One piece (albeit a small

Peter Schwartz — Tue, 14 Jan 2014 03:45:18 +0000

In reply to Second wave of health-insurance disruption affects small businesses

One piece (albeit a small one) of Obamacare is a move away from fee for service and toward treating the whole person and the whole disease and being paid for results, i.e., health.

What's the bottom line here?

Peter Schwartz — Tue, 14 Jan 2014 03:43:50 +0000

In reply to Second wave of health-insurance disruption affects small businesses

What's the bottom line here?

Obamacare?s narrow networks

artappraiser — Tue, 14 Jan 2014 01:52:20 +0000

In reply to Second wave of health-insurance disruption affects small businesses

Obamacare’s narrow networks are going to make people furious — but they might control costs
By Sarah Kliff, Wonkblog @ washingtonpost.com, Jan. 13, 2014

[...]

Did Obamacare invent narrow networks?

No, Obamacare is accelerating a preexisting trend. Narrow network plans have become increasingly popular in recent years, growing from 15 percent of the insurance plans that employers offered in 2007 to 23 percent in 2012.

As you can see in this graph from the Kaiser Family Foundation, narrow networks were taking hold well before the Affordable Care Act, as employers looked to tamp down on premiums growth. But most observers also agree that the health-care law helped accelerate the growth of these plans.

So what's Obamacare doing here, exactly?

The move toward narrow networks in Obamacare is a function of the way the law sets up competition between insurers on the exchanges. Insurers can no longer compete by trying to be the best at only covering healthy people, or by endlessly lowering benefits and raising deductibles. So limiting provider choice emerged as one of the few levers that health plans had to hold down premiums. And a lot of them did: approximately 70 percent of the exchange plans are either narrow or ultra-narrow plans, according to a study by McKinsey and Co. The consulting firm defined "narrow" as having at least 30 percent of the 20 largest hospitals in the geographic region not participating in the plan.

Many exchange carriers are offering limited provider networks," Timothy Jost, a supporter of the health law, writes in a recent edition of Health Affairs. "Consumers will like the low premiums but will be unhappy to learn that their doctors are not available and shocked to discover charges from out-of-network specialists when they go to in-network hospitals."[...]

Maggie Mahar in a reply comment on her Health Beat blog, December 29, 2013:

Bob–

Narrow networks are here to stay.

Maybe 5% of the population–or less– can afford the premiums needed to pay those hospitals and specialists that use their market clout and brand name to overcharge.

At this point, 95% of individuals and employers buying insurance care most about price. They have no choice.

Meanwhile more and more research shows no correlation between
paying more and better care. Under the ACA, infection rates at these supposedly
“primo” academic medical centers will be published — and more and more Americans will become skeptical about hte brand names. .

Higher infection rates because patients are sicker? No a well-known doctor at a prestigious academic medical center explains: “The administration is terrified of the “rain-maker” doctor and so no one is allowed to tell them they must wash their hands” (or use check-lists, or. . .) The administration is afraid that rain-makers will take their
wealthy, well-insured patients to other hospitals. Hospitals in NYC compete for these guys.

Bottom line: as narrow networks continue to tighten, many of these providers will lower their prices. And as Medicare and insurers demand value for healthcare dollars, they will have to reduce errors & infections– and improve quality.

Bob–

Narrow networks are here to stay.

Maybe 5% of the population–or less– can afford the premiums needed to pay those hospitals and specialists that use their market clout and brand name to overcharge.

At this point, 95% of individuals and employers buying insurance care most about price. They have no choice.

Meanwhile more and more research shows no correlation between
paying more and better care.
Under the ACA, infection rates at these supposedly
“primo” academic medical centers will be published — and more and more Americans will become skeptical about hte brand names. .

Higher infection rates because patients are sicker?
No a well-known doctor at a prestigious academic medical center explains: “The administration is terrified of the
“rain-maker” doctor and so no one is allowed to tell them they must wash their hands” (or use check-lists, or. . .)
The administration is afraid that rain-makers will take their
wealthy, well-insured patients to other hospitals. Hospitals in NYC compete for these guys.

Bottom line: as narrow networks continue to tighten, many of these providers will lower their prices. And as Medicare and insurers demand value for healthcare dollars, they will have to reduce errors & infections– and improve quality.

- See more at: http://www.healthbeatblog.com/2013/12/the-medias-one-sided-coverage-of-o...

Maggie Mahar in a reply comment on her Health Beat blog on how similar reform of Medicare fee-for-service is the eventual target, how Medicare unreformed is actually the main cost problem, December 24, 2013:

H–

Yes, many hospital CEO’s are overpaid. But put all of their salaries together and you are looking at a tiny fraction of what we spend on health care–Far, far, less than 1%.

Woolhander and Himmelstein aren’t very good on the economics of healthcare.

I began as a financial journalist and so am pretty good at analyzing the numbers. When you “follow the money” closely who can see where the waste is.

One reason we don’t want Medicare for All (or single-payer) is because Medicare is very very wasteful. About $1 out of $3 is wasted on unnecessary and/or over-priced products and treatments. See the Dartmouth Atlas for research that goes back more than 20 years. (www.dartmouthatlas.org)

W and H don’t talk much about overtreatment. Instead they exaggerate how much of our healthcare dollars go to insurance companies (it’s actually a small percentage.) The big money goes to doctors, drug-makers and device makers. (Some single-payer advocates acknowledge that this true. But the leaders of the single-payer movement are not open to criticism. AS one former
single-payer doctor told me: “It’s my way or the highway.”

