Posts Tagged ‘health policy’

New Health Wonk Review at Boston Health News

Friday, May 20th, 2016

Cambridge, Massachusetts-based health and science journalist Tinker Ready hosts the current edition of Health Wonk Review at her Boston Health News blog: The Health Wonk Review: HIT, LGBT and ACA. Check it out! It’s an eclectic edition covering a cornucopia of health policy topics.

And please join us for a HWR Blab (video conversation / text chat), Health Wonk Review On Air With HealthBlawg Tuesday, 05/24/2016 at 1:00 pm ET for half an hour. You can watch from here or sign in to Twitter account to log in.

New Health Wonk Review at Wright on Health

Thursday, May 5th, 2016

Check out the latest & greatest from the web’s noteworthy health policy pundits: Brad Wright has posted Health Wonk Review: Pivoting Towards the General Edition at Wright on Health. We’re 186 days away from the election but his edition is complete with hilarious photos of our next president so you’ll want to check it out.  Lots of good posts, too, from the usual suspects.

Please join the wonkers for a new multimedia experience (video conversation and text chat), Health Wonk Review On Air With HealthBlawg Tuesday, 05/10/2016 at 1 pm ET for half an hour. Watch it live here or click to login via Twitter.

The Sickest Of The Sick, The Poorest Of The Poor

Tuesday, April 5th, 2016

They comprise less than 4% of the nation’s population, yet consume nearly 34% of health care dollars. Sixty percent are age 65 or older. About 40% are younger people with ADL-qualifying disabilities. More than half fall below the federal poverty level. Almost half never graduated high school. Nearly two-thirds are female. Fifty-eight percent are white/non-hispanics.

They are America’s “Dual Eligibles,” our fellow citizens who qualify for both Medicare and Medicaid benefits. Technically, because they’re Duals, they are not the “uninsured.” Still, they sit smack dab in Obamacare’s bulls eye.

In 2003, here in Massachusetts, a pioneering visionary decided to create a non-profit HMO that would offer as its sole product a Senior Care Option plan aimed at the over-65 Dual population. As a former head of the Long-Term Care Division within the Commonwealth’s Medicaid Program, Mass Health, Dr. Bob Master knew a lot about the Duals and the many challenges they presented. Somehow, he convinced a few academics and business people to join his brand new Board of Directors for his Quixotic quest. I was one of them.

In the early days, the hunt for funding was all-consuming, but against considerable odds, funding was found, and, with the support of CMS and Mass Health, an incubator for the nation was born – Commonwealth Care Alliance.

Bob immediately set out to prove that Duals could achieve significantly better health and well-being at lower cost if they were cared for in a home-based regimen by highly trained teams of providers. And between 2003 and 2014, CCA produced eye-popping proof of concept results. For example, thirty-day hospital readmission rates for these sickest of the sick and poorest of the poor consistently beat Medicare’s overall rate. CCA achieved annual Medicare star ratings of 4.5 or better (Because of Senior Care Option demographics, it is statistically impossible for the company to achieve a higher rating).

CMS took note. And when medical, academic and political luminaries were crafting the Affordable Care Act, Bob was instrumental in convincing them Duals were a target not to be missed.

Consequently, the Affordable Care Act created demonstration projects in nine states from California to Massachusetts to see whether it’s possible to improve the health of all Duals, those over the age of 65 as well as under it, while reducing their health care costs. A tall order, indeed, because it had never been done before.

CMS and Mass Medicaid issued a humongously big RFP. Commonwealth Care Alliance answered it and won the right to play in the new sandbox, called One Care. The year 2014 was spent in preparing. For example, in order to be ready, the company had to double the size of staff (there are now more than 800) and train the newbies to successfully manage CCA’s unique model of care. That was not easy.

In early 2015, we opened the floodgates to the state’s thousands of Duals under the age of 65. Since then, it’s been a thrilling ride, because throughout 2015 CCA had a few near-death-experiences. But with the help of both CMS and Medicaid we were able to negotiate the potholes and speed-bumps, and now, after more than a few sleepless nights, the company cares for more than 17,000 Duals with Medicare and Medicaid premium of more than $850 million. In essence, CCA is beginning (barely) to do well by doing good. To my mind, if the Affordable Care Act, Obamacare, does nothing more than significantly improve the lot in life of the nation’s Duals while lowering their cost of care, it will be a success of the first order.

