healthcare

RomneyCare begat Obamacare. We believe states are the best "test tubes" for anything proposed on a national level, so if you want to get an idea how something such as Obamacrap is going to play out over time, see how it has performed at the state level.             The folks at Kaiser Foundation have provided us with this nifty update on RomneyCare, 6 years later. Since 2006 the residents of Massachusetts have:

• 94% of their population covered by health insurance 
• Witnessed increased access to health care
• Failed to control health care spending 
• Per capita health care spending is 15% higher than the national average
• Health care spending AND health insurance premiums are HIGHER than any other state in the country

Medical loss ratio's as defined (dictated) under Obamacare were supposed to bring premiums down, saving taxpayers untold millions of dollars. As Henry recently pointed out, the average "rebate" to OH consumers is about $268 to individual consumers. And that is only for those who are entitled to a rebate.                 About 1 in 3 policyholders will get a rebate, the rest of you get a lump of coal. The folks at Kaiser Foundation calculate the average rebate at $39 so you folks in Ohio must be living right. Don't spend it all in one place. Currently the MLR (medical loss ratio) provisions of Obamacrap apply only to those with individual major medical or employer (fully insured) group health plans. But changes may be coming. (More on that in a future post). What impact has MLR had on health insurance premiums, and on health insurance in general?

• Premiums are still rising at the same or higher clip than before Obamacrap/MLR
• Carriers are reducing support staff and/or hiring cheap overseas call centers
• Longer processing times for new health insurance applications
• Longer processing times for health insurance claims
• Fewer carriers offering health insurance plans
• Fewer agents willing to offer health insurance products for their clients
• Agents that do still offer health insurance cannot afford to offer the same level of service as before
• More cost shifting to the consumer as carriers "gut" plans to produce lower premium choices

This is the transcript of my recent podcast interview with Castlight Health President John Driscoll.

David E. Williams: This is David Williams, co-founder of MedPharma Partners and author of the Health Business Blog. I’m speaking today with John Driscoll, who’s just been named president of Castlight Health.

John, thanks for being with me. Congratulations on your new role.

John Driscoll: I’m very excited. We’ve got some great things to do at Castlight. I’m very excited to be working with the team to make it happen.

Williams: How did you land at Castlight?

Driscoll: Gio Collela, the founder of Castlight, and I have been friendly for many years. Even before he started the company, we talked about the need to bring more transparency and the right information to consumers when they’re making decisions.

We brainstormed about how we could leverage the power of information related to the digital revolution to help perform health care in the right way. When he came up with the idea of Castlight I was fully supportive. Over the years, I’ve watched it grow.

While I was at Medco, we partnered with Castlight with a large employer. I was very impressed.

So, when I left Medco a few months ago, it was a natural extension of the ongoing conversation. He asked me to join and I was happy to accept.

Williams: What will your scope of responsibility be at Castlight?

Driscoll: I really look at it as a partner of Gio’s to help grow the company. Gio, (our CEO) and Randy Womack, (our COO) have built an incredible team of sales and marketing professionals, technologists, and health care experts. They are all working on how to deliver the right information to consumers at the right time so they can make smarter choices with their health care dollars.

It’s my job to work with them, to get the best out of the company, and to make sure we scale and grow and become even more relevant to more consumers across the country.

We couldn’t be aiming at a bigger problem, how to bring sane and sensible solutions and information to help consumers in health care. We need to make sure that we do grow and scale in such a way that we can leverage the power of the informed consumer to make the right decisions.

I really look at it as a partnership role in helping grow and take this company to achieve the kind of a national impact I believe it can.

Williams: You spent several years as an executive at Medco and before that, at Walker Digital, Oxford Health Plans and Oak Investment Partners. What will you bring from those experiences to Castlight?

Driscoll: Different things from different places. At Oxford we were involved in going through hypergrowth, in one of the most progressive health plans in the country in terms of bringing innovations to bear in the plan world. So I think I have a fair amount of sympathy and understanding to what you need to do to succeed and survive in the health plan world. And I think health plans are a critical partner in Castlight’s success.

From Walker Digital and Oak I bring an appreciation of the power of the digital revolution to take cost out and to allow you to use transparency to drive to better outcomes.

We’ve seen it in banking, we’ve seen it in airlines. There’s no reason why we can’t see the same kind of jumps in quality and reductions in cost. Things will differ in health care but the fact that they’ve been accomplished in other industries means that they are possible in many areas in health care.

