Oct
18

Halloween HealthWonkReview!

Okay, I’m a bit early on the pumpkin-and-costume thing, but time is going by so damn fast I want to be early for once.

It’s also open enrollment time! that joyful event where we all get completely confused, baffled beyond belief, our minds all-a-boggled by all the tiny print on the screen describing in excruciatingly minute detail really important nuances in health benefit design that, if we ignore, will cause us to go bankrupt and die. Fear Not – Louise is here in her SuperWoman costume, typing madly away to bring you all you need to know about individual market enrollment – and in English too!

There’s been a lot of chatter about simplifying all this stuff, with much of it about Medicare for All. My contribution this week unpacks the argument that MFA would somehow harm Medicare. Hint – MFA is not the boogyman it’s made out to be.

Andrew Sprung’s found out that Bob Hugin, Republican candidate for the Senate seat held by Bob Menendez in NJ may well be hiding his real views on healthcare – but no one is asking. Andrew’s not afraid to ask…What’s behind the curtain, Mr Hugin?

Hank Stern over at Insureblog.net doesn’t like the HMO-only plans offered to his clients in the Buckeye State; Hank sees the evil hand of Obamacare at work, limiting his clients’ choices.

Our favorite healthcare economist, Jason Shafrin, has been looking into the costs of mental health that go beyond medical care. He’s also done a lot of research into medication adherence. And I can’t find any meme that works for this entry…darn it.

 

If you don a nursing costume, you may need to add a back brace. Nursing assistants get more back injuries than any other occupation. That’s the scary news from Tom Lynch at Workers’ Comp Insider.

The estimable David Williams is on a search to uncover a deep mystery – what happened to “Consumer Directed Health Plans”??? Join David as  he finds this to be a conundrum wrapped in an enigma; were they ever REALLY “consumer” directed?

Leaving my poor attempts at humor behind, Ranit Mishori MD MHS asks some very pointed questions about political determinants of health, determinants such as the for-profit motive and prioritizing religious beliefs over science.

Out long-term colleague Roy Poses MD FACP has been focusing on this as long as HWR has been around (15 years and counting). Roy’s learned big health care corporations, particularly pharma, biotech, device, and health insurance companies, provide significant sources of funding to dark money organizations.  It appears nearly all such money from health care organizations supports right- wing/ Republican/ pro-President Trump activities.

What happened to putting patients above all?

Thanks for reading, and thanks for writing contributors!


Aug
27

Asbestos, short term health plans, and drug price wars

Thanks to Julie Ferguson of Workers’ Comp Insider for hosting this month’s Health Wonk Review…

If you want to learn a bit about:

  • those short term health plans touted by the Trump Administration,
  • what’s up with the drug price wars (in a great video, no less),
  • how asbestos is working its way back into US manufacturing,
  • and a bunch of other “wow, I didn’t know that!”

read on!

 


Jan
17

Ring in the New year with the latest and greatest…

Blog posts!

Health Wonk Review returns to the inter-webs after a holiday hiatus. Refreshed, renewed, and revitalized, we bring you the best from the brightest!

Drug costs 

Typically, we think that drug co-payments as affecting patient payments.  However, cost sharing can also affect the price drug companies charge for their goods.  The Healthcare Economist examines a case study in Germany to see how changes in cost sharing have affected drug prices.  

Adam Fein’s entry reveals a scary new cost shift; “plan sponsors—employers and health plans—will save big money because accumulators shift a majority of drug costs to patients and manufacturers.” 

ACA and related matters

Enrollment figures are almost final, and no one has a better grasp on the data than Charles Gaba.  HealthCare.Gov ended up exactly 5% behind last year( which in turn was 5.3% short of the previous year) State enrollments were also about 5 points lower. Considering the shortened deadline, lack of outreach/advertising and so on, this is actually pretty damned good all things considered.

From HealthAffairs blog, a post discussing how state-based strategies may help protect against the instability that the federal mandate repeal could introduce to health insurance markets.

Louise Norris looks at the impact of the Affordable Care Act’s medical loss ratio provision and explains how the “80/20 Rule” works, noting that it’s forced health carriers to devote more premium dollars to care and required them to send more than $3.24 billion in rebates to plan members when they haven’t.

