U.S. Healthcare – Moving Forward

Last week I gave a presentation to the leaders of some women’s health advocacy organizations about where the U.S. healthcare system is heading, i.e., where we go from the current situation with the A.C.A. We had a great discussion, and the organizer of the event emailed me afterward to say, “Amazing is all I can say. You are the first person who could speak to [the] ACA in which people listened and engaged.”

Some of the key points I made included:

  • Focus on the future. Don’t relive the past.
  • Move forward from today’s strengths and weaknesses. The slide below describes health insurance coverage for 2015 showing dramatic increases in coverage in individual insurance and Medicaid, and a decrease in the uninsured. 

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Health, Healthcare, and Government Spending (and a Culture of Health)

Why governments care about health spending and healthcare, how they are connected to overall government spending and priorities, and why addressing social determinants of health is so important for making lasting improvements, were the subjects I covered in a presentation at George Mason’s graduate policy school in September. My goal was to provide the soon-to-be policy analysts and advisers with a framework for understanding those issues so they will be able to provide useful recommendations to their future decision making bosses. (See the slide below for the topics covered in the presentation.) Links to videos of the talk are below, along with short descriptions – I think that Part 6 is particularly good.…

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Health Promotion, Prevention, Wellness, and Government Fiscal Policies

I recently had the opportunity to give guest lectures at Georgetown University and the University of Virginia. At Georgetown I focused on employer’s perspectives on health promotion and disease prevention. (Videos of portions of that discussion are below.) At UVA’s Batten School of Public Policy I discussed fiscal issues and policies for government healthcare programs, e.g. Medicare and Medicaid. (A few slides from that discussion are below….. sorry no video.)

The opportunity to talk with our future clinicians, health system administrators, and policy makers was heartening and a bit terrifying. While the students are eager and passionate, I wonder about their historical understanding of our complex healthcare systems and the policies, programs, and initiatives that got us to where we are today.…

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Jimmy Buffett Medicare and Healthcare

The title of Jimmy Buffett’s song “Changes in Latitudes, Changes in Attitudes” is a good description of the fundamental changes occurring in the US healthcare system:  Within the Federal Government – and Medicare in particular – widespread “Changes in Latitudes, Changes in Attitudes” are evident in the implementation of the Affordable Care and HITECH Acts, and the overall leadership of the Department of Health and Human Services.  Healthcare leaders in private organizations – and state and local governments – are embracing these changes, which collectively are leading to better healthcare quality and lower costs…. Or at least slower increases in healthcare costs, a.k.a.…

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Cutting Employer Healthcare Costs

Over the past 20+ years larger companies have tried many tactics to control the growth of their healthcare spending, including HMOs, consumer-directed healthcare, wellness programs, value-based insurance design, selective contracting for high-cost procedures, personal health assessments, etc.  While some of those efforts temporarily reduced employers’ healthcare spending, they did not change the long-term trends, in part because they only targeted employees and did not focus on high or very high cost individuals – many of whom are not active workers. [A recent Health Affairs article analyzing conditions associated with employee healthcare spending reflects this “searching under the streetlamp” phenomenon.]

Company Health Benefit Costs Do Not Equal Employees’ Healthcare Spending

The cost of providing health benefits for most larger companies includes not only the health benefits for employees, but also costs for retirees, and spouses and dependents of active workers.…

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Health Insurance Security Creates Jobs

People feeling secure that their health insurance will continue (or be easy to get) creates an often overlooked societal benefit, i.e., it promotes job creation – particularly for entrepreneurs. Because this value is hard to quantify, it is seldom seen in policy or political rhetoric. (It is also overshadowed by the general “job lock” phenomenon of employment-based health insurance.)

This week’s National Journal has a great article on this topic (“The Other Jobs Bill”) that examines Massachusetts’ experience with their insurance reforms and coverage requirements: The expert consensus is that these reforms have boosted Massachusetts’ economy and job growth compared to other states.…

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Era of Accountable Care

For many months I’ve been talking about the array of health transformation initiatives the Department of Health and Human Services has been deploying as both demonstrations and programmatic changes.  I’ve been characterizing this strategy to create more accountability as an evolving menu, buffet, or map – sort of like those magical Harry Potter maps where the lines keep appearing on the parchment to create a recognizable image.