At Medco I was responsible for growth outside the core, leveraging a lot of new opportunities. That included building Medicare Part D from employee number one to the largest, most successful Part D program in the country, to working in the software world developing a drug safety program in Sweden or helping drive e-prescribing.

I was involved in remarkable initiatives where we brought innovation to bear on problems and challenges for people who thought it could not be moved. We were effectively leveraging innovation as a PBM –where other people didn’t necessary expect to see it. There’s opportunity to innovate all throughout health care. That’s probably the biggest insight I bring from the PBM world.

What is also very relevant from the PBM world is how quickly and clearly people make decisions when you provide in information on cost and quality. The best examples is the higher use of generic drugs in the country. It’s been a huge boon for consumers, and the rise of the PBM industry has been a key enabler.

PBMs also reformed drug safety quite dramatically, by just leveraging information and wrapping software solutions around it to help the prescribers and doctors make smarter decisions. I’ve seen the impact that information can have in terms of improving outcomes and lowering cost.

Effectively that’s what we’re trying to accomplish at Castlight. We want to drive the kinds of reforms that leverage information about pricing, about quality, and about service to improve health care outcomes and reduce cost.

The opportunity is there. The information often isn’t. It’s our job to provide it.

Williams: Castlight has raised what seems like a very large pile of venture capital. Can you provide some insights into what you’ll do with so much money?

Driscoll: It’s a large amount of money relative to the size of the company we are today, but the capital provides the flexibility to scale appropriately to the size of the challenges we have in front of us.

Health care has systematically under invested in technology and software. One of the reasons why we feel like we need to raise a lot of capital is because there’s a lot of opportunity to invest in tools, technologies and services.

As customers are demanding those services, we needed the capital to scale with quality.

Williams: Everyone in health care and perhaps the society more broadly is keeping an eye on Washington, D.C. to see what happens with the Supreme Court with the fate of Obamacare and the election. These things will have big implications for health care.

To what degree is Castlight affected by what happens to Obamacare and what happens in the upcoming general election?

Driscoll: Shenever there’s a structural shift in health care, it will affect everyone.

But for what we want to do, which is to provide the right information in the right hands in the right way, to derive information that allows consumers and employers and payers to make better decisions at the point of care and the point of decision, that opportunity is going to exist under any legal or political change.

Over the last decade, we’ve seen a tremendous amount of the burden of pain for health care shifted from the employer to the individual. From both the employer and the plan, the information hasn’t always been available to help anyone make informed choices, particularly from a consumer perspective.

That increasing need for the consumer to have price and quality information is only going to grow and will not be affected by any legal or political changes.

Williams: I’ve been speaking today with John Driscoll, newly appointed president of Castlight Health.

John, thanks for your time.

Driscoll: Thank you, David.

 

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Medicare recently released the Medicare Spending per Beneficiary (MSPB) measure on Hospital Compare. This measure includes all payments to doctors, hospitals or other facilities for services provided to a patient during the three days before the hospital stay, during the stay, and during the 30 days after discharge from the hospital. Kaiser Health news provides an analysis of this measure and also provides an interactive graph of state level efficiency and a list of hospital MSPB scores.

The Kaiser Health News article notes that:

“Patients treated at most or all hospitals in Las Vegas, Fort Lauderdale, Newark, Miami, Los Angeles and Orange County, Calif., tended to cost more than the national median, which is $17,988. Patients treated at most or all hospitals in Anchorage, Des Moines, Honolulu, Minneapolis and Portland, Ore., tended to cost Medicare less.”

The article also recaps the opinions of a number of industry and policy thought leaders.

Jennifer Faerberg, director of health care affairs at the Association of American Medical Colleges stated that differences in the MSPB measure across hospitals is primary due to how well hospitals  can control post-acute costs.  This is generally true. The MSPB measure controls for the type of admission (i.e., MS-DRG) of the index admission.  Thus, differences in the MSPB measure are due principally to differences in post-acute spending and the frequency with which the patient is readmitted to the hospital within the 30 days after the initial hospitalization.

Some policy experts were critical of the MSPB measure:

Nancy Foster, a vice president at the American Hospital Association, said the data do not answer key questions: Did the patients that got more services fare better than others? Could the patients that cost Medicare less actually have benefitted from more care? ”What we don’t know is if those additional investments yield differences in outcomes,” Foster said.

