index.php?rid=3374380&cid=t_92177_150_f&fid=38374&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FePharmaSummit%2F%7E3%2FzuYFf-EOc3I%2Fehealth-ready-to-move.html (Source: ePharma Summit) ePharma Summit blogs http://www.medworm.com/rss/comments.php?id=3374380 Tue, 16 Mar 2010 19:39:00 +0100 3374380 http://www.medworm.com/index.php?rid=3359114&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2F%3Fp%3D3193 Remember the 1980s and early 90s? That’s when HMOs successfully slowed or even reversed health care spending increases with tools such as prior authorization, gatekeepers, restrictive drug formularies, narrow networks and capitation. Employers were happy to save money and also didn’t mind that the HMOs took the blame when patients were unhappy. Then in the mid-90s a backlash against managed care began, leading to the dumbing down of managed care’s cost saving practices and the re-emergence of indemnity insurance by other names (e.g., POS plans). Not surprisingly, costs started rising fast again, a trend that has continued to the present day. And yet the backlash against managed care continues. Health insurers are being beaten over the head by politicians and others. No do... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=3359114 Thu, 11 Mar 2010 22:30:56 +0100 3359114 http://www.medworm.com/index.php?rid=3358963&cid=t_92177_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FcTe5RcfvNgw%2F By Michael F. CannonEzra Klein quotes the Congressional Budget Office’s latest cost estimate of the Senate health care bill when he writes: “CBO expects that the legislation would generate a reduction in the federal budgetary commitment to health care during the decade following 2019,” which is to say that this bill will cover 30 million people but the cost controls will, within a decade or so, leave us spending less on health care than if we’d done nothing.  That’s a pretty good deal. But it’s not a very well-understood deal. Indeed, because that’s not what the CBO said. First, the CBO said the “federal budgetary commitment to health care” would rise by $210 billion between 2010 and 2019 under the Senate bill.  Then, after 2019, it w... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=3358963 Thu, 11 Mar 2010 18:53:40 +0100 3358963 http://www.medworm.com/index.php?rid=3354301&cid=t_92177_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FNhKpCeZLjag%2F By Michael F. CannonNoting that premium increases, such as Anthem’s proposed 39-percent hike in California, have caused individuals and employers to purchase less coverage, Kaiser Family Foundation president Drew Altman writes: Rising health care costs and insurance company practices are leading not just to more expensive premiums, but to skimpier, less comprehensive coverage as well; slowly redefining what we have known as health insurance. To be sure, some economists argue that this is precisely what should happen…But this is not likely how regular people see it. Appropriate cost sharing is one thing, but we may be reaching the point in the individual market where the policies many people have simply cannot be considered meaningful coverage. Of course, this is the whole idea ... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=3354301 Thu, 11 Mar 2010 15:57:34 +0100 3354301 http://www.medworm.com/index.php?rid=3314712&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2F%3Fp%3D3146 Sara Rosenbaum’s has an informative Perspective (Can States Pick up the Health Reform Torch?) in the current New England Journal of Medicine. She argues that reforming health care at the state level is not a realistic alternative to national health care reform. I agree with her conclusion but don’t find all of her arguments  persuasive. Rosenbaum highlights four hurdles: Fiscal reality Practical considerations The law The “reality of health care today” In number 1, fiscal reality, Rosenbaum cites the high costs of subsidizing health insurance and says “an infusion of federal resources” is needed. I agree that the magnitude of spending is high and that states would have a hard time raising the money. However, the country is just a collection of the sta... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=3314712 Fri, 26 Feb 2010 22:57:52 +0100 3314712 http://www.medworm.com/index.php?rid=3302274&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F02%2Fbentley-stanton-two-uk-docs-talk-about-health-20.html By Matthew Holt Last week in London I met with two of the brightest lights in the UK's community of physicians looking at Health 2.0. Annabel Bentley is the medical director and head of informatics at Bupa, the UK-based non-profit... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=3302274 Wed, 24 Feb 2010 00:00:00 +0100 3302274 http://www.medworm.com/index.php?rid=3298293&cid=t_92177_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FZHT934nOUDw%2F By Michael F. CannonIn a recent paper, I showed that the health care legislation passed by the House and Senate would impose punitive implicit tax rates on low- and middle-income workers.  