Apr
21

Politicians’ views on health care

You’ve just got to read Matt Holt’s blow by blow report from the World Healthcare Congress.
Here is one of the more interesting excerpts.
Allan Hubbard, the Administration’s point man on health care
“Question to Hubbard – “Do you think HSAs could make the problem worse by driving the young, healthy or wealthy into these plans leaving the sicker in traditional plans which will drive up the cost of health care for the most vulnerable part of society?
Hubbard says that its not for the wealthy, as 40% of people getting them earn less than $50,000 (of course that means that 60% earn well more than the average, but lets leave that aside!) For the chronically ill–he says 2-5% of population–this doesn’t work so well. so Administration wants to allow employers to put a bigger amount in the HSA for the chronically ill. But thats the problematic part…”
Paduda comment – 2-5% of the populatin is chronically ill? Perhaps, although it depends on what your definition of “chronic illness” is. They drive a majority of health care costs, so Hubbard essentially admits that HSAs as conceived by the Administration don’t work for the chronically ill– and as for putting more dollars in there, isn’t that just encouraging usage?


Apr
20

Cover Tennessee – a “market based” approach to universal coverage

While Massachusetts has adopted a program designed to cover almost all of the Commonwealth’s citizens with a pretty comprehensive health plan, Tennessee is pursuing a program that is considerably more modest in both plan design, expected enrollment, and cost.
According to the AP story published in Insurance Journal;
“The Cover Tennessee plan calls for a $150 monthly premium for basic health insurance, with the state kicking in $50. The individual would be responsible for the remainder, though businesses would be given the option of paying half.
The program would limit benefits, for example the number of nights for hospital stays, instead of requiring a high deductible to keep costs down for the insurer.” Copays will be modest for drugs and physician office visits, and individuals’ coverage will be portable.
This initiative began with a grant from the federal government (HHS in particular) to provide funding to study ways to cover the state’s uninsured. The report, a 119 page monster, provides a comprehensive and quite detailed review of the state’s population demographics, existing health insurance infrastructure,
Of note, “the largest portion of the uninsured worked more than 40 hours per week…for small businesses.” 20% of the uninsured work for employers who offer health benefits, but either can’t enroll yet, can’t afford their contribution, or are ineligible for the plan.
Unlike Massachusetts, the program will be limited to selected insurers. There will be competitive bidding, with the state soliciting bids from insurers, after which the plan will be implemented by the end of the year. My sense is this process will encourage insurers to adopt strict cost control measures.


Apr
19

Fiserv’s focus on work comp pharmacy

The workers comp drug management landscape is getting even more complicated, with new entities and renamed ones entering the space seemingly every day. One of the latest to hit the radar is Innoviant, a subsidiary of Fiserv.
Remember Fiserv owns Third Party Solutions as well as DirectCompRx, a third party biller and PBM respectively.
It appears that an Innoviant unit that specializes in marketing to injured workers and their attorneys, telling them that Innoviant will eliminate out of pocket costs and hassles, delivering drugs quickly via mail order etc. Sources on the payer side indicate that Innoviant then bills at rates above what is usually deemed appropriate, claiming that their requested reimbursement levels are reasonable.
Moreover, one payer in Florida has seen a recent and rather large influx of bills from the Innoviant mail order folks; this payer is concerned that TPS bills are finding themselves inserted into the “mail order” category, thereby circumventing existing processes for capturing these scripts and redirecting to network pharmacies.
Innoviant also goes so far as to recommend attorneys to those injured workers who are in need of a little legal assistance. One wonders if there is a quid pro quo here…
So, Fiserv owns a third party biller, PBM, and home delivery company (marketed to physicians and attorneys); it does appear that they are seeking to serve all masters, even competing ones.


Apr
19

Property and Casualty 2005 results are down

Weiss Ratings has released its analysis of the P&C industry’s 2005 results; it will come as no surprise that results are down due to hurricanes and related disasters.
For those unfamiliar with the industry’s risk structure, here’s a quick snapshot. Primary insurers, such as Allstate and USAA, sell the policies and usually reinsure some portion of the potential losses with another insurance company. Thus, when big claims, or lots of claims, hit, the reinsurers get hammered.
Such was the case in 2005. Although the number and size of claims were high, reinsurers picked up a big chunk of the losses.
And, insurance companies did a pretty good job of investing premiums and therefore gained substantial returns on those assets. As a result, despite underwriting losses of $4.2 billion, on the whole the industry earned $46.7 billion, up 13% from the prior year.
The entire industry has just over half a trillion dollars in surplus available to pay claims. So, even if a major disaster hits, we should be OK.
What does this mean for you?
With reinsurance rates going up and coverage harder to obtain, expect to see the market continue to waver between hard and soft as underwriters wait for the hurricane season.


Apr
18

Ambulatory surgery centers – the financial black hole

Colleague and friend Peter Rousmaniere has an excellent column in the latest Risk and Insurance detailing some of the issues with Ambulatory Surgery Centers. To net it out, while they can get patients in quickly, are usually much nicer (in appearance) than hospitals, and can have equivalent outcomes, they are also wicked expensive (that’s my New England accent) , especially in states without an ASC fee schedule.
As a result, payers are increasingly looking to outside expert firms to assist in determining an appropriate reimbursement level. One that is especially adept in this area is Fair Pay Solutions (also an HSA client).


Apr
18

Not disability but ability

An article in today’s Baltimore Business Journal highlights a study by the American College of Occupational and Environmental Medicine on the impact of disability on employers’ bottom lines.
It will come as no surprise to industry experts that disability costs a ton of money, both hard dollars and soft, for insurance premiums, wage replacement, medical expenses, replacement workers and lost productivity. And, while it is good to see ACOEM publicizing the real costs of disability, this is not something that has not been addressed by many employers and experts in the past.
Jennifer Christian, MD, is the most articulate and insightful expert on the role of the physician in disability management. Tom Lynch of Lynch Ryan is the industry’s leading expert on safety and return to work planning. There are any number of physicians in private practice who focus deeply on return to work – Jorge Trujillo and Yemi Owi are two occupational medicine physicians who focus on what the patient can do, rather than what they can’t, and as a result have a stellar record in this area. Choice Medical Management has proven that sending injured workers to the right docs can dramatically improve return to work results.
And I’ve argued till blue in the face that any group health payer that wants to really differentiate in the market can do so by demonstrating their impact on absenteeism and productivity. Here’s hoping that a nascent initiative to do just that (evaluating a large HMO’s impact on a large University) gets things rolling (I’m involved as the chief nag to keep things moving along).


Apr
17

Medical malpractice – insurers are darn lucky!

A thoroughly excellent synopsis of the med mal insurance industry’s good fortune reveals that the number of suits filed is a small fraction of those that could be filed, and likely won.
According to Jason Shafrin;
“Less than 3% of people who receive negligent physician care actually sue.”
So, could politicians, physicians, and misguided health care economists please stop whining about med mal? It could be a whole lot worse.