We overpay our specialists. we grossly over-pay for medical devices, and we over pay for drugs. We overpay academic medical centers. There is also much fraud– particularly in for-profit nursing homes and for-profit hospitals.

We also overpay hospitals for preventable mistakes. When a doctor removes the wrong leg (and this happens more often than you would believe) both he and the hospital are paid a second time to remove the correct leg. Surgical infections kill some people. In other cases they survive, but stay in the hospital longer and need a second operation. Again, both the hospital and doctor are paid a second time.

Bedsore are actually the most expensive “preventable mistake.” In some cases they kill people. In other cases bed sores lead to much longer hospital stays– sometimes the patient never goes home. He is simply transferred to a nursing home where he is bedridden for the rest of his life.

It is very easy to prevent bedsores by “turning patients” throughout the day. But hospitals that refuse to hire enough nurses to do the job let patients stay in one position for too long. This is how bedsores develop.

Many single-payer advocates are reluctant to blame doctors and hospitals for the waste. Some like W and H are themselves doctors. They would rather blame insurance companies and
administrators.

If we expanded Medicare to cover everyone of all ages we could never afford it.

We must reform Medicare first–then consider whether we want single-payer (Medicare for all.)

But only after Medicare reduces overpayemnts and squeezes out waste. When Medicare spending is cut by 15% or 20% (adjusted for regular inflation) then we talk about
Medicare for All. .

- See more at: http://www.healthbeatblog.com/2013/12/the-medias-one-sided-coverage-of-o...

H–

Yes, many hospital CEO’s are overpaid. But put all of their salaries together and you are looking at a tiny fraction of what we spend on health care–Far, far, less than 1%.

Woolhander and Himmelstein aren’t very good on the economics of healthcare.

I began as a financial journalist and so am pretty good at analyzing the numbers. When you “follow the money” closely who can see where the waste is.

Many single-payer advocates are reluctant to blame doctors and hospitals for the waste. Some like W and H are themselves doctors. They would rather blame insurance companies and
administrators.

If we expanded Medicare to cover everyone of all ages we could never afford it.

We must reform Medicare first–then consider whether we want single-payer (Medicare for all.)

But only after Medicare reduces overpayemnts and squeezes out waste. When Medicare spending is cut by 15% or 20% (adjusted for regular inflation) then we talk about
Medicare for All. .

- See more at: http://www.healthbeatblog.com/2013/12/the-medias-one-sided-coverage-of-o...

H–

Yes, many hospital CEO’s are overpaid. But put all of their salaries together and you are looking at a tiny fraction of what we spend on health care–Far, far, less than 1%.

Woolhander and Himmelstein aren’t very good on the economics of healthcare.

I began as a financial journalist and so am pretty good at analyzing the numbers. When you “follow the money” closely who can see where the waste is.

One reason we don’t want Medicare for All (or single-payer) is because Medicare is very very wasteful. About $1 out of $3 is wasted on unnecessary and/or over-priced products and treatments. See the Dartmouth Atlas for research that goes back more than 20 years. (www.dartmouthatlas.org)

W and H don’t talk much about overtreatment. Instead they exaggerate how much of our healthcare dollars go to insurance companies (it’s actually a small percentage.) The big money goes to doctors, drug-makers and device makers. (Some single-payer advocates acknowledge that this true. But the leaders of the single-payer movement are not open to criticism. AS one former single-payer doctor told me: “It’s my way or the highway.”

We overpay our specialists. we grossly over-pay for medical devices, and we over pay for drugs. We overpay academic medical centers. There is also much fraud– particularly in for-profit nursing homes and for-profit hospitals.

We also overpay hospitals for preventable mistakes. When a doctor removes the wrong leg (and this happens more often than you would believe) both he and the hospital are paid a second time to remove the correct leg. Surgical infections kill some people. In other cases they survive, but stay in the hospital longer and need a second operation. Again, both the hospital and doctor are paid a second time.

Bedsore are actually the most expensive “preventable mistake.” In some cases they kill people. In other cases bed sores lead to much longer hospital stays– sometimes the patient never goes home. He is simply transferred to a nursing home where he is bedridden for the rest of his life.

It is very easy to prevent bedsores by “turning patients” throughout the day. But hospitals that refuse to hire enough nurses to do the job let patients stay in one position for too long. This is how bedsores develop.

Many single-payer advocates are reluctant to blame doctors and hospitals for the waste. Some like W and H are themselves doctors. They would rather blame insurance companies and
administrators.

If we expanded Medicare to cover everyone of all ages we could never afford it.

We must reform Medicare first–then consider whether we want single-payer (Medicare for all.)

But only after Medicare reduces overpayemnts and squeezes out waste. When Medicare spending is cut by 15% or 20% (adjusted for regular inflation) then we talk about Medicare for All. .

dagblog - Comments for " Second wave of health-insurance disruption affects small businesses"

One piece (albeit a small

What's the bottom line here?

Obamacare?s narrow networks