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Archive for February, 2013

California coalition’s report calls for overhaul to rein in health care costs – Health and Medicine – The Sacramento Bee

February 26, 2013 Leave a comment

Simply put, participants said Californians should “collectively” create a health culture.

A critical part of this involves creating environments where people are eating healthier foods in smaller portions and getting exercise, especially walking.

“We need to reduce the burden of illness on the health care system,” said Shortell. “It’s important that we design communities and schools to increase and encourage physical activity.

via California coalition’s report calls for overhaul to rein in health care costs – Health and Medicine – The Sacramento Bee.

I would add that how people work should not be overlooked as it was in the Berkeley Forum report.  We should rethink how knowledge work is done in the 21st Century and develop more modern ways of performing it rather than adhering to the outmoded 20th Century paradigm of sitting in a commute to go sit another 8 hours in a centralized office.

Is the sedendary commuter/cubicle treadmill that also wastes time that could be spent engaged in sustained exercise really worth the price to our health?  I say it is not, especially when most information and knowledge work can be accomplished outside of a central office location.   If Californians are properly to be expected to take more responsibility for their health status and prevention, they must also be afforded the fullest possible degree of freedom and time to exercise — literally– that responsibility.

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Feds freeze enrollments in interim high risk pool

February 20, 2013 Leave a comment

(Reuters) – The Obama administration on Friday said it would stop enrolling new beneficiaries in a special $5 billion insurance program for people with pre-existing medical conditions, because of rising costs and limited funding.

The news comes a day after a top U.S. healthcare official told lawmakers on Capitol Hill that the administration is grappling with financial difficulties but determined to keep the Pre-Existing Condition Insurance Plan (PCIP) operating in 23 states and the District of Columbia through 2013.

via Special insurance program for the sick suspends enrollment | Reuters

The PCIP goes into run off mode as federal officials freeze new enrollments hoping to keep it solvent through the rest of the year until medical underwriting in the individual market ends January 1, 2014.   In 2010, this blog noted the challenge of maintaining solvency of the PCIP, citing a paper by the National Institute for Health Care Reform.  Notably, the Institute predicted the $5 billion the Patient Protection and Affordable Care Act allocated for the PCIP might only cover 200,000 people a year — just half of the number currently enrolled according to the Reuters item.

Health plans concerned ACA’s age rating rule could spawn adverse selection

February 17, 2013 Leave a comment

Health plans worry the limitation on using age as a basis for setting premiums in the individual health insurance market come January 2014 could jeopardize its financial viability and lead to adverse risk selection the Patient Protection and Affordable Care Act is intended to alleviate.

The ACA requires individual health insurers to deemphasize age as a rating factor by reducing the current five or six age rating bands currently used to a maximum of three, meaning the oldest plan members would pay premium rates not exceeding triple those of the youngest.  The goal under the ACA’s modified community-based rating scheme is to flatten out premiums to make them more affordable to middle aged people who over the past several years have seen them rise to a level rivaling the amount of a modest mortgage payment.

According to this Washington Post article, while older people would enjoy lower rates, younger people would consequently experience rate increases.  Particularly those under age 30 that modified community-based rating envisions balancing out state risk pools by bringing in a typically healthier population with lower medical utilization.

The Post article contains contrasting analyses on the how this so-called “young invincible” demographic will respond to higher premiums.  Consulting firm Oliver Wyman – which the article notes has been retained by the health plans’ dominant trade association – predicts the age rating limitation will result in 80 percent of those in their 20s paying more for tax subsidized coverage purchased through state health benefit exchanges than they now pay for even basic, low cost coverage.  But economist Jonathan Gruber – who consulted in the drafting of the ACA – expects plans sold on the exchanges notwithstanding higher premium rates will appeal to this cohort when income tax credits to offset premiums are taken into account. More so than going bare and paying a penalty — and even more than low cost, high deductible catastrophic plans available only to those under age 30.

Which prognostication ends up being more on target won’t be known until plan issuers release premium information this summer and the exchanges gear up for open enrollment in the fall for coverage effective in January 2014.

