Showing posts with label Healthcare Reform. Show all posts
Showing posts with label Healthcare Reform. Show all posts

Tuesday, July 12, 2016

President Obama Writes About Health Care Reform in JAMA

All aboard!
In a first for the Journal of the American Medical Association ("JAMA"), President Obama has authored a Special Communication on "United States Health Care Reform."

As the Population Health Blog would expect of any modern sitting President's essay on any political achievement, there are no new insights, no new useful lessons learned and no regrets. The reader is instead treated to an Affordable Care Act (ACA) legacy-building "bus tour" of selected facts and gratuitous framing of the Affordable Care Act (ACA). a

Briefly, Mr. Obama points out that, thanks to the ACA, the national uninsured rate dropped by 7% from 16% to 9%, which was accompanied by a 3.5% increase in the number of individuals with a personal physician and 2.4% increase in access to medicine. He takes credit for declines in the inflation rate for health care spending, decreases in consumer out-of-pocket health care spending, the rise of value based care, and improvements in quality of care.

The President goes on to putter around the edges with some suggestions for "building on progress to date":
He closes with "lessons for policymakers":
  • While change is difficult, "hyperpartisanship" makes it doubly so. The tools of hyperpartisan sabotage include "inadequate funding, opposition to routine technical corrections, excessive oversight, and relentless litigation."
  • Special interests "like the pharmaceutical industry" still "pose a continued obstacle to change."
  • The ACA is an example of American middle ground pragmatism between the extremes of vouchers for all and single payer. It should continue.
The PHB's Take

As years of over-lawyering has taught Americans (indeed, JAMA has put the academic credential "JD" after Barack Obama's name), real peer-reviewed policymaking benefits not only from the truth, but the whole truth.

What makes this JAMA piece less than the whole truth is failure to mention (other than in passing) how lingering of the Great Recession is what blunted the majority health care inflation, that a shocking amount of treasure as well as political capital was used for a seemingly modest 7% absolute reduction in the uninsured rate, that government sponsored plans will likely put the remaining regional insurers out of business, and that the prospect that any company doing business in the U.S. being legally compelled to share proprietary cost information is highly unlikely.

Oh, and by the way, short of firing up some more money-printing presses or some real reforms, Uncle Sam has no money to pay for any of the additional proposed suggested goodies.  There is no political appetite for shoveling any more federal money toward health care.  

Last but not least, the ACA was midwifed by a hyperpartisan ramrod that failed to get even one Republican vote in either chamber of Congress. This Special Communication does nothing to diminish that legacy.
Was this a squandered opportunity to set the record straight and address some meaningful reforms?

You be the judge.

But don't take the PHB's word it. Appearing in the same issue of JAMA is this editorial by the Brooking Institution's Stuart Butler.  He points out that Medicaid and not the marketplaces was responsible for a significant majority of newly insured Americans, that, even with premium support (or its expansion), commercial insurance enrollees are now saddled with very high out-of-pocket costs.

Oh, and then there is a consensus - now that the Recession is waning and the ACA is taking hold - that health care inflation is poised to accelerate.

Image from Wikipedia

(Updated July 14)

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Tuesday, June 2, 2015

The Myriad Ways of Strategy and Population Health for Governance Boards and Health Care Leaders

What's it take to be a "luminary?"
As healthcare organization leaders grapple with health reform's uncertainties, a common refrain is importance of "strategy".

It's no longer enough to maximize revenue, increase patient throughput, lower costs, manage debt, embrace financial risk, optimize FTEs, assure compliance or strengthen the balance sheet.

While those present management and fiduciary functions are still critical, governance boards and c-suite executives in both purchaser and provider organizations also have to make bets about the future.

For example, if healthcare inflation accelerates, how will your current customers react to their future costs-sharing? How and when will today's voters reconcile the burdens from growing public debt and government-sponsorship of the insurance programs you contract with? As "the internet of things" spreads, what is tomorrow's value proposition of your healthcare "things?"  Is reading this blog today going to lead to you being smarter in tomorrow's contentious meeting?

In other words, when leaders grapple with strategy, they're really futurists. They're making bets today on how to adapt current strengths and weaknesses to myriad downstream threats and opportunities.

Uncertainty has become a new watchword. Even if an organization doesn't change and sticks with old fashioned fee-for-service, they're still making a big wager on the future of individual billing versus risk-contracting for populations.

Which is why the Population Health Blog is interested in how leaders outside of healthcare deal with uncertainty. 

Being routinely unable to resist the materialistic allure of the WSJ. Magazine fashion ads, the PHB  happily stumbled into this Soapbox column on the single topic of strategy. Six "luminaries" were asked about it.

The recording industry executive emphasized visualizing the endgame. The professional sailor trusts her gut instincts. The computer gamer is all about capitalizing on lucky breaks. The presidential historian liked ongoing experimentation. The restaurateur is constantly shaping company culture. The matchmaker likes being open to change, even if it means being vulnerable.

Lesson? The PHB has read or heard all of this and more from leaders and in boardrooms. Examples include this (the end-game), this (intuition), this (luck), this (experimentation), this (culture) and this (change management).

"Strategy" remains a highly variable work in progress.  There is no best practice.

And then there's the huge health care opportunities and risks from contracting for the care of populations. Check out this interesting post by George Washington University's Miliken Institute of Public Health that describes a survey of 37 health care luminaries on the topic of population health. As the author points out, consensus on responsibility (and, as a side note, the assets and liabilities that accompany it) is lacking.  In addition, quoting the "Triple Aim" is turning out to be less than its admirers would like.

So it turns out that this is also very much a work in progress.

The PHB's takes?

 There are two:

1) Multiply the many approaches to strategy with the multiple takes on caring for populations and the possibilities are endless. Based on the variations, no one has cracked the code applying strategy to populations and risk-contracting.

For purchaser/provider board members and C-suite leaders, the good news is that your strategic bets on the future are - for now - as good as anyone's. The bad news is that the present day fiduciary work is not lessened and you're going to have to devote more effort (and time) on developing a still unsettled strategy approach to the uncertainties surrounding health reform.

2) Regrettably, despite describing itself as a "luminary" many times to the PHB Spouse, it was not included in the WSJ. column and the Miliken Blog.  This sadly suggests that her skepticism - for now - is warranted.

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Wednesday, June 4, 2014

Looking Ahead to the Second Enrollment Wave of Obamacare This Fall

Big or small?
The latest just-published edition of Health Affairs has a sobering reminder written by Tricia Brooks ("Open Enrollment, Take Two") that the healthcare marketplace wars will recommence on November 15.