Those bills would also result in higher health insurance premiums over time because they would create large financial incentives for healthy people to drop coverage and only purchase it when they become sick. The health care proposal that President Obama released yesterday essentially splits the difference on most areas of disagreement between the two bills.  But a preliminary analysis shows that ObamaCare 3.0 would make these perverse incentives even worse.  Families of four earning $22,000 under the Senate bill (100 percent of the federal poverty level) or $30,000 under the House bill or the Obama p... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=3298293 Tue, 23 Feb 2010 13:49:17 +0100 3298293 http://www.medworm.com/index.php?rid=3290781&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F02%2Fwellpoint-just-incompetent.html By Matthew Holt I’m viewing the latest rumblings in the US health care debate from the confines of a clear but cold Britain, where the big news is that the country is joining the PIGS in entering economic meltdown—or at... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=3290781 Sat, 20 Feb 2010 00:00:00 +0100 3290781 http://www.medworm.com/index.php?rid=3262743&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2F%3Fp%3D3089 Anthem’s getting a lot of grief for planned increases on individual premiums in California of up to 39 percent. No doubt they deserve some blame. And yet those who decry the move as price gouging and point to Anthem’s multi-billion annual profit don’t have the whole picture either. Anthem and other commercial carriers are seeing younger, healthier people –even those with moderate to higher incomes– take a pass on health insurance. With the monthly cost of insurance approaching the cost of rent or food, it’s not a completely irrational move. Twenty and thirty-something’s figure they won’t get sick or injured and even if they do they’ll blow off their bills completely or have someone like Medical Bill Helper negotiate bills on their behal... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=3262743 Thu, 11 Feb 2010 03:36:21 +0100 3262743 http://www.medworm.com/index.php?rid=3254412&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F02%2Ftough-day-for-wellpoint.html By Matthew Holt Following my cynicism about the Braly WSJ interview, not only have they been called out by the Secretary of HHS, but now they’re really in trouble. The Mommybloggers are after them… (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=3254412 Mon, 08 Feb 2010 00:00:00 +0100 3254412 http://www.medworm.com/index.php?rid=3248524&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F02%2Fwellpoints-wasted-opportunity.html By Matthew Holt Sometimes with something so egregious gets written that, even if it’s in the Wall Street Journal, you have to notice it. Angela Braly, the CEO of Wellpoint—compensation a hair under $10m in 2009—ought to be happy, even... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=3248524 Sun, 07 Feb 2010 00:00:00 +0100 3248524 http://www.medworm.com/index.php?rid=3227705&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F02%2Fuwe-and-heritage-agree-we-need-a-tax-funded-universal-pool.html By Matthew Holt When you’re at a party and someone explains to you that they just read a great article in the NY Times explaining why Peggy Noonan doesn’t understand basic math, and you know that they’re referring to Uwe... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=3227705 Mon, 01 Feb 2010 00:00:00 +0100 3227705 http://www.medworm.com/index.php?rid=3139006&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F01%2Fthe-five-things-to-pay-attention-to-in-2010.html By Matthew Holt There’s no doubt that despite my thoughts that Obama wouldn’t (and shouldn’t) have pushed health reform in 2009, it was a very big year for health care. Death panels, public options et al—one hundred thousand visits to... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=3139006 Mon, 04 Jan 2010 00:00:00 +0100 3139006 http://www.medworm.com/index.php?rid=3039742&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F11%2Fthe-post-reform-insurance-market-or-will-mega-survive.html By Matthew Holt I had an interesting call from a member of the legal profession the other day, and it got me thinking about the post-reform prospects for my own particular collection of bete noirs—the insurers who prey on desperate... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=3039742 Mon, 30 Nov 2009 00:00:00 +0100 3039742 http://www.medworm.com/index.php?rid=3015255&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F11%2Fso-will-the-public-option-hurt-hospitals-not-in-the-ozarks.html By Matthew Holt I've had this sitting in my inbox a while, but I thought that with the Senate bill out it was time to have a bit of weekend fun with it. The topic is the fear that a... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=3015255 Fri, 20 Nov 2009 00:00:00 +0100 3015255 http://www.medworm.com/index.php?rid=2999478&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F11%2Fsell-patients-like-baseball-players-seriously-.html By JOE FLOWER Here's a health care reform strategy that I have not heard anywhere else. Think about this: Why aren't health plans more aggressive in promoting the long-term health of their members, like getting them to eat better, stop... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2999478 Mon, 16 Nov 2009 00:00:00 +0100 2999478 http://www.medworm.com/index.php?rid=2989114&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F11%2Fabortion-coverage-is-aabout-math-as-well-as-politics.html By AL LEWIS Let us start by acknowledging that those who think abortion is a sin must be respected, and not forced into a risk pool that covers abortion. Let us also acknowledge that those who are pro-choice need to... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2989114 Thu, 12 Nov 2009 00:00:00 +0100 2989114 http://www.medworm.com/index.php?rid=2943940&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2F%3Fp%3D2782 Revival of the so-called public option in health reform legislation has big business in a big tizzy. I listened in on a Business Roundtable briefing yesterday where two talking points were hammered on repeatedly: The public plan will result in cost shifting to the private market, raising costs for businesses that provide insurance The public plan will stifle innovation (e.g., in new treatments) by focusing on cost above all else I’m slightly puzzled about why the Roundtable (which represents large businesses) feels so strongly about this. First, it is far from inevitable that a public plan would result in cost shifting. Second, the innovation argument is at best a mixed bag. Maybe a public plan would reduce the introduction of costly new technologies (and maybe not). But it might b... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=2943940 Thu, 29 Oct 2009 20:04:48 +0100 2943940 http://www.medworm.com/index.php?rid=2924791&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F10%2Fprotest-music-at-ahip-meeting.html By Matthew Holt This is much more fun and better sung than traditional protests! And given that AHIP would benefit from a public option, I suspect Karen Ignagni hired them. It looks like it happened in the closing session of... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2924791 Sat, 24 Oct 2009 00:00:00 +0100 2924791 http://www.medworm.com/index.php?rid=2901604&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F10%2Fwhy-ahip-needs-the-public-option.html By Matthew Holt It’s been a fun week. After years of THCB explaining that neither could AHIP do genuine research nor could its venerable President open her mouth without lying, the rest of the world has caught on. I won’t... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2901604 Thu, 15 Oct 2009 23:00:00 +0100 2901604 http://www.medworm.com/index.php?rid=2882982&cid=t_92177_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2009%2F10%2F12%2Fnursing-times-2009-vol-105-no-39%2F This article describes the work carried out in the NHS East of England to develop and pilot personal health plans for people with long term conditions. Contact the library for a copy of this article Posted in Current Awareness, Journals Tagged: Long Term Conditions, Personal Health Plans (Source: Fade Library) Fade Library blogs http://www.medworm.com/rss/comments.php?id=2882982 Mon, 12 Oct 2009 09:28:56 +0100 2882982 http://www.medworm.com/index.php?rid=2851715&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F09%2Fi-was-largely-in-favor-of-swiss-style-health-care.html By Matthew Holt until I found out that the people who the NY Times says are really in favor of it are Bill O'Reilly and Regina Herzlinger… Actually I’m kidding. I knew Regi says she likes it, and Maggie Mahar... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2851715 Wed, 30 Sep 2009 23:00:00 +0100 2851715 http://www.medworm.com/index.php?rid=2846326&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F09%2Fswine-flu-uninsurance-and-not-so-fondly-remembering-the-teenage-years.html By Matthew Holt We get sent lots of rants to our tips line, most of which we ignore in an amused jaundiced way. But this one I found very amusing. I'm not sure it's 100% accurate, but it is very... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2846326 Tue, 29 Sep 2009 23:00:00 +0100 2846326 http://www.medworm.com/index.php?rid=2832277&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2F%3Fp%3D2664 This is the second half of the transcript of my recent podcast interview with MEDecision CEO and founder David St. Clair. Part I is here. David Williams: There’s been quite a demonization of the health insurance industry as part of the debate about health care reform and in particular challenging whether health plans actually add value or whether they’re just focused on making money in a way that doesn’t help people.  