Insight, analysis & opinion from Joe Paduda

Dec
2

Concentra’s future

Concentra’s naming of Norm Payson MD as the company’s new “non-executive” chairman of the board appears to be yet another sign that Concentra is positioning itself for sale or IPO. Long rumored to be preparing to go public, Concentra may be closer now than at any time in the past few years.
Payson got his start in managed care at HealthSource in New Hampshire 20 years ago. He and others built that HMO from the ground up and sold it to CIGNA in 1997. He then joined Oxford in 1998, was there through the turnaround and left it in excellent condition in 2002.
Payson’s role appears to be “non-operational” to say the least; he will be working on strategy issues, providing guidance to senior management, etc. He will be making an investment of $10 million in the firm; before you jump to conclusions, understand that Payson will also be receiving “awards of restricted and unrestricted stock and options


Dec
2

California’s health insurance market

The California HealthCare Foundation has released two excellent reports examining individual health insurance and employer-based health insurance in California, comparing costs and access to other states, and assessing how employers and individuals make decisions regarding insurance.
The reports, part of the ongoing research of the Foundation, were based on work done by the Center for the Study of Health System Change, a D.C.-based organization known for its excellent work at the national level.
Highlights (term loosely applied) include:
premium increases doubled the overall inflation rate, with the latest figures at 8.2% compared to a 3.9% overall inflation rate in CA
monthly premiums averaged $858 for families and $321 for individuals
PPOs cost more in California than the national average, with HMO pricing lower
–70% of large employers are likely to raise employee contributions in 2006
–providing more and better access to information about individual health plans can have just as much impact as subsidizing premiums.


Nov
30

Covering the uninsured – research results

Research by the California Health Care Foundation on potential strategies for covering the uninsured indicates that employer-sponsored plans and insurance pools don’t hold much promise. Two studies published by the Foundation provide details; both are worth reviewing.
The employer study looked at a multi-year experiment in San Diego wherein smaller employers’ health insurance plans were subsidized in an effort to encourage the employers to offer coverage. It turns out that many employers already offered insurance while those that did not were not often swayed by the subsidy. And, less than one-fifth of the state’s uninsureds were full time employees or dependents of full time employees.
The evaluation of health insurance pools is somewhat more promising. The net is these require extensive planning, careful implementation, and thorough management if they are to be effective. In addition, market considerations such as competitive plans, the cohesiveness of pool members, and demographics have considerable impact.
The net – creating a successful pool is a time-consuming, detail-intensive effort.
What does this mean for you?
While the studies are not exactly encouraging, at least we have a better grasp of the challenges associated with these two popular ideas. Perhaps we are getting closer to understanding what might work to improve coverage.


Nov
28

Greenberg will not be charged with crime

Hank Greenberg, ex Chairman of AIG, has escaped criminal charges at least for now. A spokesman for Eliott Spitzer, NY Attorney General, announced that while civil charges may be pending, no criminal charges will be filed by the state.
However, Mr, Greenberg is not yet out of the woods. According to Insurance Journal, there are two federal investigations still in process, with the potential for federal charge. And, Spitzer is likely to add charges to his civil complaint in the near future.
Spitzer’s and other state attorneys’ probes of the insurance industry has already resulted in criminal charges filed against over a dozen individuals, hundreds of millions in fines and settlements, and a dramatic reshaping of several venerable firms including Marsh and AIG.
What does this mean for you?
Even though we didn’t need any more proof, more evidence that crime, or the appearance of crime, does not pay.


Nov
27

National health policy – coming closer

In yet another sign that health care, national health policy (or the lack thereof), and the impact of same on the US economy (free subscription required) is fast becoming a national crisis, Paul Krugman has published an editorial linking GM’s incredibly high health care tab to its recent financial problems, and using GM’s troubles to highlight the impact health care costs have on other manufacturers.
I’d extend that to any employer that provides health insurance for its workers. I was speaking with a senior partner at a large Florida law firm at the Florida Workers Compensation Conference in August about just this issue. The gentleman, a self-described conservative, was reflecting on the costs of health insurance, and the problems firms such as his encountered in obtaining and funding coverage. We had just heard a talk by former HHS Secretary Donna Shalala in which she made a case for national health insurance.
This gentleman, no fan of Shalala or governmental solutions in general, was acknowledging that the present health care “system” was not serving his firm or its employees very well, was costing a huge amount of money, and there did not appear to be any promising solutions in sight. We discussed the unseen costs of health insurance – higher costs prevented them from hiring a new associate, opening a new office, or adding a new document management system. By the end of the conversation, I sensed a willingness to relook at health care and health insurance, to consider it as not a governmental hand-out or employee benefit, but rather as a drag on his firm’s effectiveness.
The more this happens, the closer we get to a solution.
What does this mean for you?
My guess is we will have some form of consensus on national health policy, perhaps with universal coverage, within five years.