As part of releasing the final rules for the Medicare Shared Savings Program, HHS also put forth a document subtitled “Menu of Options for Improving Care,” which is a list of some of the landmarks in the future map of an Era of Accountable Care.…

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Health Law Is Reforming System Via Market Forces

All the controversial rhetoric about the new health reform law is missing a huge reality:  The law is driving dramatic changes in the real world.  Almost every major health delivery system is preparing to reorganize how they provide care to hundreds of millions of Americans by becoming Accountable Care Organizations (ACOs).

Health Systems are Voting With Their Wallets
The magnitude and level of financial interest in ACOs – and proof that it is not just cautious planning – were dramatically illuminated by recent actions and a Washington Post article:

  • On Thursday, HHS released the long anticipated proposed rule for ACOs and Medicare “Shared Savings.”

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Regulating Insurance: States v. Federal Roles

One of the fascinating issues within the health reform debate is how to improve the insurance market by changing government regulations.  While large employers who self-insure are except from state regulations, (and must only conform to limited Federal rules under ERISA), individuals, small groups, and others who actually purchase insurance have their policies regulated by individual states.

Both Democrats and Republicans agree that the current system of insurance regulation creates job lock and other socially undesirable effects, and that insurance companies should be able to sell policies across states lines.  However, their solutions are quite different.

Democrats favor national regulation to create a single playing field, and Republicans prefer permitting insurance companies to sell in multiple or all states if they are licensed and regulated in any state. …

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High Costs of Cancer Treatments for Patients Not on Medicare

Last week I wrote about the challenges of people with Medicare getting the best treatments for cancer.  Today, the Kaiser Family Foundation released a report examining the challenges people who get insurance through the private system, (i.e. employer based or individually purchased),  have affording their cancer treatments. And how the public insurance programs, (i.e. Medicare and Medicaid), have waiting periods or other enrollment requirements that delay or prevent patients from being covered immediately – something which is of particular concern for patients with cancer.

The Kaiser Family Foundation’s report presents an excellent mix of data analysis and individual patient examples.  The report’s conclusions are that our health system has a significant number of holes (or cracks) that people can slip into causing them to suffer clinicall and/or financially. …

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Auto Industry Retirees’ Health Benefits Squeezed Again

In all the discussion about the auto industry’s financial problems, health care costs for retirees are often brought up as one of the major challenges the big 3 domestic companies.  This is not a new issue, and one that I actually researched in the early 1990s when I worked for a Congressman from the Detroit area.  What is new is that the companies had worked out an arrangement with the United Auto Workers union to turn paying for retiree health costs over to Voluntary employees’ beneficiary associations (VEBAs).  These VEBAs – one for each company – were created in the fall of 2007, and were funded by the companies as a way to relieve the them of the unpredicatbility of future costs for retiree health benefits starting in 2010.…

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Another Humorous? Humana Video

Last week I wrote about Humana’s YouTube videos designed to “explain” parts of the healthcare system.  Well they just put another one titled, “Some Doctors Cost More. Why?”

Two interesting points about this video: First, at the beginning they describe  insurance companies (like Humana) as “Providers.” (The narration uses the term “health coverage providers,” but the graphic shows “PROVIDER.”)

While physicians and other clinicians really dislike being called providers, I think they wouldn’t want to see that term used for insurance companies either, since it implies that the insurance company is actually providing healthcare.  (I usually reserve the term provider to describe broad groupings of clinical entities, such as, “providers of oncology care in the Chicago area,” – which would include physicians, nurses, hospitals, etc…)

And second, the title and content of the video doesn’t focus on the total costs of care or services provided by individual physicians, but mostly only patients’ co-pays – which are lower when they use the physicians that are in-network for their insurance plan.…

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