Guest host Barbara Bogaev leads “The Brave New World of Obamacare”

Listen to or download the Jan 2 podcast of “The Brave New World of Obamacare” on To The Point with Warren Olney.

I joined a panel of experts on exchanges, health care reform and insurance to give insights on ACA plans going into effect. To The Point tweeted key comments from each of us, including:

  • Bryce Williams, Towers Watson, @brycewatch:
    The ACA could be major boost to entrepreneurship
  • Sarah Kliff, Washington Post, @sarahkliff:
    36 hrs into Obamacare, vast majority can signon & signup w/in an hr
  • Susan Shargel, Shargel and Company
  • David Nather. Politico, @DavidNather
  • Gerald Kominski: UCLA Center for Health Policy Research, @UCLAFSPH

In the full podcast, you’ll hear comments on these points and more:

The New Year brought with it medical coverage for millions of Americans under the Affordable Care Act. On Jan 1, about two million people began to receive private health coverage through the state health exchanges or the federal website.

With one of the nation’s most sweeping changes to social policy in decades, no longer can insurers deny coverage to people with pre-existing conditions, or charge them more for their coverage than other customers. It’s also the first time they can’t legally charge women higher premiums for the same coverage as men, and the first time they can’t set a specific limit on the amount they spend on “essential health benefits” for individual policyholders.

But there are a lot of “if’s” in the implementation of Obamacare:

  • Will people be able to find a doctor who accepts their new plan?
  • Are the nation’s healthcare providers ready for the change in policy?
  • How will Obamacare shape the political climate this election year?

Knowledge is power — the power to think, to act, to buy, or even to not do any of the above. Our nation’s health insurers and health care providers need to figure out how to put power back into the hands of consumers. Consumers today have too many constraints when it comes to accessing decision-critical information about the cost of health care. That’s a hard pill to swallow when there’s so much at stake.

A recent post on The Health Care Blog featured a fascinating yet not unsurprising finding: The cost for appendectomies can vary by more than $100,000 between health plans and hospitals.

Dr. Renee Hsia of UCSF was asked what appendectomies cost by a friend who had to pony up over $50,000 in co-pays for one. Dr. Hsia’s research, which looked at pricing variability across the state of California and was published in the Archives of Internal Medicine,  found that an appendectomy could run from $1,529 to $182,955 — varying as much as $7,504 to $171,696 within one hospital.

The question of where to begin is starting to be answered by sites like FAIR Health’s Consumer Cost Lookup. It uses continually updated claims data from insurers and third-party administrators for 126 million people to benchmark costs. Visitors to the site can find typical rates for certain services in their area as well as what Medicare pays.

Fourteen other states have or are setting up searchable databases to help compare health care prices and quality.

The savings that can be realized are impactful not only for consumers but for health insurers themselves. Because half its members had no idea when they were being referred to out-of-network providers, Aetna launched a service to let members know if their outpatient surgery could be done by an in-network provider. In many cases, the surgery could be done less expensively, in-network reducing out-of-pocket costs for Aetna members, not to mention for Aetna.

More and more insurers are trying to help people locate services and compare costs, like UnitedHealthcare’s postcard campaign, which lists costs for common lab services at in-network and out-of-network facilities in members’ local areas and its online tool for estimating the costs of over 100 common treatments.So what’s central to all of these stories? Information.

In the California appendectomy story the information was too hard to get: too many sources, too many different plans. And, technically Aetna didn’t offer consumers (and network doctors) anything they didn’t already have access to. The information was just too hard to piece together and act on.

What these stories show us is that health care consumers today need access to information, plus tools and services to make sense of it all. Like Aetna, United Healthcare and other insurers who have developed cost-comparison tools for consumers, the insurance side of health care has been making cost information more available to aid consumer decision-making. We look to healthcare providers and hospitals to start doing the same.

Bringing transparency to the costs of services and products can supercharge consumer decision-making, forcing healthcare providers and hospitals to be more upfront with price information and to work on getting a better handle on costs for “incidents of care.”