Foster makes a good point; the MSPB measure should not be analyzed in isolation.  CMS does not only measures hospital efficiency, but also includes a number of hospital quality measures.

Elliott Fisher, one of the main researchers from the Dartmouth Atlas, questioned the practical usefulness of the new information.  “As a hospital administrator I would go, how does this help me?” he said. “We just don’t know whether a lot of specialists are running through the hospital doing everything they can to every patient who is horizontal, or whether they’re discharging every patient to a rehab facility. Those are two very different causes of high costs.”

However, CMS did distribute a “hospital specific report” that detailed where the average spending went (e.g., inpatient, skilled nursing facility, home health physician) in the periods before, during and after the index hospital admission.  Each of these quantities is compared to the state and national average spending levels for each type of service.

Disclaimer: The Healthcare Economist worked with CMS and a team at Acumen to develop the MSPB measure.

 

A study found a sharp increase in the disease's prevalence among teens, adding to worries that diabetes may progress more rapidly in children than in adults.

Two new studies have found that people with sleep apnea, a common disorder of sleep that causes snoring, fatigue and dangerous pauses in breathing at night, have a higher risk of cancer, the first time that sleep apnea has been linked to cancer in humans.

At the heart of the Affordable Care Act (ACA) health care reforms are the premium tax credits, which will extend health insurance coverage to 18 million lower and middle-income Americans.  The idea of using tax credits to purchase private health insurance for the uninsured is one of a number of the historically conservative policy positions [...]

There is one hospital in Kabul that treats anyone, from any side, no questions asked. The horrors of the war blow through its doors every day.

Robert Sturman, an artist from Santa Monica, Calif., has traveled around the world painting and photographing landscapes, musicians and athletes. But it is the study of yoga that has triggered one of the most creative periods of his career.

Shoppers at farmers' markets may come across green garlic, which has been harvested early, before the cloves have matured. The Recipes for Health columnist Martha Rose Shulman offers five new ways to cook with green garlic.

The Tea Party and its sympathizers have pushed ideological purity to an extreme in the Republican Party, especially the House. Last year’s willingness to trash the country’s credit rating rather than raise the debt ceiling was Exhibit A. Exhibit B may be a decision to oppose absolutely every aspect of the Affordable Care Act.

As Politico reports, a group of right-wingers are pushing Speaker John Boehner to reject so-called ObamaCare in its entirety, including popular provisions such as allowing parents to keep their kids on their insurance until age 26, prohibiting discrimination based on pre-existing conditions, and closing the Medicare drug benefit’s donut hole.

From a Tea Party standpoint, the Affordable Care Act must look like a Communist plot, but in fact it is a fairly moderate piece of legislation that excludes things like single-payer and even a government run insurance scheme.

So here’s an idea for Democrats: propose all sorts of measures, especially those that Republicans have traditionally agreed with. Since there’s such a strong knee jerk response to any Democrat’s ideas, it seems like a pretty good way to paint the GOP into a corner. Bill Clinton actually did a version of this, taking credit for arguably Republican ideas such as welfare reform. (He balanced the budget, too.)

With the way the Tea Party has set itself up, Obama doesn’t need to be nearly so clever as Clinton. He just has to propose a set of right-of-center ideas and see the GOP marginalize itself over the next few years.

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On May 9th, William Nickerson, Senior Judge in the Southern Maryland Federal District Court, issued a 15 page ruling against the six Augusta, GA primary care physician plaintiffs who challenged HHS’ and CMS’ longstanding relationship with the American Medical Association’s Relative Value Scale Update Committee (RUC). The opinion did not weigh the substance of the [...]

In a few hours, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius will address a keynote speech to graduates at Georgetown University.  This is a controversial appearance.  One provision of the health of the Health Reform (i.e., the ACA) mandates that employer cover contraception coverage.  Although Georgetown University has agreed to provide these benefits, other religious institutions (e.g., Catholic hospitals) argue that this mandate impinges on their religious freedom.

Should the government mandate coverage of contraception?  Today, the Healthcare Economist provides multiple views.

