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National debt debate–pitching Part D under the bus? July 19, 2011

Posted by medvision in Healthcare Reform, Insurance Plans, Uncategorized.
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We certainly live in interesting times. Recently, I’ve noticed politicians, from all sides, highlight Medicare Part D as another mindless, unfunded entitlement. OK–we have Part A covering hospitalization, Part B outpatient services, Part C Medicare Advantage and Part D prescription drug therapy? Absent this unfunded entitlement, no coverage for prescriptions? “Hey mister, go get admitted in the hospital for Rx therapy!” Doesn’t having full taxpayer liability for hospital and doctor’s fees seem dumb if no coverage exists for drugs?  http://tinyurl.com/3s5n5yo

Clinicians strongly advise compliance with meds prevents in-hospital events . In fact, studies indicate medication compliance saves money, suffering and extends healthy lives. Here’s a great example, Lovenox is a complex, expensive blood thinner which may prevent pulmonary embolism. It’s expensive,  costing close to $100/pill. Imagine a Medicare beneficiary barely making due financially on social security. He’s suddenly identified by his doctor as having elevated risk for pulmonary embolism. Prescribed 5 pills costing $500, prior to Part D, he may have been unable to fill the prescription. Without the medication, an embolism is likely placing him in the local community hospital ICU for 10 days.

What makes this so difficult for politicians to understand? If savings are so important why not mandate generic over brand in cases where individual generic and brand drugs are bio-identical?


If air travel worked like health care July 15, 2011

Posted by medvision in health data, Healthcare Costs, Healthcare Reform, Insurance Plans, Risk Management, Uncategorized.
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Everyone trying to coordinate health care will appreciate this short video skit: http://www.cato-at-liberty.org/if-air-travel-worked-like-health-care/

Here’s an example of an amazing healthcare consumer July 11, 2011

Posted by medvision in Uncategorized.
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The first time I remember being “pitched” the benefits of “high deductible health plans/AKA consumer driven plans was 8 years ago. I sat in a conference room and kept close attention as a BUCA carrier explained the elements causing health care inflation. Many member excesses, like taking a child to the pediatrician  for an ear ache, or running to the primary care doc for a cold. They also mentioned technology, excessive litigation, state mandates, etc., etc. Maybe they were right, we may over use low-cost medical services.

I know now the true culprit in run-away cost is uncontrolled chronic disease. Much of this disease is lifestyle related. Plan managers have a huge task in developing effective strategies to coach, incent, prod/or price members into healthy behavioral lifestyles.  Other serious disease is unidentifiable to lifestyles and falls into a kind of, ‘bad luck” category. Many cancers fall into this category. The following link entitled, “E Patient”,  illustrates an example of how incredibly brave and courageous cancer patients are.

If you are a plan manager/executive, what suite of services are available to the 1% of your members battling cancer? This 1% will incur 15-25% of your annual claims.  Responding we rely upon our administrator/BUCA is the same as saying “not much”! http://www.ted.com/talks/dave_debronkart_meet_e_patient_dave.html

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