Category Archives: insurance

3 Weeks to Enrollment Deadline –ACA Tracking Study Reveals 50% of Uninsured Haven’t Even Investigated Cost

As the open enrollment deadline looms on March 31st, the pilot wave of a new Phoenix Marketing International research study reveals many consumers still lack basic knowledge on insurance costs, services offered (including prescription coverage), and penalties for remaining uninsured. Key findings of the study include: 50% of the uninsured have not yet looked into what it would cost to obtain health insurance. Most of the uninsured are not aware of the free services they would receive with new insurance – only half are aware that some prescription medications are free under the ACA. When informed about coverage options and [...]

[More...]
 

Managed Care in 2014 –How Big is Big Enough?

These days, the question everyone keeps asking  is “how big is big enough?” How big do you need to be to insulate yourself from all the converging, diverging and changing market forces? The good: Health plans will see huge gains in managed Medicaid and Medicare Advantage membership. Reform is also creating opportunities for MCO’s to diversify beyond their core insurance products. The bad: The profit squeeze is on. Reimbursement cuts and the commoditized nature of individual and small group exchanges makes it hard  for the industry’s players to competitively differentiate. The ugly: The Healthcare.gov debacle and other issues (either real or [...]

[More...]
 

Friday Rant: $630 Million for Healthcare.gov!

Forget everything you’ve ever heard about wasteful government spending. Whether it’s several million to study the breeding habits of an extinct species, John Edward’s $400 haircuts or $10,000 toilet seats, forget about all of it. It all pales in comparison to what is now being revealed as the cost of Healthcare.gov –more than $630 million and counting. It doesn’t matter who’s “side” you’re on. That’s an obscenity.The original contract was awarded for a meager $93 million –also a treasonous number. If the government takes enough heat over this debacle, don’t be surprised if you start to hear the phrase  ”procurement [...]

[More...]
 

Capitol Hill Staffers Learning the Hard Way to Read What they Write

President Obama’s centerpiece legislation, the Affordable Care Act, deserves to be considered a “work of art,” because it has definitely been exposed as colorful subject matter that is open to a significant amount of interpretation. And as we’ve learned, beauty is in the eyes of the beholder. Along those lines, it seems a number of Capitol Hill staffers are coming back for a second look. For example, our federal human resources department has finally clarified an issue that is near and dear to some 20,000 congressional workers who have been desperate to know if they are going to lose their [...]

[More...]
 

ObamaCare Part of the Solution for Cash-Strapped Cities?

Thomas Finn - July 23, 2013 7:02 AM | Categories: General News and Commentary, government policy, insurance

Did you see it coming? While it’s been said that many of the recent delays to some of the more difficult-to-implement and controversial elements of Obamacare are really more about the Democrats wanting to avoid the related consequences in the 2014 midterms, the latest news out of Detroit has allowed the opposition to take it to a new level. Why shouldn’t other cities and municipalities with insolvent pension and benefit programs unload their incurred costs and ease them onto our national system? Detroit and Chicago need to cut retiree benefit costs. Why not turn to the Affordable Care Act? In Detroit, [...]

[More...]
 

Healthcare Consumerism –Will it Finally Lead to Pricing Transparency?

If cost and risk in healthcare is shifting from employers and health plans to individuals, could it be that we’re now entering an age of “healthcare consumerism?” Sounds reasonable. But can it really be possible in a marketplace that continues to lack transparency? We continue to report on the various web services that deliver an efficient means to learn the costs of procedures, the related services and medications. And they keep getting better. The best of the best aren’t just sophisticated search utilities anymore. They are providing comparative measures of quality, access and outcomes. In fact, the newest applications are [...]

[More...]
 

Ethics Panels: Is This What Sarah Palin Actually Meant?

Thomas Finn - July 9, 2013 6:02 AM | Categories: doctors, government policy, Healthcare Providers, insurance

Following news cycles can be tedious, if not a little too predictable.  Case in point: After learning last week of the UNOS decision to change its organ donation/harvesting policies, there has been a rash of horror stories about organ donations, transplants, etc., leading all the way up to end-of-life policy decisions. Remember Sarah Palin’s “death panels?” Anyway, it’s all been negative. Everything from a woman recovering from a drug overdose who woke up to find surgeons ready to harvest her organs to state panels that denied a patient the right to a life saving transplantation procedure to highlighting the existence [...]

[More...]
 

Friday Afternoon “Document Dump” Reveals More Changes to Obamacare

Given last week’s news of Obama’s decision to delay the insurance coverage mandate for employers, it only seemed natural to inquire about the current state of insurance exchanges –for those of us who weren’t counting on our employers in the first place. And there it was. Within hours of delaying the insurance requirements for employers –in a classic, Friday afternoon, holiday weekend document dump– the administration also decided to relax several requirements for people seeking subsidized insurance coverage through the state exchanges. Beginning October 1 of this year, the state marketplaces for health insurance, or exchanges, were supposed to be [...]