We’ve got another timely post from Louise on the potential impact of expanded association health plans, including a summary of the current regulations and how they could change with expanded AHPs:

The impact will vary depending on what type of coverage people have now, but there are certainly concerns that the ACA-compliant individual or small group markets could face adverse selection in some areas of the country if AHPs expand significantly. There are also concerns that people might switch to AHP coverage and then find out that the coverage isn’t as good. 

InsureBlog’s Patrick Paule explains why the ACA’s Health Insurance Tax keeps bumping up insurance prices, including employer plans and even Medicare Advantage plans.

Workers’ Comp

At Workers‘ Comp Insider, Julie Ferguson takes a look back and a look ahead at the workers comp landscape in a substantial wrap-up of news that shaped the prior year and trends that we can expect in the year ahead.

The Pump Handle’s entry dives into a new report by the National Academies, noting that the occupational health surveillance systems in place today “have generally not evolved to address the changing nature of work.” The authors refer to non-standard work arrangements, such as through temp agencies, “on-demand” or the “gig” economy to make their point.

Interesting posts you can’t find anywhere else

In David Williams’ podcast, Vericred CEO Mike Levin describes the company’s role as a clearinghouse for health plan information on provider networks, benefit design, rates and drug formularies. 

Roy Poses has long been discussing how corruption – particularly of top health care leadership – causes health care dysfunction.  Yet now there is good evidence that the top level of US government, the presidency, has been corrupted.  A Sunlight Foundation webpage catalogs hundreds of instances of conflicts of interest and corruption affecting the president and his family.   So far, there have been no congressional investigations of this corruption, much less congressional action to combat it.  Dr Poses asks “how can we challenge health care corruption under a corrupt regime?  I now submit that doing so first requires excising the corruption at the heart of American government.”

My contribution is a brief descriptor of the change I see coming in the US health care “system”, change that will be massive, disruptive, and desperately needed.

 

 


Aug
17

Don’t miss this HWR

This month’s Health Wonk Review provides great insight into where healthcare is headed – and what we need to watch for.  Thanks to Health System Ed’s Peggy Salvatore for mining the best of the blogosphere.

A couple of don’t miss posts:

Who Really Needs the Public Option? Trump Country, Trump Country is most in need of a way to bypass the ACA marketplaces entirely. Democrats’ favorite policy option – the public option – would be most valuable in precisely the deep-red areas that went most fervently for Republicans and the President.  Get it all here.

And friend and colleague Tom Lynch focuses on workers’ compensation cost control has focused mainly on lowering medical costs, which is almost always an outsourced function. Consequently, many employers have relinquished control over their workers’ comp program, migrating away from best practices that are at the heart of true workers comp cost control. Read the full blog here.


Jun
26

Health Wonk Review update

Friday I inadvertently left out two excellent posts from long time contributors Hank Stern and Roy Poses Md PhD.

My apologies to these gentlemen, and here’s a very brief UPDATE – with their contributions.

Hank Stern, contributed a post about the Defense Base Act, and a contractor’s…challenges when encountering the Act…DBA is kinda like workers comp without the unlimited benefits…and this poor soul suffered mightily.  Hank delves into the details as to how this could happen.  The brief answer – all too easily.

Healthcare in the occupational arena is often the  forgotten red-headed stepchild of the healthcare world, yet it is a significant issue for both the workers who sustain what can be life altering workplace injuries and employers who bear the full cost burden for medical care and wage replacement. At Workers’ Comp Insider, Tom Lynch offers a primer of best practices in his Eight Steps To Controlling Workers’ Compensation Costs part 1, part 2 and part 3.

Roy Poses provided a different perspective on health care, asking why people with no healthcare background are running health care delivery organizations.  

from Roy’s post…

I believe that managerialism in a health care context (leadership of health care organizations by people with only management training, and without any knowledge, understanding or experience in health care, based only on management dogma) is one of the major causes of health care dysfunction. Here is a great example of a managerialist hospital CEO who also seemed to demonstrate the Dunning-Kruger effect, that people who lack ability are likely unaware of this lack…To belabor the obvious, true health care reform requires health care leadership that understands health care and upholds its professional values.