That's when open enrollment starts all over again. While the good news is that more than 7 million people got health insurance through the on-line marketplaces, the bad news is that there are now 7 million people who will have to use the process again to get their insurance renewed.

While Dr. Brooks is generally upbeat and hopes our politicians will put their constituents first, the Population Health Blog asks.... what could possibly go wrong?

What the PHB learned.....

Development work isn't finished yet.  The back-room and behind-the-scenes web machinery dealing with application questions, required consumer notifications and eligibility issues are continuing to get tweaked. In addition, the Feds are working to upgrade the electronic and other processes that are necessary to verify identity and immigration status. Plus, it has yet to be fully integrated with the commercial marketplaces, Medicaid and the CHIP agencies.

It is also possible that during the renewal process, persons who underestimated their income in the process of applying for tax credits may be subject to claw back, and the individual mandate's tax penalty will rear its ugly head.  We don't know how consumers will react.

It also remains to be seen how many consumers will understand the financial assistance or miss the deadline. Look to the Administration launch reprise of a marketing campaign that encourages "tell your friends and family" word-of-mouth.

And then there is no guarantee that many states will want to - or be able to - fully cooperate.

What went unmentioned is the "wild card" of the fall political campaign.  All of the members of the House of Representatives, a third of the Senate and many Governors will be spinning Obamacare.  Thanks to the fog of political war played out our TV screens, individuals may be entering the open enrollment period with a whole new set of opinions and apprehensions.

Stay tuned!
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Friday, May 31, 2013

The U.S. Health Care Debate in Five Bullet Points

"This message will self-destruct...."
The international arm of the Disease Management Care Blog is working on a presentation for the upcoming Hauptstadtkongreß in Berlin Germany.  Its "Mission Impossible" is to explain the U.S. health care system to a group of German hospital executives in a half hour.

This, in a Nußschale, is what the DMCB intends to say, using approximately eighteen PowerPoint slides:

1. While rising health care costs, as a percentage of U.S. GDP, has always been a problem, rising health care costs as a percentage of U.S. debt is widely viewed as a highly significant threat. We mean it this time.

2. The conservative vs. liberal debate over how to reduce health care costs for the U.S. government is ultimately about transferring its insurance risk.  The conservatives want to transfer risk to patients in the form of vouchers, while the liberals want to transfer risk to providers in the form of bundled payments and gain-sharing.  The liberals, so far, are handily winning the debate.

3. Risk is only half the health reform story.  The other half is quality. There is bipartisan consensus that a) U.S. health care quality could be better, and b) greater quality will mitigate insurance risk, resulting in fewer medical complications, emergency room visits and readmissions.
   
4. There is additional bipartisan consensus that a) insurance risk can be managed and b) quality can be increased when care is provided in large vertically integrated and regional provider systems.

5. If the twin exigencies of risk and quality are not addressed in the next 3-5 years, disappointment could lead to the unraveling of Obamacare and the introduction of a public payer option.

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Tuesday, September 25, 2012

The Perils of Government Involvement in Health Care

A Disease Management Care Blog spawn is implacably opposed to a Romney Presidency.  The argument is that while there's admiration for Mitt's successes as a businessman, running a government is better left to accountable politicians.

Which the DMCB appreciates. That doesn't mean there isn't a downside to the meddling of Republicans as well as Democrats.  Take health care for example.

Turbocharged by decades of direct government funding and favorable tax policies, insatiable healthcare consumer demand has created a medical-industrial bubble that is eating close to 20% of the U.S. economy.  Since Washington DC's direct costs are outstripping tax receipts, the same political process that got us into trouble is now supposed to get us out.  While the President's proposed 2013 budget has some painful cuts, that's nothing compared to the looming havoc being threatened by the coming fiscal cliff.  This is government accountability?

For a smaller example of the dysfunction created by government meddling, consider the electronic health record (EHR) mess.  Despite warnings from the DMCB that EHRs' documentation capabilities enable increased billings for the same care, both Presidents Bush and Obama promoted the EHR as an informatics cost-reducing panacea. 

It turns out the DMCB was right. This OIG report raised the possibility that EHRs are behind a recent coding uptick, which was further examined in this telling New York Times article by Reed Abelson et al. 

Government response? This threatening warning to stop using a product as designed that our political class had promoted all along.

(Latest update: Reversing course on years of being conspicuously silent in the face of the Adminstration's health reform bullying, the hospitals are pushing back.   Nothing like the threat of budget cuts to clarify just who your allies are - and aren't.  The cliff promises to be an interesting ride.)
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Sunday, August 2, 2009

We Have The Month of August To Think About Healthcare Reform: Let's Not Waste It With Choice A or Choice B

Whew! That pressure cooker known as Congressional health reform has taken a one month break. During this legislative downtime, our elected representatives will have a month to hear what their constituents think. If they’re smart, they’ll also check in with the health policy bloggers from time to time for insights unavailable anywhere else. Readers just need to watch out for all those preconceived non-transparent and recycled notions based on inflexible ideology.

Speaking of which, the Disease Management Care Blog distrusts anything that offers BIG solutions in the health reform. That includes big health care insurers, big government solutions, big power held by a single group of insulated experts or big piles of regulations. The DMCB likes small overlapping regional insurers that are tightly regulated by State governments. It’s a messy patchwork but the DMCB thinks it works pretty well for most people most of the time.

What isn’t working for the small insurers is the battle against health care inflation: as costs spiral up, the patchwork is raising prices. It doesn’t have Medicare’s advantage of being able to print money or Medicaid’s ability to pay pennies on the dollar. The DMCB also doubts the huge multi-state commercial insurers are all that effective in controlling costs either. Ultimately, because health care costs are so expensive, everyone’s ability to pay for hospital and physician services is being frayed and getting more ragged. This is effectively shutting millions out of affordable coverage.

No wonder vituperative critics to point to the ‘immoral’ and ‘villainous’ business logic of insurers diverting some of the premium dollar to administrative costs or shareholders. They have a point. Yet, the contrarian DMCB wonders why more of our leaders aren't visibly shocked by the absolute amount of premium dollar that is going to health care costs in the first place. It asks if pumping even more money toward the medical-industrial complex will only feed the beast. Which is truly better: a) insurers returning income to their investors that can be used to support other productive areas of the economy, or b) insurers spending premium in their networks that is used to build another hospital wing the size of an ocean liner (with a fountain in the lobby tossed in for good measure), buy more magnetic resonance imaging scanners so we can scan even more patients more often, pay for stratospherically expensive chemotherapy that adds weeks to cancer patients’ life expectancy or open more bariatric weight loss surgi-centers?

