Healthcare Economist Jason Shafrin hosts the latest Cavalcade of Risk blog carnival, featuring a roundup of posts on health insurance, democracy, workers comp and more.
Medicaid beneficiaries deserve the same access to healthcare services and products as people with commercial insurance or Medicare. But since Medicaid pays doctors and hospitals 27 to 65 percent less than commercial health plans (according to a new GAO report), it makes it awfully difficult for providers to be payer agnostic. Sure enough, we see even supposedly mission-driven non-profit healthcare systems looking to maximize their share of the commercial population by catering to that group.
That’s a real public policy problem as the proportion of patients with Medicaid increases, and it presents providers with an unreasonable dilemma. In many states, doctors or hospitals that take care of a high proportion of Medicaid patients will find themselves in financial distress. That’s not fair to them or the Medicaid recipients. Frankly it’s also unfair to the commercial customers who may be overpaying to compensate for Medicaid underpayments.
Compare Medicaid with the Supplemental Nutrition Assistance Program (SNAP), aka Food Stamps. SNAP recipients don’t bankrupt supermarkets. That’s because the government pays the same price for groceries as any other customer. The SNAP program doesn’t demand that the grocery store sell products below cost, nor should it. SNAP recipients have to be savvy about how they use their benefit, seeking out high value products and retailers to stretch their dollar.
Realistically we won’t see the disparity between Medicaid and commercial payment rates erased any time soon. It would be just too expensive. But there are steps that can and should be taken:
- Narrow the gap over time from the current 27 to 65 percent to something more like 10 to 15 percent
- Introduce more progressive payment mechanisms –like Medicaid Accountable Care Organizations– that provide health systems with incentives to contain costs and improve quality. Healthcare systems that figure out how to help Medicaid members become healthier for a lower cost will prosper –analogous to what Walmart does with SNAP payments
- Provide incentives for Medicaid beneficiaries to seek lower cost, higher quality care. Let’s not be paternalistic and assume that people on Medicaid aren’t capable of identifying high quality, low cost services.. I’ll venture to say that many lower income Americans are savvier shoppers than average consumers, if only due to necessity
The GAO report should be a wakeup call. It’s time to do something about these disparities beyond simply shrugging our shoulders.
https://www.youtube.com/edit?o=U&video_id=SqEf7ry112cIn this fifth episode of Health Business TV, I discuss my interview with HelloMD about cash payments to specialists, the long and slow evolution of eVisits, more on the nursing shortage myth, the United Independent Party in Massachusetts, and an update on the proposed 29% health insurance premium hike for our business..
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The latest Health Wonk Review blog carnival is up at Wing of Zock (incidentally one of my favorite blog names!). You can catch the latest on the Affordable Care Act, health care in India, hospital readmissions, and cancer treatment. Have a look.
The Boston Globe published my letter to the editor today (A third way for governor). This blog post provides more detail.
Massachusetts is the cradle of the American Revolution, and people here enjoy vigorous political debate. We generally have healthy competition between Democrats and Republicans for Governor –including this year when both parties are fielding credible candidates. (I interviewed all nine candidates about healthcare policy earlier this year.) Sometimes the race for US Senate is competitive, too. But beyond that it’s pretty much single party rule by the Democrats.
That doesn’t sound like a prescription for a healthy democracy, and in fact it isn’t.
From time to time the Boston Globe and other publications draw attention to this sad state of affairs, including in Monday’s paper (Few GOP foes for Mass. delegation), where the Globe pointed out that six of nine US House races will be uncontested this November. It’s even worse in the state legislature, where just one third of races are contested.
I respect what one Congressman has to say about it:
“Look it, I was fully prepared for a campaign. And I expected one. It just didn’t happen,” said Representative Jim McGovern, a Democrat from Worcester who is running unopposed in both the primary and general elections. “For the sake of our democracy, it’s not a bad thing to be challenged. . . . But my job is not to find myself an opponent. That’s somebody else’s job.”
The usual conclusion drawn by such articles, including this one, is that Republicans need to step up and get organized. But they’ve failed to do so even when they’ve had strong leaders such as Bill Weld, Mitt Romney, Charlie Baker, and Scott Brown.
Part of the problem is clearly a lack of leadership and discipline to build the party at the grassroots level. But there’s more to it than that. A fatal flaw is that the national Republican party has moved too far to the right, and has taken positions on social and civic issues that put it outside the mainstream of Massachusetts voters. For example, marriage equality is a settled issue here, people understand the value that immigrants bring to the economy and culture, RomneyCare is broadly popular, and there is a belief that government can work. Even those who don’t feel well served by Democrats think twice before voting in someone who identifies with the national GOP on issues like this.
