Wednesday, December 3, 2008

AHIP Releases Health Reform Recommendations: Read the Condensed Version Here

Read the America’s Health Insurance Plans' (the association that represents the nation's health insurers) comprehensive reform proposal here – or, speed read this exclusive Disease Management Care Blog summary. Go ahead, call them self serving, call them obstructionist, call them names but unless these guys are at the table, meaningful health reform is going to be very very difficult. What's more, if you're going to expand insurance, it makes sense to listen to these guys. They know what they're talking about.

Here's the summary. Ready? Go....

Reduce projected costs though evidence-based medicine, reward quality, streamline administrative processes (1), wellness, prevention and chronic care coordination, uniform quality reporting standards, an advisory group (2), an ‘independent comparative effectiveness entity’ (3), strengthened public health infrastructure, combining a community rating with individual mandate (4), tax equity for individuals and small businesses, high risk pools, tax credits, essential benefits plan (5), transparency, first do no harm to the large employer market, avoid unintentional cost shifting, strengthen public programs and partner with the States.

There. You're all done. Now here are 5 details that the DMCB thinks are interesting:

1. Multi-payer portal: instead of dealing with differing billing formats, AHIP’s members are apparently agreeing to share a one-stop web site which would simultaneously handle multiple health insurers. This would reduce the administrative hassles for the physicians. Ironically, this probably represents an additional short term cost for the insurers, who would need to alter their billing work flows. It would need to be outsourced to a third party so that the insurers couldn’t “peek” at each other’s fee schedules. Care to guess if Medicare FFS is going to participate?

2. Public private advisory group: Rather than an all powerful ‘Health Fed,’ AHIP is respectfully disagreeing with and Senator Baucus and former Senator Daschle. They’d rather have an entity develop recommendations on slowing spending, rewarding quality and reducing administrative costs (like the ‘portal'). Recommendations are easier to ignore or modify than Federal regulations.

3. Independent comparative effectiveness entity: You can bet the health insurers would like this. Contentious and sometimes embarrassing coverage decisions/denials over ‘medical necessity’ and the possible ‘investigational and experimental’ dimensions of treatment would become much easier to manage. Count them as being on the NICE bus.

4. Community rating and mandates were covered here. As a regular reader, you’re already expert on this.

5. Essential Benefits Plan: a not so bare bones but minimalist high deductable-health savings account insurance thingy that meets one of the DMCB’s recommendations: the purpose of health insurance is to reduce the likelihood of a financial catastrophe due to unexpected illness, not meet countless mandates.

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