The DMCB thinks the real answer to the question is ‘c).’ The answer is complicated, multi-faceted and some of it is scattered in prior posts.

So far, it seems to the DMCB that the current batch of reform proposals before Congress favors making things bigger without really addressing the underlying inflation problem. No coherent ‘c)’ option from inside the beltway is in sight yet.

That’s the DCMB’s preconceived notion during the August recess, but unlike other bloggers, it is a) alerting readers to its biases ahead of time and b) is more than willing to change its mind over the next month.
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Monday, July 6, 2009

An Examination of the Public Plan Option

The Disease Management Care Blog really liked this efficiently written Wall Street Journal piece on healthcare reform. While it didn't agree with everything, the inspiration led this humble blogger to review the main arguments in favor of the public plan, which are paraphrased below.

A public plan will keep the private insurers honest.

Given the prior Administration’s failures, it seems comforting to believe that a change in leadership means the Federal government’s track record in healthcare is destined for change. Yet, Veterans and American Indians have been disappointed by broken promises from both sides of the aisle for decades. Alternatively, if we agree that the D.C. mandarins are imperfect, it’s hard to understand how they are necessarily less so than many smaller and honorable not-for profit plans that remain largely unmentioned by the national media.

Private insurers have broken the public trust

While we can thank some incredibly tone-deaf plans for introducing the word ‘rescission’ into the popular vocabulary, buying insurance only when its needed and driving up premium rates for those of us who play by the rules has a more familiar word to describe it: fraud. The specter of coverage denials is also understandably frightening to healthcare consumers/voters, but the other side of the story is our collective sense of boundless entitlement and unwillingness to read and grasp the small print in a binding contract, especially when it's too good to be true. Yet somehow, we’ve been led to decide between these two extremes by abdicating a huge slice of our economy to a dysfunctional political club that relies on bombast, political expediency and unread legislation to govern.

Public insurance has a lower overhead, which means savings for consumers

The notion that government can do anything more efficiently strains credulity. What’s more, comparing Medicare and commercial insurance is like comparing the alternative universes of Nancy Pelosi and Sarah Palin. While commercial insurance has its own set of issues, the truth is that government-run programs like Medicare rely on an arcane thicket of Federal regulations subject to desultory retroactive IRS-like enforcement by the underfunded Office of the Inspector General, which is only spurred to action when the problem becomes ‘staggering.’ Add this 10% waste factor to CMS' considerable hidden overhead and the transfer of many expenses to the providers and the government doesn't look like such a good deal anymore.

The public option will control costs

The logic here is that the Federal government will be able to use its purchasing power to force a better deal for healthcare consumers. A better possibility is that the long-standing pattern of underpayment to hospitals and physicians by Medicare and Medicaid will spread to new sector of the healthcare market, leaving hospitals and doctors with nowhere else to go to recoup their costs. The end result will be price controls, which are economically indistinguishable from queues and rationing.

If you have insurance you like, you can keep it.

The insurance you like now won’t disappear overnight, but its demise in the coming years, thanks to inevitable crowd-out, hostile tax policies, clumsy regulations, Congressional meddling and unintended consequences will likely lead to a three tier system: underfunded Medicaid at the bottom, the one-size-fits-all middle public plan and the gold plated plans only available to our highest paid elites with the best benefits. Care to guess which one will be used by our political leaders?

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Monday, June 29, 2009

Cost vs. Benefit in the Healthcare Reform Debate: More on Pacemakers in Centenarians

In its Obama Pacemaker post, the Disease Management Care Blog pointed out that critics would use the President’s convoluted response about the merits of a $30,000 device in a 100-year-old against him. As if on cue, the Wall Street Journal (WSJ) editorial pages mined Mr. Obama’s answer and came up with an interpretation that predicts that government rationing is around the corner.

The WSJ’s clairvoyance aside, the DMCB has some Peggy Noonan- inspired (and unsolicited) advice for reform-minded policymakers who are struggling to answer questions about cost and value: we need to reduce our wonky paragraphs down to sentences. There is a time for careful reasoning and then there is a time for conviction. If meaningful reform is to occur, now is the time for the latter.

Take disease management, for example. While it can be thought of as ‘evidence-based population-based care management initiatives that seek to achieve maximum health care value for persons with chronic illness,’ another way to explain it is ‘your nurse that’s there to help you.’ The medical home is supposed to be a ‘team-based patient centered primary care system of care that offers comprehensive personalized care coordination,’ what it really is ‘your own family doctor on steroids.’

And what was the issue that the President was trying to communicate with the pacemaker question? That we are reaching the point where we can no longer support modest individual health gains at huge taxpayer expense. No wonder he dropped his usual laser-sharp eloquence.

Consider the following graph: as health care spending for any group or population or country increases (from low to high on the horizontal axis), the overall benefit as first increases sharply (‘A,’). Then – as more money is pumped in – the incremental additional benefit begins to slow down (‘B’), stop (‘C’) and then actually declines (‘D’).




All those darlings of the health care economists – the Mayos, the Kaisers – apparently inhabit the A and B parts of the curve, while McAllen Texas has been accused of being on the C part of the curve. Open ended health insurers that pay for everything and anything are responsible for the ‘D’ part of the curve. That’s where infections happen among hospitalized patients, where mammograms in low risk women cause more biopsies than save lives, where unnecessary colonoscopies cause more bowel perforations than detect cancer and the where invasive placement of cardiac stents cause more damage than just taking pills.

The D part of the curve accounts for Medicare’s interest in stopping payment for services such as readmissions to the hospital for avoidable complications. Easy.

The DMCB thinks one attraction of comparative effectiveness research is that it can address the C part of the curve – if it is allowed to assess cost. Less easy.

The top part of the B curve is far trickier because that is where pacemakers in centenarians comes in. Very hard. There is cost (in this case, $30,000) that results in real incremental benefit (5 years of quality life and a daughter that can visit her in the home), but it’s not as much as the same pacemaker in a 60 year old (who would get 40 years of benefit, including years of taxable income and trips with grandkids to Disney World). The DMCB thinks the 100 year old got a worthwhile use of healthcare dollars. However, there are more difficult examples of higher cost with lower levels of benefit: one example includes cancer treatments that cost 6 figures and lead to an increased life-expectancy that is measure in months. Another may include the notion that everyone should have a regular physical examination, which rarely detects a problem.