An interesting post to juxtapose comes fromJason Shafrin, who asks “Does more spending improve outcomes?” 

number of studies have claimed that increasing health expenditures may result in no better, or even worse patient outcomes.  The Healthcare Economist revisits the topic looking at the case of neonatal ward spending and patient outcomes in the UK.


Jun
23

HWR – The double edition

You get more for your money this fortnight!

The Senate Republicans’ release of their repeal-and-replace bill – plus our usual plethora of wisdom from health care experts, gives you a double-value today – the first in the history of HealthWonkReview!

Part One – Repeal-and-Replace

Let’s be real – Republican Senators’ bill is NOT an ACA replacement, rather it is best understood as a major reduction in Medicaid. For some, that’s all to the good; for others, not so much.

Here’s what you need to know.

(note I looked for other blog posts supporting the Senate bill – if you read any good ones please send them to me)

From Forbes, Avik Roy says

“the Senate bill will have far-reaching effects on American health care: for the better….if you simply kept [some tax credits from the House bill] in force, and tossed overboard the Paul Ryan flat tax credit, you’d solve all of these problems with the House bill. By making that change, the near-elderly working poor would be able to afford coverage, and the poverty trap would be eliminated. [emphasis added]

I wholeheartedly disagree with Roy’s premise. logic, and selective use of data to support his contention. He just doesn’t understand healthcare and the delivery thereof. His contention that eliminating coverage for 20 million Americans is “for the better” is patently absurd.

Andrew Sprung at xpostfactoid cut to the chase – his takeaway is the bill trades Medicaid coverage for high deductible private market coverage.  Andrew quotes Louisiana Republican Senator Cassidy…but notes Cassidy’s sentiment is misleading at best.

Right now, [low income people] might have a $6,000 deductible, which for someone who makes 150 percent of the federal poverty line might as well be $6 million. 

Sprung…

It’s true, as Cassidy avers, that an enrollee with an income of 150% FPL [federal poverty level] might have a $6,000 deductible, but most don’t…In any case, “most of those 20 million” who newly gained coverage did so through the Medicaid expansion and have zero deductible.

Ezra Klein made a similar point even more economically at Vox – “The Senate GOP health bill in one sentence: poor people pay more for worse insurance.”

Margot Sanger-Katz’ New York Times piece entitled G.O.P. Health Plan Is Really a Rollback of Medicaid reminds us of Kaiser Family Foundation reporting that Medicaid covers :

  • 20% of all Americans
  • almost half of all births, and
  • two-thirds of nursing home residents.

David Williams pushes things a bit further with his post, asking if we should consider Medicaid for all. David uses Nevada as a “template” for his assessment of the potential that  when – my words not his – the GOP destroys ACA – there will be an open revolt and we’ll end up with single payer – using Medicaid. 

Compelling case…

Timothy Jost and Sara Rosenbaum on Health Affairs Blog give us “Unpacking The Senate’s Take On ACA Repeal And Replace“; here are a few key quotes…

  • the Senate bill…entirely strikes the House bill and adopts a new bill with a new title.
  • the Senate bill is focused on changes to the Medicaid program.
  • parts of the Senate draft will be challenged under the Byrd rule. (they violate rules allowing passage without 60 votes)
  • the Senate bill would replace the House’s age-based premium tax credits (APTC) with tax credits based on age, income, and the actual cost of health insurance in particular markets.

Wrapping up our Medicaid – ACA – BCRA discussion, AHCA’s unkindest cuts is from healthinsurance.org; The premise:

The attention various AHCA provisions get is inversely proportionate to the damage they’ll do. and that the bill — and its likely Senate counterpart — should properly be called the Medicaid Dismemberment Act.

Nate Silver opines on the likelihood of BCRA’s passage – his considered opinion is: 

I’d guard both against interpretation that the bill will necessarily pass the Senate because it passed the House. At the same time, Ryan and House Republicans overcame some of the same obstacles — and if that precedent isn’t dispositive, it’s at least highly relevant.

Part Two –

UPDATE – apologies to Hank Stern, who contributed a post about the Defense Base Act, and a contractor’s…challenges when encountering the Act…DBA is kinda like workers comp without the unlimited benefits…

Healthcare in the occupational arena is often the  forgotten red-headed stepchild of the healthcare world, yet it is a significant issue for both the workers who sustain what can be life altering workplace injuries and employers who bear the full cost burden for medical care and wage replacement. At Workers’ Comp Insider, Tom Lynch offers a primer of best practices in his Eight Steps To Controlling Workers’ Compensation Costs part 1, part 2 and part 3.

