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High deductible plans not working? Here’s what works, 0 deductible! December 10, 2011

Posted by medvision in Cancer Care, Chronic Disease, Employee Wellness, health data, Healthcare Costs, Healthcare Reform, Insurance Plans, Rx Costs, Uncategorized.
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My initial introduction to consumer driven plans, HDHPs, was presented in a group setting by a national carrier, or, “industry speak” a BUCA. We were first told the reason for explosive trend is a combination of easy physician access due to low copays, better technology, our legal environment and expensive drugs. Then came the HSA regulatory part. (I used to think the 401K regs were somewhat complex)! Today, from my years of data experience, I know explosive health inflation is driven by a small percentage of members suffering worsening states of chronic disease.

Anyway, a troubling thing is sneaking up on the disciples of HDHPs and their concept of member consumerism. It’s the rapid adoption of on/near site clinics by 20%+ of employers with a thousand or more employees.

Hmm. In one corner we have plans requiring members to spend the 1st $1,000 – $10,000 before plan benefits start, And, in the other corner, all-inclusive primary care benefits with no, 0, member dollars needed. If fact, a few BUCAs are big proponents of both plans! Sort of an AC/DC strategy.

The clear winner is immediate and easy access to primary care, preferably in scenarios in which the physicians are significantly rewarded for “great” member health. A great plan discount occurs when large claims don’t occur due to prevention/early disease identification. Guess how many $70 primary care visits can be purchased for the cost of a $250K annual claim paid on behalf of a member facing end-stage renal failure? A great physician can he hired for $200K annually. So, how many members can a physician see in 12 months? Here’s a good opinion article on employer clinics! http://tinyurl.com/7rvm7sm

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Cracks in high-deductible/consumer-driven health plan models November 29, 2011

Posted by medvision in health data, Healthcare Costs, Insurance Plans, Uncategorized.
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I’ve always been confused by the values highlighted by proponents of HDHPs. My logic has consistently been: (1) 75% of healthcare payments are made as the result of treating chronic diseases and, if/when, caught at the earliest stages can be cured, or mitigated. (2) Shifting initial plan expenses to patients, in the form of high deductibles, tends to prevent doctor visits/medical treatment thus negatively impacting the early discovery and treatment of disease. (I understand wellness checks are paid at 100%)

Here’s some real evidence our physicians will be the keys to unlocking our national health care cost/quality problems: http://tinyurl.com/7acns8o

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