Five other points while we grapple with this:

a) many policy makers think solving the C and D parts of the curve are enough to solve the health care budget crisis. The DMCB isn’t too sure about that.

b) don’t believe that money saved on the B, C and D parts of the curve necessarily means more money will be available for A. The money isn't necessarily wired that way.

c) don’t expect an individual physicians dealing with individual patients to solve this curve on a day to day basis no matter how you pay or decision support them.

d) the DMCB believes disease management and the patient centered medical home - which typically charge less than $100 per patient per month - occupy the steeper part of the B curve: the investment results in considerable increases in benefit.

e) while Mr. Obama ducked the pacemaker question with a paragraph, the day of reckoning is coming: sooner or later, we'll need to use sentences to decide what life-prolonging therapies we can afford and how we intend to afford them.

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Monday, June 22, 2009

Blogs vs. Traditional Journals in Health Care Policy Making: McAllen Texas as an Example (and the possibility that it's not an outlier)

Atul Gawande’s New Yorker McAllen Texas article is the policy zombie that refuses to die. The big news is that while this still-walking undead has generated some vigorous debate, it's prompted a fascinating insight about the growing role of non-traditional media in driving health reform.

First off, there’s a lengthy Health Affairs academic, contrasting policy and business-oriented roundabout on McAllen from the learned Elliott Fisher, Gail Wilensky, Robert Berenson and Robert Galvin. Don’t want to read all 16 pages? Neither did the Disease Management Care Blog, who was reminded of an exchange by its spawn years back. The daughter was talking about something extremely remarkable to the utter boredom of her brother. Seeing her enthusiasm wasn’t being shared by the lout, she stopped and asked him what was wrong. He laconically replied the topic was interesting enough, but she was ‘using too many words.’

Thanks to some Argentinean Torrentes and grilled salmon, the wordiness became tolerable and can be summarized for your quoting pleasure as follows:

Fisher: Being from the outfit that brought out the Dartmouth Atlas, he finds Gawande’s lay person style to be an accurate portrayal of the science of variation. Given the public’s interest in health reform, the article's timing was perfect. Dr. Fisher is against slashing prices in an effort to cap McAllen’s expenses and prefers the use of positive incentives, bundled payments and better integration of primary care and specialist physicians.

Wilensky: This former Medicare and Medicaid administrator is concerned that the article may have been too simplistic and missed some other explanations, other than dysfunctional incentives, for McAllen’s outlier status. That being said, she thinks the phenomenon is real and physicians need to be better aware of it. It’d be nice to fashion some turbocharged demos to attack variation, but in the meantime, she doubts physicians are ready to walk away from old fashioned fee-for-service (FFS).

Berenson: He spotted McAllen back in 2003 but no one paid attention. Medicare might want to investigate for fraud and abuse and, if none is present, he’ll chalk it up to the community’s practice style. Speaking of which, Boston, Chicago and Atlanta have much to be desired in their practice styles also. He likes accountable care organizations (ACOs) because they don’t have to take on insurance risk and accurate risk adjusted payments are within reach. If it’s done right, physicians might even be willing to give up on FFS. He also warns that bundled payments don’t necessarily mean that a population will have better outcomes or that hospitals won’t come to dominate the health care scene.

Galvin: This General Electric medical director was also struck by how unaware the McAllen physicians were about their outlier status. He isn’t sure that (ACOs) are a proven answer to the problem of variation and, what’s more, they could become local monopolies. He prefers comparative effectiveness research linked to yet-to-be-developed payment models.

As pointed out in another post, the DMCB agrees there is variation but points out that outliers are a) randomly inevitable in any large market and b) don’t necessarily hold any lessons that can’t be learned by studying the average. The trick is to tell the difference between randomness and causality, which was conspicuously absent in Gawande's article.

But hold on. Maybe McAllen isn’t even an outlier if Medicare enrollment, socioeconomic status and disease burden are properly accounted for. Check out this very important analysis that was posted by health services researcher Daniel Gilden on the Health Care Blog. He concludes that McAllen’s utilization patterns are high, but if careful and standard statistical methods are used to neutralize the cost drivers outside of the physicians’ control, McAllen is decidedly close to the average. In contrast to the Health Affairs posting, every word on this very important article has huge implications for the argument that physicians have run amok with unwarranted practice styles.

So here’s the real lesson: Classic journals like Health Affairs and the New England Journal and their go-to authors still have a role to play in policy discussions but alternative media, like the blogs, are becoming remarkably nimble in ‘posting’ insights that seem to be out of reach of these traditional information venues. While policy giants went on and on and on in the staid Health Affairs, Mr. Gilden chose the non-traditional but widely read THCB to post an important and provocative analysis that will undoubtedly garner significant attention. It's deja vu all over again for the DMCB and its spawn.

That’s why the DMCB hasn’t submitted many manuscripts lately to any journals. Sure, keeping a blog is fun and just as remunerative as assigning eternal copyright to the publisher for free, but the emerging potential of the web as the most important source of health policy information is truly remarkable.
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Friday, June 19, 2009

A Peek at the U.S. Senate Committee's Health Reform Proposal

An expository (and exclusive) on-line summary of the U.S. Senate’s Finance Committee’s health reform proposal is available via the levorotatory Ezra Klein’s Washington Post column that the Disease Management Care Blog discovered thanks to the mulish Matthew Holt over at the hortatory Health Care Blog. The fact that he is accusing the Dems of pusillanimity suggests the proposal is practicable. But, we share an admiration for HotForWords, which makes Matthew’s point of view exculpable. But don’t take the DMCB’s 'word' for it, check it out the summary for yourself.
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Thursday, June 18, 2009

Hope vs. Optimism for Healthcare Reform

Today, the Disease Management Care Blog listened in on Michel Martin's Tell Me More, which featured an interview with three physicians (Dr. David Ellington of Lexington VA, Dr. Hector Flores of Los Angeles and Dr. Carolyn Barley Britton of the National Medical Association) who have special expertise in the care of low income patients. None of their points of view over the public option, payment reform and the role of primary care were particularly suprising. Toward the end of the interview, each were asked about their level of optimism over the prospects for health reform. 'Very optimistic,' said one, for at least incremental reform, 'stars are aligned,' said another, while the third said the ball 'will move down the field... we're going to do it.'

The DMCB hopes there is health reform if it's done right. As for being optimistic, well.........



