tag:blogger.com,1999:blog-9181810725696409953.post728094995774978868..comments2024-03-17T04:20:11.083-04:00Comments on The Population Health Blog: Mandate a Medical Loss Ratio. Close a Disease Management Care Program or Patient Centered Medical Home Support. How It Could HappenJaan Sidorovhttp://www.blogger.com/profile/05072456803925863874noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-9181810725696409953.post-56886973695357111092010-01-01T20:37:19.246-05:002010-01-01T20:37:19.246-05:00Jaan did in a prior post:
http://bit.ly/7CDf
The...Jaan did in a prior post:<br /><br />http://bit.ly/7CDf<br /><br />The Post Office has been used as an example of the kind of public-private competition that can bring credit to both parties. I'm not too sure the parallels work:<br /><br />Insurance as a payor is a different business as a provider with a service. Pooling risk is not delivering packages. Requires completely different optics. <br /><br />Insurance by mandates/regulations vs. Insurance with real overhead costs: guess who loses. The USPS, on the other hand, cannot hide its inefficiencies - it's costs are quite real. <br /><br />In addition, in the Public Option, fees to the providers will be take it or leave it. The USPS doesn't work that way. <br /><br />And yet, despite the USPS' inefficiencies (aided by a monopoly on First Class postage), it continues to exist thanks to the protection of the U.S. government, not because of any one or anything being kept honest.Jaan Sidorovhttps://www.blogger.com/profile/05072456803925863874noreply@blogger.comtag:blogger.com,1999:blog-9181810725696409953.post-44281821262167784852010-01-01T20:05:13.280-05:002010-01-01T20:05:13.280-05:00Jaan, Jaan, Jaan . . . think USPS, UPS, FedEx! (Do...Jaan, Jaan, Jaan . . . think USPS, UPS, FedEx! (Don't UPS and FedEx keep USPS 'honest,' and vice versa?)Bradley Dean Stephanhttps://www.blogger.com/profile/10735141320100233658noreply@blogger.comtag:blogger.com,1999:blog-9181810725696409953.post-1005330501067819732010-01-01T19:54:24.277-05:002010-01-01T19:54:24.277-05:00bradleydean makes a good point, but I'm sympat...bradleydean makes a good point, but I'm sympathetic to the perspective that a public option will just turn out to be so powerful that the private insurers will simply go out of business. So the risk is that two sectors will equal one.Jaan Sidorovhttps://www.blogger.com/profile/05072456803925863874noreply@blogger.comtag:blogger.com,1999:blog-9181810725696409953.post-23762401126240389602009-12-30T15:29:37.678-05:002009-12-30T15:29:37.678-05:00Yes, another good post by DMCB. But, this legitima...Yes, another good post by DMCB. But, this legitimate and worthy attempt to micromanage private insurers merely underscores the need for a public option. Currently, private insurers represent a black box relative to efficiency - as they should; they're private companies and should be able to run their businesses as they see fit, and behind closed doors. From a public policy standpoint, in order to optimize healthcare economies (i.e., limited resources chasing limitless needs - with the shared understanding that healthcare represents an 'essential public utility,' similar to education, transportation, defense, etc.) our options are twofold: 1) External management of the black box through regulation, in hopes of engineering an efficient outcome (which typically leads to unintended consequences and suboptimization), or 2) Build and manage our own, via a public option (which, common sense dictates, should be an expansion of Medicare - an expansion to include Medicaid, as there's no efficiency argument to have two public insurers). The public insurer then needs competition from private insurers, or it will become a black box of its own, in the sense that there's no efficiency benchmark for comparison. A 'two sector solution' is the only solution that makes sense.Bradley Dean Stephanhttps://www.blogger.com/profile/10735141320100233658noreply@blogger.comtag:blogger.com,1999:blog-9181810725696409953.post-15683629564769278692009-12-28T13:26:43.809-05:002009-12-28T13:26:43.809-05:00This is an important topic and an excellent post. ...This is an important topic and an excellent post. While NAIC may be up to the assigned task, they are, in part, the cause of the current confusion.<br /><br />In the early days of DM, nearly all plans categorized DM expense as medical. That made sense from an accounting perspective since the it was that category to which the benefits of a succusful program inured. Then, somehow, NAIC got involved and decided that these expenses were really "administrative," at least for not-for-profit plans. We're not sure why or how this happened.<br /><br />More recently, NAIC has indicated that it was not their intent to categorize caremanagement, prevention and wellness costs as administrative, but there has been little action to clarify the issue. Ahip, recognizing the contradicition that DMCB points out about effective programs reducing MLR, is not excited about furthering such a definition.<br /><br />There is, or was, a DMAA task force working on this issue and perhaps DMCB can get a status update from them. In the interim, the industry contiunes to be faced with about a 50-50 split as to the categorization of fees and the proposed language inthe Senate Bill, if it survives, is not likely to create an environment for a satisfactory, logical or transparent result.Unknownhttps://www.blogger.com/profile/17149664007860897156noreply@blogger.com