Nov
27

AMA’s protest of UHG-Pacificare merger

The proposed merger between United HealthGroup and Pacificare is running into objections from consumer groups and other advocacy organizations in several states. Most recently, the AMA’s Colorado branch protested the bonuses and other financial rewards that would accrue to Pacificare executives if the merger is consummated.
The total amount of the bonuses is around $315 million; the AMA appears to be as concerned, if not more so, about the threat to competition in Colorado should the merger proceed.
From the AMA’s side, it is easy to see why they are concerned. Eliminating payers increases the market power of the payers remaining. And the more market power the payer has, the more vulnerable the provider is.
More consolidation is a natural consequence of the industry maturing; that doesn’t mean the various constituencies are going to like it.


Nov
23

State initiatives for child health insurance

Two states’ child health insurance initiatives (free subscription required) show different approaches to the same problem; providing access to health care for the nation’s kids. South Carolina is adopting a scheme based on private insurers while Illinois is pursuing a plan based on public funding and management of the program.
And these are not the only states experimenting with different approaches: California activists are hoping to get an initiative on the ballot next November that would fund child health insurance through a higher tax on cigarettes; New Mexico’s Governor will propose universal health insurance for kids under 5 in his next budget; and Florida has already received approval for the privatization of much of Medicaid.
While Washington dithers over very minor changes to Medicare and Medicaid, the states are once again the laboratories for innovative ideas. These ideas can be differentiated into two broad categories; defined benefit and defined contribution.
The defined benefit programs are those that pay for any care that is consistent with the benefits outlined in the Medicare or Medicaid programs. Defined contribution plans are entirely different – they pay a set amount of money to a program state, or beneficiary that the program, state or beneficiary must use to cover as much of their care as possible.
The ideological distinction here is obvious – have the state responsible for funding the care that is needed v. make private enterprise, the insurance program, and/or the individual responsible for figuring out how much care they need.
With the present regime in Washington, expect the Feds to promote more of the defined benefit programs, and more privatization in the next two years.
While I am all for innovation, remember that administrative costs associated with private health insurance are several times higher than the costs of programs run by the government. The question remaining to be answered is “can the innovations and creativity of private firms deliver better results in terms of lower health care costs and healthier people despite their higher administrative expenses?”
Thanks to Tom Barrett of Choice Medical Management for the reference.


Nov
21

Uninsurance in Rhode Island

A quarter of employers in Rhode Island do not offer health insurance, and over half of employers said health care costs are driving down profits.
A survey by the State’s Insurance Commissioner covered 1444 employers in the state and focused on the availability of health insurance, employee adoption rates, premium increases, and the wage status of the employees.
Here are a few of the more salient results.
1. 20% of employers saw health insurance costs increase more than 25% this year
2. Almost half of the employers experienced increases above 20%
3. 71% of “low wage” employers offer health insurance; 99% of other employers do (Low wage employers are those who pay more than half their employees less than $21,000 annually)
4. Six years ago, 61% of employers paid the full cost of insurance; 21% do now.5. 20% of employers offer only high-deductible plans with deductibles above $1000
But the real impact of rising health insurance costs is seen in the rapid rise in the number of people without health insurance. According to Insurance Journal, (the report) “also shows the proportion of the state’s population without health insurance rose from 6.2 percent to 11.4 percent, between 2000 and 2004.
Clearly, the nation’s smallest state’s experience is similar to the rest of the country. Rising health insurance rates are decreasing access to health care, especially for the lower economic classes.
What does this mean for you?
Another straw added to the load on the camel’s back.


Nov
21

Revolution Health and Kaiser Permanente

I’ve been keeping my eye on Revolution Health since its founding earlier this year, and the item posted last week about Kaiser’s work on electronic health records reminded me to check back on Revolution’s progress. Why the focus on Revolution? There are other consumer-directed health plan firms out there, why them specifically?
First, they seem to have the cash. Steve Case’s investment firm, Revolution, has a half billion dollars to invest. It’s very important to understand that not all of this will go to Revolution Health; to date. Of note, Revolution has also invested in two “lifestyle resort firms”, the car-sharing service FlexCar, and other firms in the “life in balance” space.
Second, they have the attention of the media and investment community.
Where is Revolution Health (RH) today? Revolution is framing their business as focusing on three areas; coverage, content, and care. They have acquired several web-based and other companies that have some level of expertise or experience in each of these areas. As noted here previously, none of them is even close to dominant in their specific space. Notably, there are no components that are specifically health care management, managed care, or provider network management firms or have significant capabilities or experience in these areas.
The company appears to be in the process of merging its acquisitions, building the marketing image and message, and possibly looking for new acquisitions.
The only member of Revolution Health’s operating committee with extensive experience in the health insurance/managed care business is Bryce Williams, who worked at eHealth, the parent company of eHealthInsurance as their head of marketing and business development.
Why the comparison to Kaiser? Kaiser is at the opposite end of the spectrum; a company (Kaiser Permanente is actually two entities; Kaiser owns the facilities and administrative end of things, while all the physicians belong to the Permanente Medical Group; technically KP is a large group practice HMO


Joe Paduda is the principal of Health Strategy Associates

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