Hatp tip: HealthHombre
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Sunday, June 14, 2009

So, What Is a Health Insurance 'Cooperative?' and Five Reasons Why Senator Conrad's Idea is a Realistic Option for Health Care Reform

If you've been following developments in Washington's attempts at health care reform, you may have read how the concept of an 'insurance co-op' was "pitched" by Senator Conrad (D - N.D.). See him describe it here. It's a compromise offered to bridge the disagreement over just how the Feds should sponsor a public option.

Senator Baucus (D-Mont.): “I am inclined, and I think the committee is inclined, toward a co-op”

Senator Grassley (R - Iowa): "there was a thing suggested that would be kind of a private-sector option along the lines of co-ops."

Senator Rockefeller (D - W. Va) is "dubious."

Senator Hatch (R - Utah) "I'm totally opposed"

When the Disease Management Care saw the term 'insurance cooperative' bubble up in its news feeds, it was confused but, unlike our Senators, didn't offer up any snap judgments. Instead, it did its homework. At first, it thought a 'co-op' was a large carbon footprint air-conditioned store filled with baguette-laden wicker baskets where boomer earth mothers and natural-foodies drive their hybrids to buy over-priced asparagus. That plus high end Chardonnay. Thanks to some web-enabled detective work, the DMCB found out they don't necessarily involve hybrid automobiles and that the concept of a co-op can be applied to the purchase of health insurance.

So, exactly what is this thingie called an 'insurance cooperative' and what is its potential for meaningful health reform? Because you regularly read the DMCB, you'll find the answer to this question well before you can finish that lunch you've been eating at your desk.

According to this Commonwealth Fund Issue Brief, an insurance co-op exists when small employers 'band together' on a regional basis to form a purchasing block that can negotiate better deals with the local commerical health insurers. This efficiently consolidates the decision making, billing and servicing under one roof and often allows for choice among several competing plans. It also allows all the participants to 'pool' their insurance risk, which, in turn, should lead to lower and more predictable premiums. Unfortunately, the track record of co-ops has been spotty, apparently because member businesses are constantly on the look-out for better deals and may exit the co-op, leaving the higher-health risk businesses behind in the equivalent of a death spiral. If they don't keep and maintain a large market share, they can't go toe-to-toe with the commerical insurers.

For a more complete review, this paper from Health Affairs teaches us about a number of pooled purchasing arrangments including the 'co-op.' It seems this has been around for a long time. They typically operate at the state- level, are not for profit, are run by employers, don't have to accept all insurers, carve out the administrative/back office functions to an insurer for an administrative fee, leave it to employees to choose the insurance they want from a list, and, thanks to ERISA, may not be subject to all State regulations.

And if you're wondering if the famous Group Health Cooperative has anything to do with this, the answer is yes. Back in 1947, a multi-member community-based group decided to buy its own clinic to offer health care for its employees. The rest is history.

How would the co-op fit in healthcare reform? According to this link, the legislative outline currently under consideration would require them to be State-by-State or regional, non-profit, provide a coverage option for individuals and small businesses with as few as 2 employees, be subject to State laws and have 'governance standards' that would presumably trump a consumer focus in the Boards of Directors.

The naive DMCB thinks the co-op idea may develop legs:

1. As noted previously on the DMCB, as debate on the public plan option matures and stakeholders realize it's not synonymous with 'Medicare for All,' the focus will shift toward other more politically nimble options that also offer credible health insurance. The co-op is such an option.

2. According to the Commonwealth Brief and Health Affairs articles described above, commercial health insurers don't like co-ops because they force them to compete on price instead of benefit design. The fact that insurers have historically been hostile to the co-ops is telling and could be reason enough for many Democrats to support the idea.

3. Without a government-run public plan, employers will have less of an incentive to drop health insurance for their employees.

4. The very term 'co-op' has the kind of fuzzy appeal - like ''pesticide-free' or 'consumer directed' - that the Democratic majority can spin while it seeks to counter partisan Republican attacks.

5. While the the DMCB has seen little evidence of input from the NAIC anywhere in the healthcare reform debate, it suspects the nation's insurance commisioners would support the co-op as a reasonable compromise between the State and Federal governments over what is a looming intrusion by Washington DC into their space - which, by the way, they think they've done a good job regulating. Recall that Ms. Sebelius is a Past President of the NAIC, so she'd probably understand how her fellow Commisioners could shepherd the State by State co-ops into position.

The articles above are somewhat skeptical about the ability of co-ops' to control costs. While that is a fair assessment of their track records, some of the examples cited occurred during the 1990s, when health care costs were on their way down and employers were disinterested. That's not the case now, so the DMCB thinks their prospects are better. That being said, If the co-op idea moves forward, look to Congress ponder regulations that keep (as in 'mandate') small employers and individuals in the co-op risk pool and keep insurers from poaching away low risk business with side deals.
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Sunday, May 31, 2009

McAllen Texas and Healthcare Utilization: A Function of Statistical Variation, Not Poor Policy

How about McAllen Texas? Readers may recall that locale* was the topic of an essay in The New Yorker magazine by the impressive surgeon-essayist and Democratic advisor Atul Gawande. The McAllen 'hospital referral region' has the dubious distinction of having been identified by the Dartmouth Atlas as being close to the top nationwide (pretty cool graphic) for the amount of total fee-for-service Medicare dollars spent per beneficiary in 2006.

The DMCB’s first reaction was “so what?”

It took a second look when that hapless locale was seized upon by Peter Orszag of the Office of Management and Budget (OMB), Consumer Reports and some notable blogs as the symbol for all that ails American healthcare. Commentators are accusing the ‘McAllens of this country’ of consciously and unconsciously economically ripping off the system with precious little quality to show for it.

Yet, the dubious DMCB remains unexcited about Dr. Gawande’s faux discovery and disappointed that others haven’t considered the most likely cause of McAllen’s outlier status. Is there something really special about McAllen or is something else going on?

To illustrate the point, conduct a thought experiment by imaging many bags of pennies (to pay the primary care providers), quarters (for the rest of the physicians) and dollars (yes, they are available as metal coin) for the hospitals suspended above a huge map of the United States. Mentally open the bags, releasing coins that fall, clatter and roll across the map. Since the distribution of the coins is random, some areas of the U.S map will have no coins, others might have just pennies, others may have dollars and pennies, some will have all three and a few will have lots of all three. Somewhere on that map, however, there will be a pile of coins that is bigger than the rest. Perform the same experiment using Monopoly style plastic clinics and hospitals across a board-map and the same thing will happen. In these thought experiments, the area of the map with the extreme outlier status happens to be McAllen*.