Believe it or not, most voters in Massachusetts are independents. As of late 2012 there were close to 2.3 million people registered as independents compared with fewer than 1.6 million Democrats and 0.5 million Republicans.
This is why I’m excited about the United Independent Party, which describes itself as follows:
Founded in 2012 by Evan Falchuk and enthusiastic supporters from around the state, the United Independent Party (UIP) is a bold new movement on the Massachusetts political map. It is committed to changing the conversation from “small government versus big government” to one focused on greater accountability to voters, stronger protection of social freedoms, and more innovative, fiscally sane solutions that improve the day-to-day lives of individuals, families and communities.
Laws in Massachusetts make it hard for a new party to establish itself. There are limits on fundraising and it’s hard to get candidates on the ballot. But Evan Falchuk easily generated enough signatures to get on the ballot for Governor and if he wins at least 3 percent of the vote then the UIP will qualify as an official party and be able to more easily get its candidates on the ballot. It intends to recruit candidates for a wide array of offices and help express the will of the people in Massachusetts. The demand is there: a 2013 UIP poll revealed that most voters favor an independent party like the UIP, committed to fiscal moderation and the protection of civil liberties.
If it sounds interesting to you, have a look at the Falchuk for Governor website and consider changing your voter registration to United Independent Party.
When I first started working in healthcare I was told that innovations can take a long, long time to be adopted. Now I’m old enough to have experienced it for myself.
The big news in the Seattle Times this week?
“To cut medical costs and diagnose minor ailments, WellPoint and Aetna, among other health insurers, are letting millions of patients get seen online first.”
“In a major expansion of telemedicine, WellPoint this month started offering 4 million patients the ability to have e-visits with doctors, while Aetna says it will boost online access to 8 million people next year from 3 million now.”
This has been a long time coming, and we’re still at the early stages of adoption, with plenty of naysayers remaining. I first worked on eVisits (or webVisits) in 2001, when Healinx (now RelayHealth) commercialized them. Researchers at Stanford and UC Berkeley studied the webVisit and concluded that their use cut total medical costs while improving patient and physician satisfaction. Here’s a press release from January 2003 on the study (Final Results: webVisit(SM) Study Finds RelayHealth Reduces Cost of Care While Satisfying Doctors and Patients).
Here’s what I said about it five years ago (eVisits continue their slow, steady rise) –before the iPad, Meaningful Use, or the Affordable Care Act:
It’s interesting to be in late 2009 and see e-visits described as a “disruptive innovation” that “the medical establishment is fighting.” It’s a sensible concept, fairly straightforward to implement, efficient, and effective for certain situations. Yet growth has been slow. Part of the issue is that it’s health care we’re talking about, where innovation tends to be retarded when it involves changing physician practices. Another, related problem is that there’s no great financial incentive for the physician or patient to make a change. Health plans that do cover e-visits often charge the same co-pay for patients as for in-person visits, even though they often reimburse physicians at a lower rate.
My guess is that over the next decade we’ll see e-visits become common. Why?
- Adoption will follow the typical S-shaped curve, and we’ll soon get to the steep climb almost regardless of other changes
- More patients and physicians will simply expect to communicate online, as they do in every other area of their personal and professional lives
- Payment systems will evolve to support e-visits, rather than penalize them
- Adoption of electronic systems in physician offices in general will enable e-visits
- Supporting technologies will evolve and emerge. These include remote monitoring, higher bandwidth, personal health records, and mobile applications
Enjoy the next decade and don’t expect things to change too quickly.
Halfway into the decade these five factors are still playing out. Having said that I could probably have just reposted the article and changed the date and no one would have noticed.
Will things speed up dramatically over the next five years? In 2019 will we still be reading articles about this “novel” approach? I hope not but fear that we may.
Mark Hadfield makes no bones about the fact that the US is moving to a two-tiered medical system, where those with the means to pay more get better, faster treatment. His company, HelloMD helps in-demand doctors –mainly specialists– opt out of the third-party reimbursement system and serve the more lucrative, cash-paying patients.
In this podcast interview, Hadfield describes how his company is addressing the high end of the market. He explains how HelloMD fits in the broader ecosystem of concierge practices, medical tourism and high-deductible plans. And he shares HelloMD’s geographically-focused strategy to build a marketplace to serve its niche.