Thursday, May 9, 2019

Accountable Care…The Savior of U.S. Healthcare?

Since the passage of the Affordable Care Act (ACA) in March of 2010, much has been discussed, debated, written, and deployed relative to healthcare FINANCING reforms (see insurance, Medicare, Medicaid, self-insured employers, fees/taxes, pre-existing conditions, essential health benefits, community rating, minimum loss ratio, etc.).  But very little has been written, or even revealed for that matter, about the ACA’s healthcare DELIVERY reforms and incentives.  This is too bad, since we know that $.80 to $.85 of every dollar of billed health insurance premium is directly related to healthcare delivery.  So it stands to reason that if we could reduce health CARE costs, health insurance PREMIUMS would follow suit.  Enter Accountable Care Organizations (ACO) into the equation.  Let’s examine what ACO’s are…who they are…and why many are looking to them to save America’s healthcare system from imploding.

Tuesday, April 16, 2019

Prescription Drug Spending Trends

As employers, patients, and other stakeholders continue to struggle with the rising cost of healthcare (and health insurance!), one particular component of overall healthcare spending seems to be occupying the majority of attention – prescription drugs!  In 2019, the U.S. is projected to spend $500 billion on prescription drugs alone, which marks a 12x increase from less than 20 years ago!*  A number of factors are at play in the cost pressures affecting drugs, on both the supply and demand side.   Much is being discussed and debated on the topic of addressing skyrocketing drug prices, including government intervention on a number of fronts.  Needless to say, we are closely monitoring developments in the area of prescription drug trends.  So here is the first of likely several posts addressing some of the more pressing matters affecting prescription drug use and spending. 

Friday, December 1, 2017

Preventive Healthcare Services and Coverage

An important and often overlooked benefit of the Affordable Care Act (ACA) is full coverage and benefits for preventive care.  Specifically, the ACA established that virtually all private health plans must provide 100% coverage (i.e., no cost share) for a host of preventive healthcare services.  The only exception to this requirement are so called “grandfathered”LEARN MORE

Tuesday, June 2, 2015

Disproportionate Hospital Share (DSH) Payment Change

The Affordable Care Act (ACA) changed the method used to compensate hospitals for disproportionate share, sometimes referred to as DSH. This new method applies to charges “effective on or after fiscal year (FY) 2014. Under the new method, eligible hospitals receive 25% of the former “DSH” amount, and additional funds as follows:

Wednesday, October 15, 2014

Ebola ~ Just the Facts

Readers of this blog (soon to be “resource library”) typically find health INSURANCE, FUNDING, and FINANCING issues addressed here. But occasionally, health CARE issues come to light which I feel compelled to address. With all the media coverage and confusion surrounding the recent outbreak of the Ebola virus, I decided to attempt to clarify some important facts. My primary source of information for this post is the Douglas County Health Department (Douglas County, Nebraska), which under the direction of Dr. Adi Pour, does a fantastic job of data mining and educating, among other things.
The Ebola virus was first discovered in 1976 in the Ebola River…

Wednesday, June 11, 2014

Prescription Drugs – Health Care’s Low Hanging Fruit

There is an often overused metaphor equating things easily obtained with “low hanging fruit”. And in the world of health care and consumer driven health care (CDH), there is perhaps NO lower hanging fruit to be had than prescription drugs. I would further submit that few if any other product category in our entire economy has the sheer number of FREE… DISCOUNTED… REDUCED… SAMPLE offers connected to it, by a variety of constituencies including – manufacturers, distributors, insurers and employers – than do prescription drugs. But do the very people these offers of “low hanging fruit” are directed toward understand the “what”, “why”, or even “where” associated with them?

Wednesday, January 29, 2014

In Healthcare, Time is of the Essence!

We’ve all heard the expression – “time is of the essence”. But a recent blog post I came across compelled me to share the incredible application of this expression to the health care industry. Not only does effective triage and initial diagnosis portend better outcomes, it also has a significant impact on efficiency and costs. And let’s face it, at a time when health care consumes nearly a fifth of our nation’s gross domestic product (GDP), finding ways to cut health care costs is critical.
So it got my attention when Dr. Sorensen reported in his blog that – “It is in the first 15 minutes of a medical encounter that up to half of all medical costs are set in motion.

Wednesday, January 15, 2014

What’s Causing Health Care Spending to Slow?

Those of us in the health care industry (both delivery and financing) are pleasantly surprised, albeit cautiously optimistic, to learn that health care spending has slowed rather dramatically in recent years. In fact, for the first time ever, the percentage of our Gross Domestic Product (GDP) attributable to health care has decreased from 17.3% in 2011 to 17.2% in 2012 ($2.8 trillion). Fellow health care stakeholders may find it interesting that in 1960; health care consumed a mere 5% of our nation’s GDP. Put another way, in 2012 health care spending grew by 3.7%, which is virtually identical to the spending percentage growth in 2009, 2010, and 2011. By contrast, in 2002, health care spending grew by a whopping 9.7%.

Wednesday, August 7, 2013

Obesity is Now Officially a Disease!

– has roughly the same association with chronic illness as 20 years of aging
– is associated with a 36% increase in inpatient and outpatient healthcare spending
– is associated with a 77% increase in medications
– is the number two (2) cause of preventable death in the U.S!!!
But until just recently, obesity was NOT considered a DISEASE. In June of this year (2013), the American Medical Association’s (AMA) House of Delegates voted to officially declare obesity a disease. To quote AMA board member Dr. Patrice Harris,

Wednesday, July 31, 2013

How Do We Fix Healthcare?

As someone who makes his living in the healthcare and health insurance industries (for nearly 30 years), I am often asked the question – how can we fix what is broken in our healthcare system, and assure that every citizen has access to care? More recently, I get the question – do you believe the Affordable Care Act (ACA) will be successful?
In attempting to answer these, and other healthcare reform related questions, I always start with the fundamental issue that our nation struggles to address; which is, do we desire a government run, universal, single payer system (see Canada, much of Europe, etc.), or a market based, largely private run, profit based system, such as the type we presently have?