It’s hard for non-statisticians/non-economists to think of human behavior in markets as being ‘randomly’ distributed around an average, but it’s true. The best (painfully so) examples of this are the performance of mutual funds, as well as what happens to losing vs. winning teams and their professional sports coaches . The same is true in healthcare: given the overall upward growth in the number of hospitals, specialists and clinics with an inevitable distribution (both high and low) around that trajectory, it is statistically inevitable that there will be a McAllen somewhere in the United States.

It is the nature of our minds to believe there must be something “causing” outliers. In other words, there must be something about McAllen that attracted all those coins, right? The DMCB, in reading Dr. Gawande’s article, thinks that may be true in Miami (which is number 1 in the U.S), but it doesn’t think that's the case for McAllen as described in the New Yorker magazine article. The gumshoe M.D. reporting clearly shows the McAllen providers are mystified by their status. It’s not as though they planned to take advantage of the system. In fact, they didn’t. That’s because it’s all random.

This is important because most healthcare providers involved in quality improvement learned long ago that ‘identifying’ and then ‘managing’ outliers with targeted interventions is a poor way to promote overall system improvement. Outliers naturally regress to the mean over time and they're not the problem anyway. Rather, the trick is to reduce overall variation around the mean (reducing the standard deviation) and to move all providers toward a better average level of behavior. That’s a lot of complicated work that, frankly, isn’t as enthralling to editors or the readers of The New Yorker. It's too much work.

While popular media can be forgiven for using simplistic descriptions of extreme outlier anedotes to pander to a political agenda, the DMCB isn’t too sure about Dr. Gawande. However, the DMCB is most frightened by potential reaction of the OMB. Short of complete central planning for the entire health care system, random distributions of performance, expense, quality, claims, satisfaction and countless other measures around a mean will be unavoidable. Of all persons, Dr. Orszag should understand that outliers are an ironic certainty, not evidence of malfeasance. Most are anomalies, not proof of anything. They are, in short, interesting, but not lessons and certainly not the stuff of policy making.

*correction: McAllen is not a county in Texas.

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Thursday, May 28, 2009

Is 'Patient Centered Care' the Jordan River for Health Reform? Thoughts on Dr. Berwick's Piece in Health Affairs & Implications for Disease Management

Ever hear of 'patient centered care?' You might think those are just the standard buzzwords applied to any healthcare initiative that means well. Like.... reducing rehospitalizations, promoting access to primary care, increasing immunization rates and expanding coverage to the uninsured. They’re all ‘patient centered,” right?

Wrong.

The ever insightful and occasionally contrarian Don Berwick of the famous Insitute of Healthcare Improvement takes up the topic in a Health Affairs 'web exclusive.' It's worth a look for anyone interested in treading on the less traveled paths of health reform. While there is a surprising amount of policy history behind the idea, patient centeredness ultimately means that the patient is in charge. Period. That means it's the responsibility of the health care system to meet the patient's needs as defined by the patient - not the professionals, not HIPAA weenies, not pencil headed administrators and certainly not picayune insurers hiding behind reductionist definitions of medical necessity.

Wow.

Before you snort derisively at such a naïve notion and decide to surf on over to the Health Care Blog for more tiresome reruns on the virtues of single payer systems, the wonderfulness of EHRs and the evils of AHIP, pause and think about walking on this wild-side. Then realize Dr. Berwick has already anticipated the three biggest objections from us know-it-alls in the healthcare expert class:

1) Patients may override evidence-based medicine. Dr. Berwick thinks that is a small price pay in exchange for responding to a population of patients that are far better informed than we give them credit for. It is very possible to rely on education coupled with lots of provider dialogue to help patients choose wisely. While some may make unwise decisions, that’s more likely a function of the quality of the education and the dialogue. Last but not least, a few crazy and demanding patients should not hold the rest of the medical world hostage.

2) Patients may use up precious resources. Dr. Berwick asks 'as defined by who,' especially when you consider that demand for health care services doesn't drive supply, rather it's vice versa. Paradoxically, if persons were truly allowed to make their own decisions, the overall demand for health care services could go down.

3) Patients may lose out on the two-way doctor-patient relationship. Dr. Berwick points out that it is far more common for docs’ to tell patients what they can’t have, coupled with emotional distancing. This is a way out of the ‘no, because…’ Desert to the Promised Land of 'yes, if....' Patient Centeredness is our way of getting over the Jordan River.

And he has some simple suggestions. For patients, care needs to be customized, transparent and fully under their control. The training of young physicians needs to be retooled. Older physicians need to be reassured. Finally, providers of health care services can measure performance on patient centeredness using long established and validated surveys created for that very purpose.

The DMCB is intrigued. While Dr. Berwick can be forgiven for restricting his perspective to the patient-physician axis, that doesn’t mean those of us in the population-based care business can’t go further in thinking about this outside the box:

First off, disease management organizations need to approach the topic with cautious optimism. Veterans will recall that the earliest underpinnings of the industry was "patient empowerment." It sounded good at the time, but we were accused of undercutting the physicians' authority. The DMCB appreciates the irony, but doubts a word switch from 'empowerment' to 'centeredness' - even if embraced by Dr. Berwick - will make it any more palatable. That doesn't mean our colleagues in the population-care business shouldn't be prepared to speak to the topic. After all, we are experts.

A small minority of self insured employers and their broker-consultants would be the most likely to embrace a yet-to-be developed 'patient-centered health benefit.' If they can be found (and if the Obamacare blob doesn't impede innovation in commerical employer-based settings), these brave souls could end up being the vanguard of a new chapter in health care reform. An innovative disease management organization could help. Medicare will be struggling on how to sponsor a demo on the topic years from now.

The DMCB thinks the industry-wide focus on ‘evidence-based’ discreet HEDIS measures is a barrier to patient centered care. One way to dispatch this is for insurers to think about a) waiving any and all utilization review and b) pay full P4P to any provider group that convincingly demonstrates they adhere to patient centeredness. Why not? If a patient doesn’t get a mammogram, it’s because the educated patient chose not to. If a high dollar MRI is ordered, it’s because the educated patient wanted it. To go even further, insurers could offer up their own X-Prize to any physician group that develops the criteria and delivers on the promises of the patient centered care approach. Disease management organizations could provide the necessary support for a patient centeredness initiative and help sponsor the Prize.