I’m curious about what your view is on the right role between the private and public payers and how MEDecision helps those health plans add value. David St. Clair: I think that the word demonization is a very apt one in terms of the debate. I have to admit publicly that I am a staunch Democrat, but I’ve been tremendously disappointed by the lang... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=2832277 Fri, 25 Sep 2009 10:34:19 +0100 2832277 http://www.medworm.com/index.php?rid=2832278&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2F%3Fp%3D2660 This is the first part of the transcript of my recent podcast interview with MEDecision CEO and founder David St. Clair. David Williams: This is David E. Williams, co-Founder of MedPharma Partners and author of the Health Business Blog.  I’m speaking today with David St. Clair, Founder and CEO of MEDecision.  David, thanks for your time today. David St. Clair: You’re very welcome.  I’m looking forward to it. Williams: Tell me about MEDecision.  What is the company and what is it that you offer? St. Clair: MEDecision is a 21 year old company that provides health care management solutions used primarily by private insurers and government plans to manage care for about 50 million people in this country.  We have a couple of main product categories.  One is called Aline... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=2832278 Fri, 25 Sep 2009 01:14:12 +0100 2832278 http://www.medworm.com/index.php?rid=2828334&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2Fwp-content%2Fuploads%2F2009%2F9%2Fmedecision.mp3 MEDecision offers “smart, simple, state-of-the-art” solutions to health plans to enable them to collaborate on patient care. At the heart of MEDecision’s offerings is Alineo, which lets payers identify high-risk (i.e., costly) patients, apply clinical knowledge and automate the administration of health care programs. The company also offers Nexalign, a health information exchange service. I spoke today with MEDecision’s CEO and founder, David St. Clair about the company’s offerings, its customer base, the role of private health plans, and the fate of the disease management industry. Share (Source: Health Business Blog) Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=2828334 Thu, 24 Sep 2009 01:32:37 +0100 2828334 http://www.medworm.com/index.php?rid=2823929&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F09%2Freform-means-higher-costs-not-lower.html By JOE FLOWER A reader asks: "If the current bill passes are my health insurance costs likely to go up, down, or remain about the same?" If the form that I believe most likely to pass actually passes (insurance reforms,... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2823929 Tue, 22 Sep 2009 23:00:00 +0100 2823929 http://www.medworm.com/index.php?rid=2807733&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2F%3Fp%3D2639 The Kaiser Family Foundation’s Drew Altman does some Simple Arithmetic to demonstrate that the average cost of a family health insurance policy could reach $30,000 in ten years, which is kind of nuts in an era where overall price levels are likely to be pretty flat and so are wages. The law of compounding will eventually catch up with us. Health care costs simply can’t keep rising like this forever. On the other hand, Altman assumes an 8.7% compound annual rate of growth while we just learned  that in Massachusetts we can expect rates to rise 10 percent next year. It also seems that one way or the other we’re moving toward a Massachusetts model, where insurance is mandatory for most everyone. Since a lot of people can’t afford even today’s costs ($13,375 per ... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=2807733 Fri, 18 Sep 2009 01:10:35 +0100 2807733 http://www.medworm.com/index.php?rid=2793119&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F09%2Ftaxing-health-insurance-companies-to-pay-for-health-care.html By ROBERT LASZEWSKI The Congress has investigated about every conceivable way to tax people to pay for the health care proposals—a millionaire’s tax, bigger taxes on home mortgages and charitable contributions, and a couple of dozen more ideas. Now Congress... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2793119 Sun, 13 Sep 2009 23:00:00 +0100 2793119 http://www.medworm.com/index.php?rid=2765973&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F09%2Fwinners-and-losers-strategy-in-a-postreform-world.html By BILL KRAMER Most health policy experts are focusing on the daily ups and downs in the political battles over health reform. Within the health care industry, however, there is a buzz about who will be the winners and losers... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2765973 Thu, 03 Sep 2009 23:00:00 +0100 2765973 http://www.medworm.com/index.php?rid=2737873&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2F%3Fp%3D2582 In normal industries when someone makes a mistake it has negative financial consequences. When a factory damages a widget during the manufacturing process, the company can’t sell the final product and has to absorb the labor, material and capital costs of the wasted efforts. To survive in a competitive industry factories focus on increasing first-pass yield, reducing scrap, and pursuing initiatives such as six sigma to virtually eliminate defects. Factories with low yields and high defect rates go out of business. That’s capitalism and it works. Health care is a lot different. If a hospital or physician makes an error, they can typically bill for the work involved in making that error. Not only that –they can also bill for the work involved in correcting the mistake or mitigating the... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=2737873 Thu, 27 Aug 2009 00:10:34 +0100 2737873 http://www.medworm.com/index.php?rid=2719698&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F08%2Fare-cooperatives-a-reasonable-alternative-to-a-public-plan.html By TIMOTHY S. JOST First, a word about history. We have tried cooperatives before. During the 1930s and 1940s, the heyday of the cooperative movement in the United States, the Farm Security Administration encouraged the development of health cooperatives. At... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2719698 Wed, 19 Aug 2009 23:00:00 +0100 2719698 http://www.medworm.com/index.php?rid=2705126&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F08%2Fenthovens-abcds-and-why-that-socialist-gingrich-is-wrong-on-standardized-benefits.html By Matthew Holt Here's Alain Enthoven's four part plan for fixing healthcare. As THCB regulars might guess, it's familiar and very sensible stuff. (Here’s the PDF) A. Create an exchange with standardized plans, make individuals buy through the exchange and... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2705126 Sat, 15 Aug 2009 23:00:00 +0100 2705126 http://www.medworm.com/index.php?rid=2699590&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F08%2Fkp-lawsuit-doesnt-sniff-quite-right.html By Matthew Holt It’s about time we had a fun Kaiser Permanente scandal, as it’s been a while, and it appears that they’re having some influence on the side of the angels in DC these days. And tracking vis HISTalk... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2699590 Thu, 13 Aug 2009 23:00:00 +0100 2699590 http://www.medworm.com/index.php?rid=2681891&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F08%2Foped-a-practicing-doctors-prescription-for-health-care-reform.html By JORDAN SHLAIN, MD Our national healthcare system needs a 'step-change', not incremental change. We are facing a vast and complex problem. Let's use it as an opportunity; rather than blaming our nation's health problems solely on corporations, providers, insurers,... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2681891 Thu, 06 Aug 2009 23:00:00 +0100 2681891 http://www.medworm.com/index.php?rid=2674380&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2F%3Fp%3D2516 Today’s Boston Globe (State Aided Baker’s Business Triumph) makes several points to undercut gubernatorial candidate Charlie Baker’s claim to have turned around Harvard Pilgrim Health Care: Attorney General Thomas Reilly (a Democrat) petitioned the Supreme Judicial Court to put HPHC in receivership, which saved the company The state created a public/private alliance, which saved the company The state’s actions were against Baker’s stated principles, but he supported them He is a charming “slash and burn” artist HPHC imposed premium hikes on policyholders HPHC valued its real estate at market value rather than replacement value, increasing HPHC’s net worth and enabling borrowing HPHC used a “quirk of insurance accounting” to stage... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=2674380 Wed, 05 Aug 2009 20:52:00 +0100 2674380 http://www.medworm.com/index.php?rid=2670805&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F08%2Fare-cadillac-health-plans-the-problem-.html By BILL KRAMER The debate over proposals to tax health insurance plans is confusing and frustrating. The proposals are usually described as a tax on “gold plated” or “Cadillac” health coverage. According to the media and many spokespeople on the... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2670805 Mon, 03 Aug 2009 23:00:00 +0100 2670805 http://www.medworm.com/index.php?rid=2663930&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F08%2Fonline-behavioral-health-on-american-wells-platform-and-a-hint-at-ciscouhg.html By Matthew Holt As usual I am way behind on tech and Health 2.0 news but here's one that was "thrown out with the trash" late last week because the service went live on Saturday. American Well has has added... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2663930 Sun, 02 Aug 2009 23:00:00 +0100 2663930 http://www.medworm.com/index.php?rid=2653882&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2F%3Fp%3D2494 Charlie Baker has filed to run for Governor. That’s no big surprise; in fact he’ll be a welcome entrant into the political scene. According to the Boston Globe (Baker depicts himself as turnaround specialist), Baker is following in former Republican Governor Mitt Romney’s footsteps: Baker’s pitch was reminiscent of the tack taken by the last successful GOP candidate for governor, Mitt Romney, who emphasized his expertise in business and in turning around the 2002 Winter Olympics in Salt Lake City, as chief executive of the organizing committee. Romney even authored a book called “Turnaround.’’ The Boston Herald –and Baker himself– say that he’s following the mold of ex-GOP Governor William Weld. Actually, there’s no reason Baker needs to pa... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=2653882 Thu, 30 Jul 2009 02:29:23 +0100 2653882 http://www.medworm.com/index.php?rid=2637805&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F07%2Frantology-whats-good-for-lawyers-is-good-for-america.html By ANONYMOUS I'm retired now, but as a former lawyer, I simply must speak out in opposition to the various health care proposals that are being bandied about. It used to be said that what was good for GM was... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2637805 Thu, 23 Jul 2009 23:00:00 +0100 2637805 http://www.medworm.com/index.php?rid=2634387&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F07%2Frantology-whats-good-for-lawyers-is-good-for-america.html By E. GOLNEY I'm retired now, but as a former lawyer, I simply must speak out in opposition to the various health care proposals that are being bandied about. It used to be said that what was good for GM... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2634387 Wed, 22 Jul 2009 23:00:00 +0100 2634387 http://www.medworm.com/index.php?rid=2605974&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F07%2Fhouse-health-care-reform-ignoring-the-elephant.html By ROGER COLLIER After some frantic last minute political gyrations and a lot of pressure from the President, House Democrats have announced details of their draft health care reform bill. Much as expected, the 852-page bill emerging from three House... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2605974 Tue, 14 Jul 2009 23:00:00 +0100 2605974 http://www.medworm.com/index.php?rid=2598228&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F07%2Foped-forward-thinking-health-plans-look-for-the-guys-with-the-white-hats.html By RICHARD NOFFSINGER The public noise about health care reform has painted the parties involved in broad brush strokes that tell consumers which in the fray are the good guys and bad guys. News reports have for so long vilified... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2598228 Sun, 12 Jul 2009 23:00:00 +0100 2598228 http://www.medworm.com/index.php?rid=2598226&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F07%2Feliza-gets-a-nice-write-up-in-businessweek.html By Matthew Holt Indeed, it’s so nice that methinks Lucas & Alex were quite seductive! Speaking as a friend and one who’s been indoctrinated into the cult of Alexandra Drane, its interesting to see the mainstream press picking up the... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2598226 Sun, 12 Jul 2009 23:00:00 +0100 2598226 http://www.medworm.com/index.php?rid=2570885&cid=t_92177_118_f&fid=34850&url=http%3A%2F%2Fwww.healthbusinessblog.com%2F%3Fp%3D2430 With the current depression, there’s been some fear that we may enter a period of deflation, which could create a downward spiral for the economy as people hold off on spending and debt becomes crushing. But after opening today’s mail I’m a little less worried. Why? Well it’s annual renewal time for the boutique consulting firm I run. This year’s premium increase is a hearty 11.6 percent. This comes on top of increases in recent years of 13.3 percent, 26.3 percent increase and 11 percent. Thanks to the magic of compounding that means our premium costs have risen by more than 77 percent over four years! And we were not starting from a low base either. When I wrote about last year’s increase, I asked Wal-Mart for some help. Maybe they will come through. Sh... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=2570885 Thu, 02 Jul 2009 19:26:56 +0100 2570885 http://www.medworm.com/index.php?rid=2556114&cid=t_92177_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F06%2Fcannon-on-freedom-or-power.html By Matthew Holt Ah-ha. Michael Cannon has now replied to me and it basically comes down in his mind to me being a crypto-fascist Stalinist wanting to break the will of the American people mediated through its representatives, the health... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2556114 Mon, 29 Jun 2009 23:00:00 +0100 2556114