AHIP Steps Up With Their Version of Health Reform

While HHS Secretary Sebelius reassures the House Republicans that the Fed's health insurance exchanges are on track, that the implementation of the Affordable Care Act will not be a "train wreck" and flies around the country touting Obamacare, Disease Management Care Blog readers may want to check out this 3 page article by the notorious anti-Sebelius a.k.a. AHIP's CEO Karen Ignagni.  In it, she mounts a vigorous defense of her trade association's commercial insurer members.

She points out:

1) Commercial insurers' versions of accountable care organizations include a variety of prospective payment approaches that are tailored to the provider's willingness to take on insurance risk.  What's more, commercial insurers can "calibrate" the benefit so that consumers', physicians' and hospitals' economic incentives are all aligned.

2) Health plans are quite able to share data and analytics support that translates into early identification of trends, accurate payment designs and the targeting of programs at patients who are at greatest risk.

3) AHIP's members are routinely providing health risk assessment tools, predictive modeling, medication compliance programs and care management services.

4) AHIP is well aware of the difference between true cost savings versus mere cost shifting.  As a result, they are asking for greater transparency on commercial and government fee schedules so that the potential impact of cost shifting can be better understood.

5) While Washington DC deserves a lot of credit for promoting a quality agenda, it could do a better job of working with all insurers to come up with a set of universally used quality measures.

6) While commercial plans are required to use uniform billing systems, providers are under no obligation to submit their claims electronically.  While this certainly helps physicians over the short term, the long term inefficiencies are not cheap.

7) Commercial insurers would rather cover treatments that have been shown to work. The "Patient-Centered Outcomes Research Institute" is not mentioned by name, but you get the idea.

8) AHIP supports letting non-physicians practice "to the top of their license."

9) State-based "laboratories of democracy" are a useful way to try out a variety of health reforms before they are adopted by Washington.

The DMCB's take?

AHIP and Karen Ignagni have been mostly out of the public eye.  Could this be a sign that they're less wary of the Administration's anti-insurer bluster?

While Medicare's Innovation Center continues to get high marks, the commercial insurers appear to be advantaged by having more leeway to test new payment and care management strategies.

AHIP's members are aware that many providers could fold if they mismanage the risk that underlies prospective payment systems.  Unike Washington's one-size fits all approach, they seem prepared to adapt their contracting accordingly.

Care and disease management programs?  The commercial insurers have rolled this into standard operating procedure.

The Spin in HHS Secretary Sebelius' Year In Review Video

In her end-of-year-in-review video below, Secretary Sebelius extols the many accomplishments of HHS. As the Disease Management Care Blog has come to expect of our national leadership, this latest Affordable Care Act (ACA) commentary is laced with spin. Just repeatedly SAYING stuff about the ACA's impact on small businesses, health information technology, community health centers and anti-fraud efforts doesn't necessarily mean that its true, or that our Republic is getting our money's worth in government or leadership.

Some of the counter-arguments below are just partisan, but there is enough truth in all of them to make the DMCB hope that Ms. Sebelius' 2011 end-of-the-year review has more ballast and less bombast.

To wit:

Tax credits to help small businesses buying health insurance. "The value of the benefit declines quickly, so many business owners in high-cost states get no tax break, and those elsewhere often say the credit is too small to make much of a difference."

National standards for health information technology. "Among themes of cost savings, workflow efficiency, and quality, the only benefits to be reliably documented were those regarding efficiency, including improved access to test results and other data from outside the practice and decreased staff time for handling referrals and claims processing. Barriers included cost, privacy and liability concerns, organizational characteristics, and technical barriers. A positive return on investment has not been documented." (Assuming national standards are eventually shown to be effective, the ACA really sets up a process to define those standards which remain a controversial work in progress.)

Community Health Centers. "Although most people probably imagine that community health centers are an inexpensive way to provide health care to poor people, the Colorado experience suggests otherwise. Medicaid payments to the FQHCs are far above Medicaid rates for private physicians and clinics."

Tough Medicare anti-fraud efforts: "Congress has been increasing appropriations for the anti-fraud program that’s jointly run by Justice and HHS. Administration leaders promote the value of a special fraud prevention and enforcement task force known as HEAT. The health care law enacted this year dedicates even more federal dollars to these efforts. Yet, despite the record number of defendants, actual criminal convictions for health care fraud violations are flat resulting in a falling conviction rate" (After so many years or promises that we really REALLY mean it this time, can we prosecute our way out of the problem?)

To give credit where credit is due on the non ACA issues, the DMCB finds Ms. Sebelius was more truthful:

Dramatic changes in cigarette packaging. The link to the evidence says the FDA is getting this one right thanks to it's expanded powers under the recently passed Family Smoking Prevention and Tobacco Control Act. It remains to be seen if this will translate into the outcome that counts: declines in the national rate of tobacco use.

Childhood nutrition in public schools: The DMCB says Ms. Obama's Healthy, Hunger-Free Kids Act of 2010 is evidence-based, but let's see if it really makes any difference and leads to less childhood obesity: it was only just passed.

Emergency response efforts for the "Swine Flu" epidemic: The DMCB notes that CDC's expertise was outstanding but public support is not a given.