Month: August 2016

Aug
4

Opioids – the cost of the drug isn’t the problem.

Posted by Joe Paduda on Thursday, August 4th, 2016 | Comments

http://khn.org/news/opioid-dependence-leads-to-tsunami-of-medical-services-study-finds/?utm_campaign=KFF-2016-The-Latest&utm_source=hs_email&utm_medium=email&utm_content=32453515&_hsenc=p2ANqtz–R56ID_OnOVWjPZWVWUZ34PdboXT6Rx5x0F_qrHGLoAkd8YE0i7kZZ-AsE8M0F2vb5iMU58twYkIaV66wZWIWv_Q_BhN37G-VZ3Mc0ACGTbIhT8xQ&_hsmi=32453515

That’s the headline for a study that you – dear reader – need to read.

Here’s why – “Medical services for people with opioid dependence diagnoses skyrocketed more than 3,000 percent between 2007 and 2014.”

And that’s for privately insured people.  Based on research covering 150 million insureds, the report indicates the problem is particularly severe for younger men (19 – 35 year olds in particular).

We’ve all hypersensitive to the societal and personal cost of opioids, the Fair Health research is proof positive that the dollar cost of the drug itself is the least of the cost issues; dependency is strongly associated with much higher utilization of drug testing, overdose treatment, office visits and (my assumption) higher usage of other drugs intended to address side effects of opioids.

What does this mean for you?

Three thousand percent means you can’t afford to NOT address opioid addiction and dependency.

 

Aug
2

ACA – a little perspective on who’s going to win

Posted by Joe Paduda on Tuesday, August 2nd, 2016 | Comments

Premiums are SKYrocketing!

Deductibles are HUUUGE!

Insurers are DROPPING OUT!

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Can’t we all just chill for a minute?

Truth is, premiums in the individual marketplace today are lower than they were a couple years ago.

Yes, rates are going up, but the proposed rate increases are:

  • lower than historical trend rates
  • still to be approved by regulators
  • not as big a deal as one might think because consumers are shopping around and getting better deals
  • for plans that cover 17% more benefits than pre-ACA plans

To be fair, deductibles and coinsurance costs are much higher than pre-ACA, continuing a trend that’s been around for years.

My take is these economic cost control mechanisms are going to run their course, and we’ll see much more focus around care management and network management going forward.

That said, isn’t this EXACTLY what we were supposed to get from consumer-driven health care plans?  Insurers that are using economic levers to incent consumer behavior, narrowing networks to use buying power to get lower prices and focusing care management efforts on the 5% that generate 50% of costs will succeed, those that don’t understand this market or how to compete will fail.

What does this mean for you?

Expect health plans totally committed to the new health care market to win.  And that success will make them much tougher competitors in the group health market in years to come.

Watch out, Anthem, UHC, and Aetna

 

Aug
1

More insured via Exchanges is good news for Work Comp

Posted by Joe Paduda on Monday, August 1st, 2016 | Comments

People who obtained private health insurance coverage thru the Exchanges in 2014 were less healthy than those previously insured. A just-published article in HealthAffairs provides details on their medical issues and conditions, more on this below. [sub req]

That’s not surprising; prior to ACA, many individuals and families weren’t able to obtain coverage at a reasonable price, and some couldn’t get any coverage at any price, due to insurers underwriting practices.

Now that medical underwriting and pre-existing exclusions are outlawed, folks with health problems can get insurance.  Before we jump into the implications discussion, here’s the specifics.

among those with individual private coverage, the likelihood of reporting fair or poor health and the likelihood of being obese increased by 1.5 and 4.2 percentage points, respectively (Exhibit 1). We also found that the likelihood of having at least one of ten specific chronic conditions5 increased by 6.7 percentage points for this group—a change that was driven by increases in the likelihood of having hypertension (a 4.0-percentage-point increase) and diabetes (a 2.9-percentage-point increase)

The good news is many of these chronic conditions respond well to relatively inexpensive treatment, and the cost of caring for these individuals is much lower if they have access to good primary care.

For work comp payers, the good news is a bit less obvious – but it is good news – for two reasons.

First, in general the working population will be slightly healthier – because more workers will have insurance, and the least-healthy are more likely to be improving their health status. Thus if they do get injured, they will likely heal faster as their overall health status is better.

Second, work comp insurers won’t have to pay to treat their non-occ medical conditions, as the patients are more likely to have health insurance.