Study: Computer Model Could Curb Costs, Improve Patient Care – iHealthBeat

February 13, 2013 Leave a comment

Study: Computer Model Could Curb Costs, Improve Patient Care – iHealthBeat.

The Star Trek television series Voyager set in the 23rd Century features a holographic physician character programmed with a vast repository of medical data to aid in rapid and effective diagnosis and treatment.

Meanwhile, back in the present time in the early 21st, this item reports on research indicating that the application of algorithm-based artificial intelligence produced treatment plans that increased positive care outcomes — one of the key elements of the coveted “triple aim.”

Americans are first in un-health: the US health disadvantage | Health Populi

February 10, 2013 Leave a comment

Little noticed ACA provision may hold key to restoring primacy to primary care to bend cost curve

February 4, 2013 1 comment

Witnesses at a recent California legislative committee hearing bemoaned what is well known among health care policy wonks: poor access to primary care and its relationship to complex, chronic conditions that drive the 80-20 rule on health care spending: that 20 percent of patients account for 80 percent of the health care spend.

An excerpt from the California HealthCare Foundation’s California Healthline report on the hearing:

“We need to look at better management of chronic conditions,” said Assembly member Richard Pan (D-Sacramento), chair of the Committee on Health. “It’s one of the greatest cost factors in our health care system.”

How much cost?

The numbers are “astounding,” according to Sophia Chang, director of the Better Chronic Disease Care Program at the California HealthCare Foundation and one of the panelists at yesterday’s hearing. CHCF publishes California Healthline.

“We’re dealing with an epidemic,” Chang said. “Growing numbers, growing costs.”

The article goes on to quote testimony by Kevin Grumbach, chair of family and community medicine at UC-San Francisco:

“All this talk about chronic care and the patient-centered medical home is fundamentally about the primary care foundation of a well-functioning health care [system],” Grumbach said. “Systems that are built on a solid foundation of primary care are much better able to deliver the triple aim of better care, better outcomes and lower cost, and in an equitable way.”

Unfortunately, he said, California’s primary care system “is completely topsy turvy,” he said.

A little noticed provision of the Patient Protection and Affordable Care Act could contain the means of restoring the primacy of primary care and putting health insurance into the more logical and sensible role of covering large, unexpected medical costs.  It allows state health benefit exchanges to offer qualified health plans (QHPs) that are bundled with primary care directly paid by the insured, not the QHP. These “Direct Primary Care Medical Home Plan” QHPs would logically be those offering lower actuarial value (such as the “bronze” and “silver” metal tier plans that cover 60 and 70 percent, respectively, of expected claims costs).

Such a product could offer real benefits for both individuals and small businesses purchasing coverage in the exchanges starting this fall as well as for health plan issuers.  The former would benefit from lower premiums since they would be purchasing a lower cost plan. Health plans would benefit because insureds that pay for their own primary care – likely through pre-paid primary care contracts with primary care doctors and clinics – would have access to primary care and lifestyle coaching to ward off the development or progression of chronic conditions.  And primary care providers would also benefit by pre-paid direct primary care plans since they would provide a degree of predictability to their business models and potentially attract the large number of new primary care physicians that will be needed by the many newly insured under the ACA. That sounds like a promising means to achieve Grumbach’s triple aim.

Plan issuers, however, might initially resist offering such Section 1301(a)(3) plans since they would require them to retool their plans to be more like the “major medical” plans that predominated in the United States until all inclusive managed care plan models covering primary care proliferated beginning in the 1970s. But amid relentlessly rising medical costs that threaten their current business models and the opportunity presented by the new exchange marketplaces to devise new plans, now may be the right time for them to adopt DPC-based plans. Such plans might be marketed as “DPC (Direct Primary Care) compatible” just as high deductible plans are termed “HSA compatible.”

To spur their adoption, the Internal Revenue Code should be amended to allow individuals to take an income tax deduction for pre-paid direct primary care, just as they now can for contributions to health savings accounts.

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