March 24th, 2010 by AlanDappenMD in Primary Care Wednesdays
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Many companies and consumers are turning to higher-deductible health care plans (HDHPs) in order to keep their insurance policies more affordable. The rational basis of these plans is that since you’re using your money and you are in control, you will pay more attention to what is really being offered to you as well as to the cost relative to value. You will be more likely to challenge your doctor to provide the rationale for an expensive test or drug, and to encourage your doctor to innovate to provide lower-cost alternatives.
A trap of these new health plans, as currently structured, is that you’re herded into in-network ‘preferred providers.’ The rationale of the insurance company is that they can control doctors’ prices, thus brokering a better rate for you. They also want to use your loyalty to the network to control physicians’ practices. “Preferred,” in reality, does not refer to quality; rather it just means the doctor has signed an agreement with the insurance company, binding them to the insurance company rules, which favor the insurance company, not the patient.
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March 10th, 2010 by AlanDappenMD in Primary Care Wednesdays
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Introduction: Here’s a recap of the scenario to date: Mrs. Doctor, a primary care physician is in marriage counseling to determine the fate of her marriage with Mr. Insurance. While she loves her career (medicine), dealing with Mr. Insurance’s increasingly abusive financial and administrative demands are crushing her soul. Yet leaving preferred provider protection guaranteed through the marriage would be devastating too. And Mrs. Doctor doesn’t want to lose her kids (the patients); decades of historical indicators show that 95% of kids (patients) stay with Mr. Insurance and refuse to see Mrs. Doctor ever again.
Last time, the therapist performed a therapeutic technique on Mrs. Doctor akin to psychological judo. When she claimed she was helpless under the power of Mr. Insurance’ ability to pay the bills, the therapist pointed out that Mrs. Doctor has many more powers than he does, including education and training as a doctor, the ability to order labs and meds, and the understanding and trust of each patient. Why, then, would she abandon the kids without a battle? Mr. Insurance wants nothing to do with the kids, and creates hundreds of games to reduce or eliminate his financial obligation to them.
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February 17th, 2010 by AlanDappenMD in Primary Care Wednesdays
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Introduction: As we pick up with this ongoing series, here’s a synopsis for those of you new to the story: Mrs. Doctor, a primary care physician, has been going to marriage counseling alone since here husband, Mr. Insurance, has refused her pleading to attend the sessions together. He claims she is too spoiled and is threatening to find a new partner and a happier union, not to mention to find someone new who can help take care of their children (Patient 1, Patient 2, Patient 3 …).
Previous therapy sessions went well — until the last one, when the therapist seemingly accused Mrs. Doctor of being to blame for her marriage crises. At this point in time, the therapist asked her to return explaining why she should be at fault, and this is where we pick up:
Mrs. Doctor: I’m upset with you. I don’t know if I’ll continue therapy.
Therapist: I’m sorry you feel that way. Let me get this straight, you can’t decide whether to stand up for your kids (Patient 1,2,3) or abandon them … or whether stand up to your husband, Mr. Insurance, or abandon him … or whether to stay with therapy or not.
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February 3rd, 2010 by AlanDappenMD in Primary Care Wednesdays
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Introduction: To those readers picking up this series for the first time, here’s a synopsis for you: Mrs. Doctor is a primary care physician who is in an unsavory marriage with Mr. Insurance. They care for their adult children (Patient 1, Patient 2, Patient 3…) with the following arrangement: Mr. Insurance will take care of all the financial requirements by paying Mrs. Doctor and to do all the caring and nurturing to keep the kids well.
Mrs. Doctor has come to realize that Mr. Insurance is a jerk and asks her to do more and more while giving less and less money for the care of the kids. Mr. Insurance refuses to see anything wrong with his relationship he has stonewalled all requests for marriage counseling. Mrs. Doctor began counseling on her own to ponder her dilemma through the impartial eyes and ears of a marriage and family therapist. Read more »
January 27th, 2010 by AlanDappenMD in Primary Care Wednesdays
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Health and wellness go hand in hand; there is little question of this. I therefore ask why isn’t primary care at the heart of the health and wellness movement? This, I feel, would make outstanding economic sense for all involved.
In an effort to survive these sour economic times, more and more companies are trying to stave off the escalating cost of healthcare by pushing for wellness. There is good reason for this. According to Buck Consultant’s third annual global wellness survey which was cited on the Society of Human Resources Management web site those U.S. companies who measured financial outcomes of their wellness programs reported a 43% reduction in healthcare costs or about two to five percentage points per year. Read more »