[More...]
 

Obama Delays Employer Insurance Coverage Mandate

I was sitting with a friend last evening who owns two restaurants. He was celebrating. The Obama administration’s decision to delay the requirement for employers with at least 50 employees to provide health coverage saved him more than $100K –for now. That’s a lot of money. For this particular restaurant owner with 62 employees, that’s more than a third of his annual income. Why the delay? What constitutes a 50-employee firm? Who is full time and entitled to coverage? These should be easy questions to answer. But not for employers in full denial –in avoidance mode. Laying people off to [...]

[More...]
 

Partners Health, South Shore and UPMC Making News

The Massachusetts Health Policy Commission (HPC) is an independent state agency that was established in 2012 through the state’s new landmark health care cost containment law. The focus of the commission is to improve the quality of patient care in Massachusetts while reducing costs “through increased transparency, efficiency and innovation.” Although this particular commission claims that it has no power to approve or deny a proposed hospital merger –like the one sought by Boston’s South Shore and Partners Health— it does have the power to hold them up, pending completion of its formal review process. Of course, if the commission’s [...]

[More...]
 

Making the Case for a “HAI Category of Spend”

One in twenty patients contract infections in U.S. hospitals they didn’t have before they arrived. Tens of thousands of these patients die each year from these same infections. The government and most all insurers have told U.S. hospitals to clean up their act. Medicare simply won’t pay for certain hospital acquired infections (HAI) anymore and payments for patients who are readmitted with complications related to HAIs are also being steadily eliminated. In fact, the CDC claims that HAIs cost the U.S. healthcare system greater than $30 billion annually –a number, by the way, that many regard as absurdly low. And [...]

[More...]
 

What A Hospital Charges Vs. What Medicare Pays — Yet Another Case for Pricing Transparency

According to “A Study of Hospital Charge Setting Practices” by the Lewin Group, “the Medicare Payment Advisory Commission (MedPAC) has expressed concerns about the accuracy and fairness of the current Medicare hospital in- and out-patient prospective payment systems (PPSs). Payment rates for these systems are based, to varying degrees, on hospital charges. However, little is known about how hospitals set their charges.” Really? Isn’t it getting old. Why the “shell game” with hospital charges? Charging everyone the same published price –a la Walmart—is exactly what Walmart will do at thousands of outpatient clinics, so saying it can’t be done is, [...]

[More...]
 

Fee For Service On Life Support in Michigan –New BCBS & Trinity Contract Sets Industry Example

The new contract between Trinity Health (Trinity owns a dozen hospitals in Michigan that include Saint Mary’s Health Care in Grand Rapids and Mercy Health Partners in Muskegon, both of which now operate under the Mercy Health banner) and BCBS of Michigan puts a heavy spotlight on reform era reimbursement models. This deal highlights the latest and preferred compensation mentality –one that eliminates fee for service in favor of putting the focus on patient outcomes instead. BCBS and Trinity both refer to the agreement as a “value-based contract,” saying it should improve care quality and drive costs lower, not only [...]

[More...]
 

ObamaCare’s List of Unintended Consequences Conspicuously Alarming –And Growing

Just last week, the Kaiser Family Foundation released a study that indicates that ObamaCare has caused annual family health insurance premiums to increase at a rate three times higher than in 2010. It’s just one more unintended and negative consequence that has been added to a list that continues to grow at a conspicuously alarming rate. Remember that provision that guaranteed health insurance for children? And what about the simplest goal of all –how Obamacare was supposed to quickly reduce the number of uninsured? Not only are less people insured these days, but health insurance costs significantly more. In fact, [...]

[More...]
 

Surprise Surprise –”Competitive” Exchanges Promise More of the Same

Thanks to the Kaiser Health News for the following guest post: In Alabama, if you get your health insurance through your employer and you lose your job, you quickly realize there aren’t a lot options for purchasing coverage on your own. Blue Cross and Blue Shield of Alabama has had a virtual monopoly in the state since the Great Depression, and today it covers a whopping 89 percent of Alabamians. In part, Blue Cross and Blue Shield is dominant in Alabama simply because it has been there for so long — it sold its first policy in 1936 — and [...]

[More...]
 

Michigan Blues get Governor’s Reprieve

Thomas Finn - March 25, 2013 7:27 PM | Categories: General News and Commentary, insurance, payers, Supply Chains

The U.S. DOJ and the state of Michigan have asked the U.S. District Court in Detroit to dismiss an antitrust lawsuit filed against Blue Cross Blue Shield of Michigan (BCBSM) over its use of “most-favored nation” clauses in some of its hospital contracts. The lawsuit alleged that BCBSM pushed some hospitals into signing contracts with clauses that required them to charge higher prices to competing health insurers. If you aren’t yet  properly nauseated, read on. In a motion filed jointly with BCBSM, the parties agreed that injunctive relief is no longer necessary, however, because legislation signed into law this month [...]

[More...]