Why not?
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Wednesday, May 27, 2009

The Healthcare Reform Circus

The Disease Management Care Blog spouse doesn’t understand why her husband likes to go to the circus. Well, it’s the Technicolor noisy 3-D spectacle of it all: the elephants, trapeze artists, the ringmaster’s bombast, the army of silly clowns, grimacing tigers, brazen horse-riding Cossacks plus the children of all ages whooping it up while they wave their overpriced battery-powered blinking plastic batons.

Plus, as an added bonus, who else but the DMCB would use this year’s version of The Greatest Show On Earth as a link-laden metaphor for the Big Top of healthcare reform?

In General: compared to previous years, this show was skinnied down: the arena seemed cavernous compared what was happening on the floor: fewer acts with fewer actors. It seemed the economy was sucking some of the air out of the theatrics. It reminded the DMCB of $1.5 trillion worth of air.

The Clowns: the DMCB may have been touchy thanks to the sugar-based caloric density in the surrounding miasma, but it thinks the jesters sported a rather snooty European French-accented persona. This is what we aspire to? What's more, the clowns were clearly responsible for filling the ‘empty’ parts of the show with distracting feel-good silliness while the real work went on outside of the spotlight.

The Elephants: good grief, they are huge. There may have only been ten of them but when they appeared, there was no looking away. Like the uninsured. And one of them, well, did what elephants are known to do while they’re stomping about. A warning perhaps?

The Trapeze Artists: success of Le Cirque du Soleil has clearly prompted a disruptively innovative change from the old fashioned airborne aerial acrobatics to a more flowing crowd-pleasing style of eye candy. Behold the new style of policy making.

The Guy Being Shot Out of the Canon: Absent. Just like the Republicans. ‘Nuff said.

Dogs Chasing Frisbees: quick, nimble, never giving up and often unwilling to let it go. Reminds the DMCB of the healthcare blogs.

Motorcycles: that’s right, a metal caged sphere of death filled with up to seven (seven!) noisy high-speed choppers that miraculously failed to crash into each other. The DMCB doesn’t know how they did it, but it has come to appreciate the how the physics of centripetal force can be altered to make things go up when they common sense says they should go down.

The Tigers: what magnificent beasts. It was quite the sight to see them slinking meekly into position, either sitting, laying down, rolling over or leaning back with claws up on command from the trainer. The DMCB, however, remembers the days when a rifle toting guard was discreetly posted just outside the ring. That may not be such a bad idea even today.

The Horses: and at full gallop too. When they and their riders were stampeding across the floor, it seemed there was no stopping them. But, as persons in the front rows quickly discerned, the horses’ trajectory was not inevitable.

The Ringmaster: The appearance and style were eerily similar.

The $16 Dollar Seats: Considerably cheaper than the seats down below and probably far less than the ‘celebrity’ guests who got to ride around in festooned carts right in the middle of the show. While the righteous DMCB is thinks it’s a crime to deny equal access to first-dollar coverage of the best circus view available for everyone, the DMCB is sad to report that the likelihood of getting the spouse into clown wagon next year is remote. In the coming year, the DMCB will seek movement across the stages of change and aggressively attempt to modify her noncompliance.
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Monday, May 11, 2009

The Rumor Mill About the Medical Home Demo (and good news about today's meeting at the White House on health reform)

The Rumor Mill:

The Disease Management Care Blog has heard a completely unconfirmed report that CMS will delay until 2010 the announcement about which States will be chosen to participate in the Medicare Medical Home Demonstration.

It would make sense. The Medical Home may well be a component of major healthcare reform and it wouldn't make sense to have a concurrently running demo. What's more, my primary care colleagues are concerned that participation by smaller primary care sites may be put out of reach by imposing a Tier 3 requirement. Perhaps the whole thing is so star crossed, it should be scuttled.

Let The Horse Trading Begin

Nothing like being invited to the White House for a friendly chat. The DMCB would have liked to been in on some of the background conversations leading up to today's meeting on healthcare reform. If the details about simplification, efficiency, coordination and improvement seem vague, it's because they are. Think of this as a warm up to the painful details that will be discussed at the May 12 U.S. Senate Finance Committee.

Unlike the Bank CEOs, however, everyone hopes they have a chance getting something in return. DMCB readers are already aware of AHIP's posture toward the public insurance option. Kaiser's excellent Health Policy Daily Report points out pharma is holding out to keep cost-benefit analyses out of comparative effectiveness research while providers want to avoid onerous take it or leave it fee schedules. Care to guess what the physicians would like?

However, the disease management community doesn't need to necessarily 'trade' anything. Today's White House meeting affirmed that billions in healthcare costs can be achieved via

'Encouraging coordinated care, both in the public and private sectors, and adherence to evidence-based best practices and therapies that reduce hospitalization, manage chronic disease more efficiently and effectively, and implement proven clinical prevention strategies.'

The DMAA has it right. If there is any hope of intelligently reducing healthcare costs in the coming years, we have to address the burden of chronic illness. Let the details begin.
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Sunday, May 10, 2009

Snatching Humiliation From the Jaws of Compromise

Much is being made of the apparent ‘concession’ from America’s Health Insurance Plans (AHIP) to drop gender as part of underwriting.

You can read Karen Ignagni’s statement here. On first read, the Disease Management Care Blog wouldn’t have caught the its significance, but on page 4, it says ‘We envision a rating system based on the following demographic factors: geography, age and [insurance] product type.’

That’s right, the word ‘gender’ as an underwriting factor is absent.

Massachusetts’ Senator John Kerry’s staff certainly picked up on it, which enabled some public puffery over the issue of gender discrimination in the follow-up Q&A. This in turn flushed Ms. Ignagni ‘s page 4 insurance industry ‘setback’ out into the open.

What has been absent from the press reports about this is how the commercial insurers are hanging tough over the linkage of an individual mandate to guaranteed issue and community rating as well as the non-necessity of the public plan option. It may be paying off. Senator Charles Schumer of New York is working hard to find a compromise that will allay the concerns of enough conservative democrats who are apparently willing to break ranks and vote ‘no’ against what could be shaping up to be a public-option poison pill. The optimistic and naïve DMCB believes compromise is in reach and will ultimately depend on how a ‘public’ plan is defined. A very regulated plan administered by a private insurer of last resort could fit the bill.

But how about that gender issue? As a physician, the DMCB is well aware that women are, well, built differently. That translates into different healthcare needs. To further research the issue, the DMCB went to many interesting web sites but ultimately headed on over the USPSF’s Guide to Clinical Preventive Services and searched on the word ‘women.’ It found things have not changed much since Senator Kerry’s wisdom was given such public display: women have considerable healthcare needs. What’s more, they deserve to access to the full range of services that will address them. It could be argued that insurers agree and charge women more in their premiums so that they can be assured that those services will be available to them.