Now, it’s time to turn the reins over to a new era of leadership. Last Friday, we had a retirement party for Bob Master where CCA employees who could free themselves from work for a couple of hours came to Boston to say hail and farewell. Many came on their own time. There was a great big cake and a lake-full of diet soda and coffee, but no dignitaries, just current staff and a number of Directors. The Chair of the Board said nice things about Bob and the ride we’d all been on. I described how, after all this time, Bob and I had discovered less than a year ago over lunch that, in addition to growing up in the next town to each other, we had been comrades in arms back in the late-60s in Vietnam; in the same Division, even, at the same time. Funny, that.

Many employees read stories they’d prepared for the occasion. Honest tears were shed. Bob gave an extemporaneous speech that was heartfelt and touching. He thanked all who had joined in the noble quest, many by name. Then he rode off into the sunset.

But the work goes on.

 

 

 

 

Some Final Thoughts Following WCRI’s Annual Conference

Wednesday, March 16th, 2016

 

This year’s conference was an interesting blend of hard data and subjective debate.

On the hard data side we learned the preliminary results of some studies addressing what most in the business consider to be the key issues of the day, and they are all medical (a position with which I do not agree, but, admittedly, I am a minority of one). Some of the studies produced  results that validated what I like to think of as the “Duh!” conclusions. These are conclusions that seem totally logical and predictable, conclusions reached by mere intuition. Trouble is, policy, at least good policy, should be based on verifiable evidence, the kind that these “Duh!” studies produce, and not by intuition.

For example, workers’ compensation pays providers better than group health, in some states way better. So, it is logical and intuitive to believe that providers in those way better states would categorize soft tissue injuries as work-related rather than group health if given the chance. And, what do you know? Preliminary results from one of the studies put “You betcha” to that one.

So, cost shifting happens, and now we have proof, proof that policymakers can cite as they suggest system improvements.

Subjective debate was alive and well in the two Opt-Out panels. There were eight panel presenters, and only one of them, Elizabeth Bailey, from Waffle House, Inc., produced any data. As I wrote during the conference, Ms. Bailey presented data on cost savings Waffle House achieved since Opting-Out of Texas workers’ compensation in 2002. The savings were impressive, indeed, but, as attendees pointed out during the question period, Waffle House has made other workers’ compensation, safety and employee involvement improvements since Opting-Out, so it’s hard to say just how much Opting-Out has contributed to the cost savings. In other words, Waffle House’s cost savings may be nothing more than a painted hook on which Opt-Out enthusiasts want to hang their collective hats. More study is needed. Let’s hope it happens.

And let us not forget Bob Hartwig, the illustrious outgoing President of III, the Insurance Information Institute. Dr. Hartwig, who delivers presentations at Gatling gun speed, spoke on the Sharing Economy, or, as Hilary Clinton calls it, the Gig Economy. His formidable presentation was entertaining, educational and scary all at the same time.

For me, three things are memorable from the presentation:

  1. The Gig economy is bigger than anyone thinks, and is growing swiftly. And, as you might imagine, Millennials are deep into it. This is a movement that has the power to change an economic system.
  2. Hartwig suggested that the days of AI, Artificial Intelligence, taking over America’s jobs are farther in the distance than have been predicted by AI experts. His position is one with which I, respectfully, disagree. I think we’re closer to a cataclysmic shift than he believes. To put a point to that, Gary Anderberg, Senior VP of Analytics for Gallagher Bassett, suggested, no, pronounced, during the question period that all of the WCRI attendees could be replaced given today’s Watson-like technology. That’s heady stuff.
  3. I got to ask the last question of Dr. Hartwig, and it was this: “To what degree do you believe the Gig Economy correlates to the relative stagnation in hourly wages over the last 40 years?” His reply? “Good question. A lot.”

Bob Hartwig now moves to a professorship at the University of South Carolina, and the students in the Finance Department have no idea what is about to hit them. I predict his classes will be over-subscribed from the get-go.

Hope to see you at next year’s WCRI conference, March 2nd and 3rd in Boston.

 

Hospital Medicare Charges: You Don’t Always Get What You Want

Monday, June 8th, 2015

In early June of this year, the Centers for Medicare and Medicaid Services (CMS) let loose a treasure trove of data. One data set lists inpatient charges of 3,000 hospitals for the 100 most frequently billed diagnoses of 2013. The differences between what the hospitals billed and what Medicare paid are eye-popping, as are the differences between what hospitals within just a few miles of each other charged.

