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How To Pick Good Health Insurance

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 cervical cancer with mammograms and pap smears respectively? Do kids only get antibiotics appropriately for strep throat and not overtreated and unnecessarily when they have a viral illness or cold? Are adults over 50 screened for colon cancer (something Dr. Oz can relate to). Read more »

*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*

Emergency Care’s Ambiguity In The Affordable Care Act

There’s just so much hidden and buried in the Affordable Care Act (ACA) that it’s like trying the find all the goodies in an Easter egg hunt. ACEP News pointed out one hidden goodie, nicely illustrated in this article from Kaiser Health News:

Under the new health law, insurance companies must extend several new protections to patients who receive emergency care. One of the biggest guarantees: Patients who need emergency treatment will have their costs covered at the same rate, regardless of whether they are treated at “in-network” or “out-of-network” hospitals.

The law also bars health plans from requiring prior authorization for emergency services. And it mandates that plans follow the “prudent layperson” rule. For example, if a person goes to the ER with chest pain, but ends up being diagnosed with indigestion, the claim has to be covered because going to the hospital under those circumstances made sense.

The provisions go into effect for every health plan issued after Sept. 23 – six months after the law was enacted — that offers emergency coverage.

This is potentially quite significant. As with so many things, the devil is in the details, and the implementation is not yet actualized. Read more »

*This blog post was originally published at Movin' Meat*

Will Large Employers Dump Healthcare Coverage?

Fortune magazine has made some news recently about the impact of healthcare reform on large employers:

Internal documents recently reviewed by Fortune, originally requested by Congress, show what the bill’s critics predicted, and what its champions dreaded: many large companies are examining a course that was heretofore unthinkable, dumping the healthcare coverage they provide to their workers in exchange for paying penalty fees to the government.

The only trouble? There’s no way these employers are seriously thinking about doing this.

I can understand why the employers would do the math. According to healthcare reform law, penalties for failing to provide health coverage are a small fraction of the cost of that coverage. But as with most everything else in healthcare, there’s much more to it than just a simple math equation. Here’s what I mean. Read more »

*This blog post was originally published at See First Blog*

What We Have Here Is A Failure To Communicate

If you were hoping for a thoughtful discussion on the reform of our health care system, I have bad, bad news.

It turns out that health insurers are “villians.”  Public anger over the massive, mostly unread, reform bills is “manufactured,” and anxiety created by the expectation of unknown changes to people’s most valued benefits is the result of disinformation and “fishy” stories.

It’s like an employee benefits roll-out gone horribly awry.

The protests and disastrous town halls look to me just like the kinds of angry protests that happen all the time when employers make important changes to a benefit plan and the employees either don’t understand them or don’t agree.

Blaming the people who don’t follow what you’re doing and why is a big mistake.  Sure, there is politics.  But health care is a serious, emotional issue, and it should be no surprise that people react badly when they think something to do with it may be taken away.

Dreaming up ideas of how health care ought to work is relatively easy.  But figuring out how to implement it is hard, and there are no short cuts.  The people who actually run benefits plans – employers, benefits consultants, HR professionals – can tell you:  there is no replacement for communication, engagement and respect for opposing views.

The strategy of demonizing those who aren’t on board is a mistake, and is as likely to set back the cause of reform as it is to further inflame an already volatile audience.

*This blog post was originally published at See First Blog*

Unintended Consequences: Penalizing Insurers Kills Employer-Based Wellness Programs

I thought everyone knew the major goal of health care reform is to control spending.

Then why are Democratic leaders proposing changes that would outlaw some of the most successful cost-savings programs in the country?

Today’s The Hill reports on the new strategy to attack insurance companies as “villains.”  No doubt, health insurers have a bad reputation and have done plenty to earn it.  As the Hill reports, the message is going to be that the reform plan will lead to “capping what [insurers] can force you to pay in out-of-pocket expenses, co-pays and deductibles.”

But for at least half of Americans – those who work for large and mid-sized companies and their families – their “insurer” is actually their employer.  And many of these employers have been using out-of-pocket expenses, co-pays and deductibles to improve employee health, and reduce the cost of care.  They are creating strong wellness programs and creating financial rewards and penalties, all based on employee participation.

As I wrote in April:

Companies like Safeway, Wal-Mart, Michelin, General Mills, Marriott and so many others have implemented programs to create a “culture” of wellness among their employees and their families.  Leaders at these companies constantly talk about living healthy lifestyles, and are paying to make it happen.  At Michelin, employees get a cash reward for getting a biometric screening and for participating in company-sponsored health improvement programs.  It even started work-site exercise programs, including yoga (although it found that with a workforce that was 82% male it had to call its yoga classes “strengthening and conditioning”).

General Mills published wellness statistics about its different plants and found that the workers in each one competed with the others to get the best scores for BMI and other important health metrics.  Marriott found that by eliminating co-pays on drugs for certain chronic diseases, more employees followed doctors’ orders to take them, and although Mariott’s drug costs went up, overall health expenses went down.  Abbott Labs brings in motivational speakers and set up weigh-in kiosks in its offices that took pictures of employees as they got healthier so they could see the difference.  All of these companies reported on enthusiastic participation, and a sense among employees that their company cared about their well-being.

Safeway has taken this idea even further, and redesigned its entire benefits plan around this concept.  Employees who live unhealthy lifestyles and refuse to participate in wellness programs pay more for their health insurance — just like a bad driver pays more for  auto insurance.  Safeway did this in a highly positive and motivational way, making available a wide array of free services to help employees be more healthy and enjoy lower health premiums.  The results have been dramatic:  Steve Burd, Safeway’s CEO reported at the WHCC that Safeway’s health costs have been flat since 2005.

This Safeway model – creating both soft and hard incentives for employee health – is one of the fastest growing trends in plan design.  The idea is to give employees control over their own health care, including financial  responsibility.  When this happens, employees live healthier, look for value in their health care spending, and overall costs are lower.

And yet the statements from the Congressional leadership suggest they want to severely limit these kinds of innovations.

It may be good politics to demonize the insurers, but we should realize that “insurers” aren’t exactly who we think they are.   Health reform that stifles the innovation that’s working at America’s best companies is no reform at all.

*This blog post was originally published at See First Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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