Readers need to decide for themselves if the insurers are guilty of clandestine conscious and unconscious sexism or enlightened business practices aimed at doing the right thing for an important market segment. As for Senator Kerry’s comment about ‘the disparity between women and men in the individual marketplace is just plain wrong and it has to change,’ the DMCB is having trouble between the choosing between a) grandstanding for political advantage and b) showboating by beating up on a favorite whipping boy, er sorry, person. Compromise is one thing. Making it appear as if it's humilation is another.

Post script: By allowing rating based on age and geography, is the US Congress going to permit ageism and geographism? Don’t the elderly deserve the same consideration? Shouldn’t persons living in New York have the same low insurance costs available in Minnesota? Tsk tsk.
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Sunday, May 3, 2009

Would You Want To Do Business With Medicare Under These Two Scenarios?

The Disease Management Care Blog doesn't think so. It may be dating itself, but it recalls an original Star Trek episode that featured Harcourt Fenton Mudd. His shady promises proved to be part of a grand design concoted to serve Mudd's devious interests, and Mudd's interests alone.

So with that introduction, the DMCB found two other scenarios within the U.S. Senate Finance Committees' “policy options” that are under consideration as part of its healthcare reform efforts. Based on rosy interpretations of some existing science that are really tilted toward to the government’s advantage, they aren’t win-win, or even win-lose. They’re simply Mudd-like win.

‘Payment for Transitional Care Activities’ (page 10)

This would pay for ‘transitional care management’ for recently discharged beneficiaries with a chronic illness DRG, based on interventions that have ‘proven successful’ in the Medicare Coordinated Care Demonstration Program, the Medical Home and ‘other care management models.’ Physicians would be reimbursed for ‘in person’ activities performed by non-physician professionals within 30 days of discharge. Payment would be contingent on not being readmitted.

That may sound good except for one small problem: the Medicare Coordinated Care Demonstration hasn’t really proven to be successful. In addition, the reason the Medical Home has been slated for a demo is because we don’t know if that’s going to be successful either, especially when it comes to readmissions. Limiting payment to ‘in person’ activities is not only Neo-Luddite, it’s an example of there-you-go-again, here comes one-approach-fits-all Medicare. What, Medical Homes will not get credit for telephoning patients? Can they count on Medicare alerting them in a timely manner when a patient is discharged from the hospital? Since re-hospitalizations will never get to zero despite the best of care, the DMCB suspects the only winner in this payment methodology would be Harcourt Fenton Medicare.

‘Accountable Care Organizations (ACOs)’ (page 17)

Since the Physician Group Practice (PGP)Demo ‘showed promise,’ the option here would be to set up a mechanism in which groups of providers would aggregate into business units that would exist to a) meet quality thresholds and b) benefit from a 50% gainshare once savings get beyond a 2% baseline.

Recall, based this DMCB post about the PGP, that a grand total of two out of ten organizations received any money in the gainshare, though the Senate Finance policy paper says there were four. Hmmm, doing the math, that means the odds are against the average ACO provider group ever making any money on this. However, assuming that a 40% chance of payment from Medicare is an accepted business practice, keep in mind that the types of physician groups that participated in the PGP demo in the first place provide less than 1% of the entire healthcare in the U.S. But the lack of generalizability to the other 99% is not all: what is missing from this policy option is any mention of how the PGP groups relied on old-fashioned disease management. As the DMCB recalls, the groups in this demo were also stymied by the lack of data support from Medicare. Based on what the DMCB is reading, this is also very tilted toward Uncle Sam-Mudd.

(There's lots more on Accountable Care Organizations here)
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Sunday, April 5, 2009

Governor's Sebelius' Nomination, Delay and the Art of War

Not too long ago, the Disease Management Care Blog read Sun Tzu’s classic, The Art of War. Given the news of the delay in Ms. Sebelius’ nomination as Secretary of HHS, believes the Congressional Republicans have also.

While the DMCB read it years ago, it recalls Sun Tzu had a dim view of obvious frontal attacks. Rather, his was a game of strategy, flexibility, deception, deflection, feinting, leverage and delaying until the time was right. General Tzu’s opponents knew an apparent lack of activity by his army did not mean all was well. Quite the opposite: more likely, disaster was on the way.

Ms. Sebelius’ Congressional confirmation as the Secretary of Health and Human Services (HHS) has been delayed. Republicans have asked that further action be put off until answers to ‘additional written questions’ can be reviewed. That will push the nomination back two weeks. While two weeks may not seem like a long time, the DMCB is vaguely aware that Congress has a very proscribed legislative calendar and that getting a major health bill to the President by September involves a lot of moving pieces – including a number of deadlines and a visible and supportive HHS Secretary. Quietly depriving HHS of a leader of Ms. Sebelius’ caliber for even a short time would be approved of by General Tzu.

As those days pass and other delays add up, the minority opposition’s disadvantage may lessen even further, thanks to the 1) eventual evaporation of the ‘Blame Bush’ marketing strategy, 2) the likely intrusion of other newsworthy distractions, 3) inevitable decline in the President’s approval ratings, 4) more bad economic news (unemployment is bound to rise further, tax receipts are likely to be lower than anticipated and other shoes are getting ready to fall) and 5) the natural second thoughts that arise once the details of Any Big Plan become apparent.

This isn’t enough to derail the ObamaExpress entirely, but the momentum has been slightly slowed. The DMCB suspects that Dr. Tzu would calculate the likelihood of large scale reform this fall decreased by one notch. Disease management organizations may want to plan accordingly.

While the Federales continue to tie themselves up in knots, check out this report from Hewitt. Employer-sponsored population care programs are continuing their torrid growth. The challenge, as always, is to engage more enrollees, even if it means developing performance guarantees, value-based benefit designs, financial incentives and sophisticated and industrial strength employee communication, outreach and marketing strategies. Growth opportunities in the non-government commercial health insurance sector continue to increase by additional notches.

General Tzu knows the DMOs are already planning accordingly.
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Friday, March 6, 2009

Last Minute Thoughts.....


According to the President's remarks at yesterday's Summit (they're here, fast forward to 6:20), healthcare costs lead to a bankruptcy 'every thirty seconds.' Is that so?

The Disease Management Care Blog invites the White House staff to follow its playbook: take the effort to read the underlying science for yourself and measure twice and cut once when it comes to making public conclusions.

And for those who feel left out: the DMCB feels your pain. It wasn't there either.
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