The inpatient data shows Medicare paid about $62 billion to cover more than 7 million discharges. Our good friends at Modern Healthcare have analyzed the data. This, from Modern Healthcare’s Bob Herman:

Hospitals have been under intense scrutiny for their billing practices, often triggered by extremely high charges—or sticker prices—for common procedures. Consumer groups and patient advocates argue hospital pricing is shrouded in secrecy, which has put patients on the hook for costly bills. But hospitals have said the listed charges are irrelevant because they only serve as a starting point for negotiations with insurers and that patients rarely, if ever, pay those prices.

The CMS data is shining a light on the process. The agency has now released data from 2011, 2012 and 2013. Charges for various inpatient and outpatient procedures differed significantly again in 2013 as they did in prior years. In many instances, charges fluctuated greatly among hospitals in the same region.

A Modern Healthcare analysis of the inpatient payment data shows Philadelphia, Los Angeles and Newark, N.J., had the largest gulfs in charges between the top and bottom hospitals. For example, in Philadelphia, the average difference in average hospital charges across all procedures was $123,847. In Los Angeles—an area rife with academic medical centers such as Cedars-Sinai Medical Center—the average difference between the highest-charging hospital and the lowest-charging hospital was about $112,000.

Did you catch the part about the listed charges being irrelevant, because they’re only starting points for negotiations? Reminds me of the last time I bought a car.

You might be tempted to say, “That’s crazy! Why do hospitals do that?” Let me answer with a little story.

A few years ago, I was a Trustee at a major teaching hospital in Massachusetts, a tertiary care facility, one of the biggies. At one Board meeting early on in my trusteeship I asked the CEO how the hospital was compensated for uninsured people who were indigent. His answer? “We charge them the moon.” Note to reader: he’s talking about the indigent patient, here. “Then, when the state’s uncompensated care pool gets around to paying us, we’ll get a lot more than if we just charged them what the procedure cost, in which case we’d get a lot less than what the procedure cost.” I never forgot that lesson in hospital economics.

So, you see, when hospitals say their charges are “starting points,” they’re telling the truth. And that is one spooky scary example of what a first-class horrendoma the American healthcare system (if you can call it that) has become.

Health Wonk Review, “Football Is Here” Edition at Colorado Health Insurance Insider

Thursday, September 13th, 2012

Check out a fun and smart Health Wonk Review – “Football Is Here” Edition posted by Louise Norris at Colorado Health Insurance Insider.
We don’t want to step on her toes here, just go read the whole edition, which is a pretty full one — Louise always does a very thoughtful job in framing each entry — but we would echo her recommendation to be sure to visit the post from Amy Berman – the first one in this edition. It’s so very worth reading and thinking about. Thank you Amy, and best to you!

Health Wonk Review, medical costs, price hikes, joint & several liability, and more

Thursday, December 11th, 2008

Health Wonk Review — The “Just the Facts, Ma’am” Edition – hosted by Vince Kuraitis at e-CareManagement – Dragnet fans take note!
NCCI report on medical benefits – The medical share of total losses has grown dramatically — from just over 40% in the early 1980s to almost 60% today. NCCI takes a closer look: Analyzing the Shift in the Medical Share of Total Benefits (PDF)
Price hikes forecasted – economists at Swiss Re are predicting a deep recession and price hardening across all lines of insurance through 2010, insurance and reinsurance inclusive.
Walmart death – This topic has been making waves in the law blogs. Troy Rosasco talks about the likelihood that exclusive remedy will preempt any lawsuits in the case of the trampling death of a Walmart employee in a post-Thanksgiving sale stampede, and talks about how the retailer could face criminal investigations. Of course, that doesn’t mean that lawsuits haven’t been filed – Eric Turkewitz updates us on the family bringing suit; Walter Olson offers his perspective on “5 minute after” suits. My colleague Jon had blogged about this last week: Walmart’s Killer Bargains.
Can you say Joint & Several liability? – a recent study profiled in Risk and Insurance shows that small business owners are not fully aware of the financial risks involved in obtaining workers’ compensation insurance through self-insured groups. Despite several high-profile failures, “…85 percent of respondents indicated that they had not seen, read or heard about the closure of several self-insured groups over the past year. More than one-half (58 percent) of respondents reported that they were unaware that companies belonging to self-insured groups remain financially responsible — often for years — for the claims of all companies in their group, not just their own businesses.” See: joint & several liability.
Fumes and confined space – We noted a sad story last month about two amateur winemakers in France who died after being overcome by fumes while trampling grapes. While this might sound like unusual circumstances, the issue of confined space and the danger of fumes is a significant agricultural risk. Hydrogen dioxide-related deaths (PDF) also occur in manure pits – there have been several instances when rescuers enter the pit only to succumb to the fumes as well.