Those who support the contraception coverage mandate.  Why should your job determine your health benefits?  Shouldn’t all individuals have access to a minimum level of healthcare regardless of their employer.  Although Catholic hospitals have argued that mandating contraception coverage impinges on their religious freedom, but not covering contraception the religious views of the employer are hoisted on their employees.

Those who do not support the contraception coverage mandate.  Why should the government tell employers what services to cover?  Even more importantly, why should the government tell employers to covers services against which the employer has religious objections.  Of course, it may seem ‘unfair’ that employees who want to use contraception do not receive coverage.  However, these employees are free to work for other firms.  Further, these employees are not barred from purchasing the contraception.

The policy wonk.  This argument can also be seen as a part of a larger debate about mandated benefits.  Mandated benefits may improve outcomes by facilitating access to care. Further, it may help consumers compare health plans since all plans would be required to offer a minimum benefit level.  The key drawback of having a minimum benefits package is the expense.  Covering more service is expensive. It is not only expensive to provide the services, but is also administratively expensive.  For instance, if the government mandates coverage for cancer treatment, a plan must specify which specific types cancer drugs and procedures are covered.  Over time, provider special interest interest group will lobby to have their (profitable) services included in the mandated benefits package.  Thus, although mandated benefits may improve access to care in the short-run, in the long-run it will be difficult to maintain a mandated benefit package that does not lead to significant increased growth rates in health care costs.

 

Health care reform will result in lower health insurance rates, up to 60% lower than current rates. Yes, health care reform seems to be working . . . for those who live in Maine.     Falling health insurance rates due to health care reform is the lead in of a post at The Maine Wire.

PL 90, the free market based health reform law, was passed last March by a Republican majority in Maine’s legislature. Governor Paul LePage signed the bill in a ceremony at the statehouse amid cries from Democrats that it wasn’t right for Maine.

Well that's a twist.
Republican health care reform but Democrat's protest the move.
The law has resulted in a drop in rates for small group plans but individual rates are expected to drop as much as 60% . . . for some age groups . . .
Maine has two provisions on the books that make health insurance premiums unaffordable for most folks. Community rating and guaranteed issue, two things that are cornerstones of Obamacare, drive premium rates through the roof.
Community rating means essentially everyone pays the same rate, regardless of age or gender. Guaranteed issue means anyone can buy coverage, regardless of their health or existing medical conditions.
In the parlance of Obamacrap, "Insurance companies can no longer discriminate against you because you have a pre-existing condition".
The flip side of that argument is, "Insurance companies will be allowed to charge significantly higher premiums to those who are healthy to pay for the claims of those who have expensive medical conditions".
That is analogous to auto insurance carriers charging drivers with perfect records the same rate as one who has had multiple DUI's and speeding violations. Or banks imposing much higher interest rates to the most creditworthy so they can also extend credit to those with severely damaged credit.

PL 90, the health reform law that Republicans guided through the legislature despite passionate opposition from Democrats, expanded the “rate bands” to allow a wider variation in cost between different aged applicants. In the past, insurance companies had to treat a 21-year-old and 55-year-old as basically the same. The new law allows for distinction in age groups. 

Once the new rates are approved, a 21 year old will pay $215 per month for a plan with a $2,000 deductible. Before health care reform, that person would pay $448 per month.
The rates are still high, mostly because the guaranteed issue provisions remain in play, but are much more affordable. A healthy 21 year old in Atlanta, Georgia could buy a comparable plan from Cigna for $98 per month.
So the Obamacrap-like guaranteed issue provisions mean healthy people will still pay double the normal premium so everyone can have health insurance.
Seems fair, right?

“Getting more young people into the market is a major plus for all Mainers and was a primary goal of the law,” Allumbaugh notes. “As this happens, the claims experience tends to improve and it can lower the rates even further for all age groups,” Allumbaugh said.“This is precisely the impact the health reform law aimed for, lowering rates generally, but in a way that helps our insurance markets reverse the death spiral and begin to grow.”

Death spiral. Now that's a word you don't hear every day.
Hyper-regulation by the Maine Department of Insurance has resulted in most health insurance carriers leaving the state. Anthem Blue Cross controls most of the health insurance market in Maine. Less competition, higher rates.
The same thing we will have in 2014 when Obamacrap is in play.
How is this health care reform idea working for you?
About as well as hope and change.

