United pulls out of ACA exchanges: Should we care?

Walking wounded?

Walking wounded?

Insurance exchanges are a key feature of the Affordable Care Act, aka Obamacare. They enable individuals to compare insurance plans from a variety of carriers and choose the policy they like. Exchanges got off to a rough start with website glitches but overall they’ve been quite successful: enrolling millions of newly insured people, many of whom receive premium subsidies and some of whom receive additional assistance on out-of-pocket costs.

Recently we’ve heard what could be interpreted as bad news about the viability of exchanges: UnitedHealth is considering withdrawing from the program. In the highly politicized world of health reform, that information has Obamacare foes sounding the death knell.

I see things differently.

The biggest premium increases reported in the press were generally from the largest, most well known health insurers –like United. They may be losing money on the policies they offer on the exchanges and are jacking up prices as a result. But the whole purpose of an exchange is to give people the opportunity to shop around and to change plans if they want. Even in the face of big headline price increases, consumers who shop around can still typically keep their premium increases modest or even reduce what they’re paying.

The big name insurers that have a large share of the corporate market are not necessarily the winners on the exchanges. Rather, the leaders in the new price-sensitive era are lesser known plans, many of which cut their teeth in the Medicaid managed care market where tight cost control is key. They have what it takes to play in this brave new world.

There are some similarities to the airline business. Remember the days when you had to buy a ticket 30 days in advance and stay over a Saturday night to get a reasonable deal? Then carriers like Southwest came into the market and changed all that. Carriers like USAirways used to withdraw from markets that Southwest entered –they just couldn’t compete. That doesn’t mean air travelers suffered.

Don’t get me wrong. I’d like to see some changes to make the exchanges more vibrant –like increasing the allowed ratio of premiums based on age, which would make the plans more affordable for younger people. And it would be nice to have more flexibility in benefit designs. Still, United’s departure is likely to be more of a problem for the legacy carriers than it is for the exchanges or consumer choice.

Image courtesy of stockimages at FreeDigitalPhotos.net

By healthcare business consultant David E. Williams, president of Health Business Group.


DocChat puts ER docs online (podcast)


Dr. Steve Okhravi and his son Michael decided to do something about overuse of the emergency room. They founded DocChat to leverage telemedicine for triage and to counteract the forces of defensive medicine that send many patients to the ED that don’t belong there. Early results are strong and they are looking to scale.

I asked the Okhravi’s about their service in this podcast interview.

  1. (0:14) What unmet need are you addressing?
  2. (1:33) Are patients to blame for unnecessary visits to the ED, or do physicians deserve some of the blame?
  3. (4:26) DocChat uses emergency room physicians instead of primary care. Why?
  4. (7:00) Is DocChat appropriate for geriatric patients?
  5. (10:08) Your service is not covered by insurance. Who is the paying customer now and what do you expect in the future?
  6. (12:23) You offer a subscription service as well as charging per call. Is this the type of business where a subscription makes sense?

By healthcare business consultant David E. Williams, president of Health Business Group.

Health Wonk Review is up at Wright on Health

Wright on Health hosts the Counting Our Blessings Edition of the Health Wonk Review blog carnival. He’s worked in posts on understanding the rising death rates among whites, managerial overreach, workers comp, diabetes (my post), health IT and more.

Enjoy it!

Invokana makes diabetes fun again!


Question: What do obese, middle-aged and older, mute Americans with Type II diabetes do for fun?

Answer: At least according to this TV commercial for Invokana, they wander around waiting for frisbees with alluring images to glide down from the sky, then clutch the discs tight to change their lives.

I was struck by this 2-minute ad, which I saw a couple times while at the gym. The group really does personify the obesity and Type II diabetes statistics you read about. The ad makes the pill sound quite promising –explaining how great it is for glucose control and adding that it can even help patients lose weight.

The actors keep enjoying new frisbees right through the extensive discussion of side effects. It seemed odd to see a woman clutch a frisbee with what looks a lot like a diagram of the female pelvic anatomy at the same time the urinary tract infection and genital yeast infection side effects are discussed. Check it out around 1:07.

Screenshot 2015-11-16 16.49.10

At first I thought this was an ironic and unintentional placement but when I watched it again I noticed that during the dehydration side effect around 0:50 the guy pulls down a frisbee with a water bottle on it and packs it up for his hike.

Screenshot 2015-11-16 17.38.11

The commercial is somewhat surreal but on the whole I do find it communicates effectively. I bet it will be a success.

As much fun as it looks to have Type II diabetes, I still prefer this video from Virgin America , which takes the boring airplane safety video and turns it into something much more exciting and active than expected. It also includes actors holding on to things from the sky, in this case safety cards.

Screenshot 2015-11-16 17.48.30


(And you’ll see there is absolutely zero cast crossover…)


By healthcare business consultant David E. Williams, president of Health Business Group.

Marty, Bernie, Hillary –Ready to talk health policy?

Last year I interviewed all nine candidates for governor of Massachusetts about healthcare policy. I asked each of them the same questions and they all gave thoughtful replies. I received encouraging feedback from readers and from mainstream media, such as WBUR.

The presidential race is a whole different ballgame, with a lot more bluster and superficiality than the race for governor. And although it’s pretty popular for a niche publication, the Health Business Blog is not going to have the reach of more general outlets.

