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Another HDHP rant! March 28, 2012

Posted by medvision in health data, Healthcare Costs, Healthcare Reform, Insurance Plans, Risk Management, Uncategorized.
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Today we are in the middle of the arguments concerning healthcare reform before the US Supreme Court. The individual mandate is the issue of the week; however, I’d like to discuss the lack of procedure pricing in health markets. Although lack of pricing information is not the main problem with High Deductible Health Plans, the issue is amazingly resilient. First, I’d like to describe personal experience with my own HDHP.

Somehow during December 2011 my family actually met the large deductible of our plan. Given this was the first month of any reimbursable expenses over the last several years, I elected to follow my primary physician’s advice and submit to a sleep study. My physician is owned by a local hospital and I was referred to their outpatient center. I tried to check the pricing on my MCO’s website only to find no information exists for sleep studies. So, around December 30th I traipsed over to the hospital ending up in the basement in a drab, lifeless room. Subsequently, I was met by male technician who proceeded to stick wires all over my head and chest to the point I looked like Frankenstein. Somehow, I fell asleep, was awoken after four hours and drove home.

About two weeks later, I noticed the EOB in the mailbox and quickly opened it. Shock, outpatient billing $4000, BUCA allowed $2000, BUCA paid $1600, member amount due at 20%, $400. Subsequently, I start receiving calls from hospital to schedule my next delightful evening, another four-hour visit, but this time entirely subject to my fantastic $3000 deductible. I answered, “Hmm, let me get back to you”.

By now, I’m feeling pretty stupid and decide to call another facility to inquire the discounted rate for the same procedure/CPT under my MCO. The facility answers, “we don’t know what you’re MCO pays”. Then I say, “forget the MCO, I’m paying cash”. “Oh, you should’ve mentioned that at first, yes the cash price is $300 per evening or $600 for the entire procedure”. Pretty big variance? Drafty hospital, $4000 or brand-new facility $600!

Here’s a supporting posting today on Kevin M.D. The subject has a little more clinical risk significance.  Again, I’m not in the HDHP corner!




State of Georgia 2012 health enrollment guide–OMG March 11, 2012

Posted by medvision in health data, Healthcare Costs, Insurance Plans, Uncategorized.
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No wonder we are confused with employer health plans! While researching benefits available to state employees, I came across Georgia’s, State Health Benefit Guide, SHBG. (This acronym is the easiest element of the plan to understand) Now before I criticize the 1000s of billed consulting hours that produced these 13 health benefit options, please realize I have access to population claims expense distribution data which never sees the inside of the consultant’s highrise offices. Here’s an example!

I bet 40% of all Georgia employees/dependents covered (40 of 100) average incurring less than $100 in claims annually from the state health trust fund. Not accounting for the member’s required premium contributions of umpteen $1000s. 70% of all covered members spend less than $500 after their premiums and 85% incur less than $1000. So, let’s set the record straight: 85% of the population’s incurred claims average less than the payroll premiums they contribute to be covered under the plan! Now back to the options. They offer the exact same options, HRA, HSA (plus countless employer fund contributions) and HMO, all with individual wellness, yes/no from (2) national managed care organizations, MCOs. Throw in a Tricare supplement option and we have 13 options.

Maybe I’m too simplistic? 5% of Georgia’s covered employees will account for close to 60% of the plan’s $100s of millions in plan expenses. Why not make sure the sick 5% are getting the best quality, value based care in the world? For the 95%, provide all the low-cost doctor services, screenings, preventative medicines, wellness, weight loss and stress reduction to prevent their entering the top 5%? Drop all the HSA/HRA individual account stuff and their accompanying VISA cards! Many covered members don’t even have their own VISA cards in today’s weakened economy!

These plan designs look to be more tinkered with than a rusted 1955 Chevy in Havana Cuba! The enrollment guide covers 35 pages! I’d bet the consultants and Georgia HR staff don’t understand the options in their entirety. How’s a state trooper working nights and part-time jobs going to understand? Logical rework option: Go back a few decades and provide care to covered beneficiaries? Manage risk instead of burying it under acronyms, ink and paper! Georgia needs to realize it’s the largest purchaser of health services in the state, so act like the largest. Demand quality and value, and of most importance demand accountability from all stakeholders, providers, patients, MCOs and consultants.


The light of free markets slipping into employer sponsored health care! March 6, 2012

Posted by medvision in Employee Wellness, health data, Healthcare Costs, Insurance Plans, Risk Management, Uncategorized.
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Free market practices appear to breaking through the screens covering our American health care system. Healthcare is a unique marketplace in which our current lack of financial and quality transparency produces high cost and poor clinical outcomes. How many patients will flock to a hospital experiencing 300% increases in cardiac death for heart surgery?  Read this physician’s post: Why we are busier than we’ve ever been.

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