Hot off the presses: Health Wonk Review

Thursday, October 30th, 2008

David Harlow of HealthBlawg has posted the Samhain edition of Health Wonk Review. If you are like me and don’t know what Samhain refers to, go and get yourself educumated – it’s interesting! As are all the entries in this last-call edition for health policy posts before the upcoming election. David is one of our long-time participants in the biweekly wonkery. If you wonder why he calls his site a “blawg” that is a little legal pun used to signify the blogger is an attorney. While many of our regulars are consultants and physicians, David brings also his perspective as an attorney to the legal, policy and business issues facing the health care community.

Health Wonk Review: Political Convention Style

Thursday, September 18th, 2008

Jaan Sidorov’s posted the Health Wonk Review, Political Convention Style at his Disease Management Care Blog, and it’s a good one. We have three more HWR’s before the election, and I think they will be a very good source of info on the candidate’s health plans. They should be a platform for some spirited debates among some very smart people!
A few financial links:
Freakonomics has a very good, plain-speaking overview on the recent financial upheavals as explained by Douglas W. Diamond Merton H. Miller Distinguished Service Professor of Finance and Anil K. Kashyap, Edward Eagle Brown Professor of Economics and Finance, both of the University of Chicago Graduate School of Business.
Countdown to an Insurance Giant’s Collapse – Eric Dash and Andrew Ross Sorkinof the International Herald Tribune offer a close up view of events as they transpired.
Interested in how various newspapers throughout the world are playing the U.S. financial news? You might enjoy Newseum which offers front page snapshots of 690 front pages from 63 countries. It can be an interesting resource when large events occur.

Health Wonk Review, scaffold survivor update, hand protection, and potential cancer cluster

Friday, June 13th, 2008

Jane Hiebert White has posted a great edition of Health Wonk Review: Washington Week at Health Affairs – and she notes that this issue coincides with Academy Health’s Annual Research Meeting held in DC this past week, a gathering based on the concept that health policy should be informed by research. In this HWR issue, one of the major themes centers on health care reform. It’s worth your time to check it out – it may be one of our biggest and most substantive issues yet.
Survival story – at the beginning of the year, we posted about miracle survivor Alcides Moreno who lived through a NY scaffolding collapse which sent him plummeting 47 stories. Today, the New York Post features a story about Moreno entitled 47-story guy walking tall. But not all the news associated with this story is good: his brother who was also on the scaffold was killed in the fall. Earlier this week, The New York Times covered the OSHA report about the accident, which found fault with City Wide Window Cleaning, the service that employed the Morenos, and Tractel, the firm that had repaired the scaffold.

OSHA issued five citations against City Wide for what it called serious violations. Three carried proposed fines of $7,000 apiece, the highest the agency can impose. One was for lack of a system to protect against falls — cables that would have left the Morenos dangling at the top of the building when the scaffold gave way.

Another citation against City Wide was for failing to train employees in how to inspect the scaffold, and for not training them to wear “personal protective equipment” before they stepped onto the rig. The article lists other charges against both companies. Commenting about the fines imposed, the Daily News editorializes that death comes cheap, noting that, “Financial penalties like that are meaningless as a deterrent to corner-cutting by contractors.”
Hand injury prevention – According to an article on hand injuries by Don Groce in Occupational Hazards, gloves can prevent injuries and reduce costs. Recent research shows that “The cost of hand injuries in just one sector of the construction industry is six times what it would cost those employers to offer every employee appropriate hand protection.” This preventive measure represents potential to reduce pain, reduce lost productivity, and save dollars. According to the CDC, hand injuries account for more than a million emergency department visits by U.S. workers per year. Groce’s article also discusses advances in glove manufacturing and various types of safety glove alternatives.
Dupont cancer cluster? – Celeste Monforton of The Pump Handle raises the question of whether there is a cancer cluster associated with Dupont in response to 19 cases of rare carcinoid tumors among DuPont employees, with 6 of the cases surfacing among workers at the Washington Works plant in West Virginia. She reports that adverse health effects have been associated with exposure to perfluorooctanoic acid (PFOA or C8), the chemical used to make Teflon and other non-stick surfaces.