Nonetheless I decided to reach out to the three Democrats who remain in the race to see if they’ll be willing to speak. I would really like to see a competitive race and am still a little puzzled as to why Martin O’Malley hasn’t gotten more attention. He’s a credible player, if not as colorful as Bernie Sanders or as famous and controversial as Hillary Clinton.

The O’Malley site contains reasonably detailed policy prescriptions, but the only one on healthcare is about addiction treatment. That’s an important topic, but doesn’t make for a healthcare policy.

Sanders has a lot to say about prescription drug pricing. He frames it in the context of universal coverage, but again he doesn’t share a comprehensive policy.

Clinton’s site includes the most comprehensive views including one on healthcare broadly, another on addiction and another on Social Security and Medicare.

I do hope the candidates will take me up on my interview offer.

By healthcare business consultant David E. Williams, president of Health Business Group.


Why Republicans will stumble on drug pricing policy

Get 'em while they're cheap!

Get ’em while they’re cheap!

Prescription drug pricing has quickly risen toward the top of the list of voter concerns. Democrats running for President have been talking about it for a long while, but now Republicans feel they need to have something to say. (See GOP hopefuls, long quiet on drug prices, begin to make some noise.)

I predict the GOP candidates will mainly fail to come up with compelling approaches. Why?

The article includes certain wise things Republicans are saying on healthcare policy. But I want to point out that these won’t do anything to control drug prices:

  • Expand public/private partnerships for drug development. (They would do well to look to the Forum for Collaborative HIV Research as an incredibly effective and efficient model that started in HIV but has since expanded to liver disease)
  • Provide more funding for the NIH. We really need this if we are to stay ahead in the global competition for highly-educated talent. Yes, this policy would be even more effective if coupled with immigration reforms to enable graduates of US universities to stay after obtaining their degrees

Image courtesy of digitalart at FreeDigitalPhotos.net

By healthcare business consultant David E. Williams, president of Health Business Group.


Health Wonk Review: Open season on open enrollment edition

You'll feel better after reading this

You’ll feel better after reading this

Health Wonks are nothing if not opinionated. Their views burn bright in the submissions I received for this edition, which coincides with the start of the Affordable Care Act’s third annual open enrollment period. Enjoy!


GOP presidential candidates including Marco Rubio keep insisting that Medicare is on a path to bankruptcy. But as Medicare Resources explains, the insolvency date has been pushed back 13 years under Obama’s watch. On the other hand, the GOP has actually worsened Medicare’s finances through implementation of Part C (Medicare Advantage) and Part D (drug benefit).

Health Affairs Blog chronicles two warring political narratives about health spending growth. Conservatives blame the patient, while Progressives blame physicians. Author Jeff Goldsmith dissects the narratives, finds fault with both, and suggests a more complex and balanced approach. Now there’s a wonkish mindset for you!

Mattering mabobs of managerialism

Leave it to Health Care Renewal to scour the globe for medical managerial malfeasance. In The Scourge of Managerialism we learn of an Australian source that sums up the sins of mission-hostile management and its adverse impact on patients and academics.

Psych out

Workers’ comp claims adjusters want nothing to do with psychologists, fearing they’ll turn any referral into a lifetime annuity. Workers’ Comp Insider has the scoop, as expected.

Where B all the hospitalists?

There’s no specific billing code or board certification for hospitalists, so how do you track them down? The Hospital Leader has two suggestions: ask everyone “are you a hospitalist?” or dig deep into the Medicare Part B claims database to identify hospitalists based on what they bill. The analysis lays the groundwork for important conversations about care delivery, but also makes it clear that hospitalists need a unique billing code.

Bundle it up

Archway Health Advisors describes a real-time patient tracking app to improve patient care during a bundled payment episode. This timely feedback is a must if providers are to manage care episodes across the continuum.

Where and what are MACRA and MIPS?

With the notable exception of health wonks — and I do mean notable– no one paid much attention to the provisions of the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) beyond the so-called ‘permanent doc fix.’ But fortunately Healthcare Economist lays it out for everyone else, explaining how MIPS and Alternative Payment Models will make significant impacts on physician payment.

Open season on open enrollment

The National Center for Policy Analysis has seen Obamacare Open Enrollment before, and is none too thrilled to see it come around again. The Nothing to Celebrate post makes important points about rising premiums, especially for those who don’t qualify for subsidies. We’ve seen premiums jump with our own business in Massachusetts. Still, it probably would have been worth noting that premiums for those with subsidies aren’t really changing.

ACASignups has been looking at the data to try to figure out which way ACA exchange enrollments are heading. From this –perhaps the wonkiest post of the whole bunch– it appears that while overall exchange enrollment is up, the big plans are losing market share. From where I sit that’s no bad thing. As premiums rise (see post above) patients who are willing to switch plans are often able to keep their own premiums well below the advertised levels of increase, typically by choosing plans from smaller, more nimble carriers.

InsureBlog has been around for more than a decade, and I’m still waiting for the first pro-Obama post. (Actually I never really got my hopes up.) In any case Musings on ACA Open Enrollment Day tells the story of a patient skipping care because of a super-high deductible.

Finally, Managed Care Matters comes to tell us that the whole idea of high deductible plans is “stupid.” They just lead to cost shifting and don’t encourage lower spending by high-cost members.

That’s it folks! Meanwhile if you’re in the mood for more, you can always check the Health Wonk Review site for past posts and upcoming hosts.

Image courtesy of imagerymajestic at FreeDigitalPhotos.net

By healthcare business consultant David E. Williams, president of Health Business Group.