There is an urgent need for rigorous data to strengthen the evidence base of the medical home model. In an effort to harness and share lessons from the many disparate medical home pilots and evaluations under way, The Commonwealth Fund established the Patient-Centered Medical Home Evaluators’ Collaborative in 2009.

In honor of National Women’s Health Week, U.S. Senators Tom Carper (D-Del.), Thad Cochran (R-Miss.), Mary Landrieu (D-La.), and Kelly Ayotte (R-N.H.) hosted a briefing on the text4baby program today.

What is Text4Baby?

Text4Baby is a free national health texting service that promote senrollment in both Medicaid and the Children’s Health Insurance Program (CHIP) and provide pregnant women and new mothers free text messages on important health care issues.

One question is who would sign up for Text4Baby?  There are abundant resources available on the internet giving tips for pre-natal care and childrearing.  Why does the government need to create a text service offering parenting advice?  This initiative could be useful for individuals without internet access or limited internet access (e.g., only at work and/or at a library).  However, one would think that private companies could also provide a similar service.  Since new mothers often a desirable demographic for advertisers, one would think that health tips sponsored by companies would readily be financially sustainable.  Thus, it seems that the government would have a limited role here.

However, Text4baby is the largest mobile health initiative in the country and in just over two years has enrolled over 345,000 individuals in the service.  Why have so many people enrolled?

One reason is that individuals may trust the government more than other sources.  More relevant may be that individuals can sign up for CHIP and Medicaid through the Text4baby system.  Any program that can simplify the enrollment process for Medicaid and CHIP likely is in high demand.

Thus, is the demand for Text4baby due to the medical advice it offers or due to the fact that it facilitates enrollment in public health insurance programs?  I would bet the latter.

If the thought of yoga doesn’t bring to mind long-haired, half-naked gurus in India, it probably makes you think of thin young people in pretzel poses. True that, but it’s also become popular among populations that you might not expect. Yoga increasingly is being incorporated into treatment programs for young people who may be too thin or too fat – adolescents with eating disorders.

Dr. Cora C. Breuner helped conduct a study of 50 girls and 4 boys with diagnosed eating disorders that randomized them to treatment with standard care (every-other-week appointments with physicians or dieticians) or standard care plus individualized yoga for 12 weeks. The yoga group showed significantly reduced food preoccupation immediately after each yoga session and significantly decreased Eating Disorder Examination scores at 12 weeks (J. Adolesc. Health;2010;46:346-51).

Speaking at the annual meeting of the North Pacific Pediatric Society, she gave a brief update: the teens in the yoga group showed greater improvements in weight a year after the study ended compared with the control group.

“Pretty much every eating disorders unit in the country now has yoga,” said Dr. Breuner, professor of pediatrics at the University of Washington, Seattle.

I don’t know about every eating disorders program, but a quick look on the Web found plenty that include yoga and lots of independent yoga classes geared toward people with eating disorders. On this list of eating disorder treatment programs from EDreferral.com, for example, yoga is mentioned by nine facilities in California and one each in Arizona, Hawaii, Mississippi, New Jersey, Pennsylvania, Tennessee, and Virginia. I found others online in Michigan and Washington too with just a few clicks.

Dr. Breuner’s 2010 study isn’t the only one endorsing yoga for eating disorders. Here’s another (Psychology of Women Quarterly 2005;29:207-19). Columbia University reported on this trend in 2007. And the Wall Street Journal reported in 2011 on increasing use of yoga not only for kids with disorders but for healthy students, under the clever headline, “Namaste. Now Nap Time.”

Some of the key goals of yoga are to strengthen the mind and body and the connection between the two. It’s not a solo treatment for eating disorders, but supplements the standard strategies of weight stabilization, nutrition therapy, cognitive behavioral therapy, and family-based therapy.

That last one is another big change in the field that has happened since Stanford University researchers began showing in 2007 that it’s very helpful in treating children and adolescents to use parents as agents for positive change in a non-judgmental manner.

“Now, we bring parents in right away to help with refeeding the child,” Dr. Breuner said.

It’s only a matter of time, I suspect, until we see special yoga classes for parents of children with eating disorders.

–Sherry Boschert (on Twitter @sherryboschert)

Filed under: Alternative and Complementary Medicine, Family Medicine, Internal Medicine, Pediatrics, Uncategorized Tagged: anorexia, bulimia, cora breuner, eating disorders, North Pacific Pediatric Society, Sherry Boschert, yoga