Roy Poses provided a different perspective on health care, asking why people with no healthcare background are running health care delivery organizations.  

from Roy’s post…

I believe that managerialism in a health care context (leadership of health care organizations by people with only management training, and without any knowledge, understanding or experience in health care, based only on management dogma) is one of the major causes of health care dysfunction. Here is a great example of a managerialist hospital CEO who also seemed to demonstrate the Dunning-Kruger effect, that people who lack ability are likely unaware of this lack…To belabor the obvious, true health care reform requires health care leadership that understands health care and upholds its professional values.

An interesting post to juxtapose comes fromJason Shafrin, who asks “Does more spending improve outcomes?” 

number of studies have claimed that increasing health expenditures may result in no better, or even worse patient outcomes.  The Healthcare Economist revisits the topic looking at the case of neonatal ward spending and patient outcomes in the UK.

Are the exchanges failing? well, depends on who you ask…

Louise Norris has become one of the nation’s leading experts on ACA and exchange matters; she tells us Nevada has a unique approach to their MCO contracts, and the result is that all of their current exchange insurers filed plans for 2018, and two new insurers have also filed QHPs to be sold on the exchange in the fall.

Health Access California’s reports that while Congress considers cuts and caps to Medicaid, California is showing a stark contrast in investing in this core health care program, restoring benefits like dental and vision, and using tobacco tax money to increase provider rates.

CMS Meaningful Use Payments to Providers: Incentives or Sophie’s Choice?is what I love about HWR; really smart, intelligent, deep thinking about what really drives healthcare.

For healthcare providers who are caught in the Meaningful Use regulatory net by participating in the program, they were given a choice between installing an electronic health record system, attesting to meeting a list of nearly-impossible targets to get reimbursement for their multi-million dollar investments, or choosing not to participate which resulted in losing participation in government-funded programs and incentives. Most providers bit. They had no choice. And when it came time to collect the Meaningful Use incentive dollars, they attested to meeting at least the minimum requirements. Now, the government has bitten back asking for repayments of $729 million.

This is Neil Versel’s obituary of Larry Weed, who invented the problem-oriented medical record and the SOAP note, and had been advocating for the computerization of medicine and the inclusion of patients for at least 60 years. One of the leading change agents in healthcare, and one we would do well to think about as we try to drive change

Adam Fein’s entry focuses on the wonders of charity care, and providers thereof.  I did not know that “Pharmaceutical Manufacturers Operate the Biggest U.S. Charities…”

Dr Fein’s post says in part:

growth [of Patient Assistance Programs] is linked to pharmacy benefit designs that shift prescription costs to patients. Many insured patients face economically-debilitating coinsurance—in some cases with no limit on out-of-pocket expenses. The programs are an imperfect, but necessary, fix to our imperfect drug channel system.

Finally, I wondered why the Senate Republicans were so secretive about their healthcare bill, and now we know.

From HealthAffairs blog, a trenchant piece reflecting on the ways the AHCA would harm efforts to address the opioid crisis includes this

Because of the ACA, an estimated 26 million people have health coverage through the marketplaces or Medicaid that includes substance use disorder (SUD) treatment and prevention…Repealing the ACA will remove coverage for SUD treatment and prevention from millions of Americans, leaving a gap in care when it is most needed.

Whew…

Thanks for reading, and hope your weekend is splendiferous!


Mar
23

What you need to know about AHCA today

Is here at HealthWonkReview thanks to the estimable Louise Norris.  She’s picked the most insightful posts from around the web-o-sphere so you don’t have to.

One must-see – Charles Gaba’s analysis of the impact of ACA repeal on Congressional Districts…

Here’s his summary of my home state:


Feb
23

HWR on ACA

The real experts opine on what’s going to happen with ACA – all collected in one place for your reading enjoyment.

Kudos to David Williams for hosting this fortnight’s edition; among the posts worth your consideration are:

As Julie would say, “Quelle Surprise!”