Extend Health Medicare Exchange Interface

Extend Health Medicare Exchange Interface

The Extend Health exchange platform is a great example of transparency in an insurance shopping site. It delivers information on thousands of private Medicare plans to our customers — and it does it in an easy-to-understand way. Our system supports benefit and cost transparencyby allowing customers to compare plans side-by-side and estimate their prescription drug costs for the year. These tools, along with the opportunity to speak with a benefit adviser if they wish to, help ensure that our customers find the plan or plans that meet their health needs and the needs of their budget.

Massachusetts and Utah already offer the ability to buy health insurance online through their state exchanges. The upcoming Supreme Court decision on the Patient Protection and Affordable Care Act will determine if citizens in every state will have the same opportunity. If all or part of the ACA is struck down, health insurance exchanges — a forum whose effectiveness is based on transparency in costs, benefits, services and products (such as drugs) — could be in jeopardy.

Related articles

For regular commentary on developments and trends in health care, insurance, and health IT, follow @brycewatch and @ExtendHealth on Twitter and check out Extend Health online.

Three highly qualified experts wrote this thoughtful post for the Health Affairs Blog, examining how the recurring brinksmanship attending the SGR “doc fix” distracts from a larger discussion that needs to happen around how to save money on Medicare in the coming decades.

Such a discussion must begin with the recognition that the purpose of the Medicare system is not to save money.  If our goal was to spend less, we could abolish the system and spend nothing.   The goal of Medicare is to provide protection for elderly Americans against the financial risk associated with illness, and in the process provide beneficiaries with access to high quality care.  Our challenge is to accomplish those goals in a fiscally sustainable manner.

The three authors, (Michael Chernew, PhD, Professor of Health Care Policy in the Department of Health Care Policy at Harvard Medical School; Darius Lakdawalla,  Director of Research at the Schaeffer Center for Health Policy and Economics at USC; and Dana Goldman, holder of the RAND Chair in Health Economics and Director of Health Economics at RAND) have written a cogent and thought-provoking argument for the economic necessity of bundled payment systems in Medicare.

Aetna CEO, Chairman and President Mark Bertolini, speaking at the HIMSS 2012 conference in Las Vegas, says the days of the insurance industry as we know it are numbered.  “The system doesn’t work, it’s broke today,” and  the insurance industry needs to change: “We need to move the system from underwriting risk to managing populations. We want to have a different relationship with the providers, physicians, and hospitals we do business with.” Worth reading for his take on how the industry can re-invent itself.

It’s been an insane month – lots of travel, and I haven’t had a chance to post anything lately.  The Extend Health blog just posted a great roundup of news and opinion on the Ryan-Wyden plan, which is worth a read – reprinted here in its entirety for your convenience.

Bryce

Overview:

Paul Ryan (R-WI) and Ron Wyden (D-OR) released their proposal to overhaul Medicare this week. It is not at the bill stage yet, as the authors hope to cut down on the political rhetoric and start a serious national dialogue about the future of Medicare. Ryan and Wyden have not asked the Congressional Budget Office to review their proposal yet, so it is not known how much their plan would save compared to current Medicare.

Here is a brief overview of some of the plan’s key points:

People over 55 would see no change to their benefits. They would be free to opt into a private plan when the Medicare Exchange is established in 2022.

The “premium support” system would ensure affordable coverage by empowering seniors to choose either traditional Medicare or private plans. And there would be more help for low-income seniors who need it, and less for wealthier seniors who don’t need the assistance.

Medicare plans could be purchased on an insurance exchange established by congress.

Strong consumer protection would include:

  • All participating plans would have to offer benefits that are at least equal to traditional Medicare plans.
  • Risk-adjusted premium-support payments would guarantee affordable coverage for those with the greatest health needs.
  • Plans could neither refuse coverage for pre-existing conditions, nor charge rates that discriminate based on health status.
  • CMS would oversee all plans to ensure transparency and fairness.

Competition would drive program growth. Competitive bidding would force providers to reduce costs and improve quality. Competition between private and traditional Medicare plans would incentivize both to develop better delivery models and ways to care for patients.

Employees in small businesses with up to 100 workers could use their employer’s contributions to purchase their own health insurance, and the cost of free choice options would be fully tax deductible to the employer. In addition, allowing workers to keep the same insurance when they retire would ease their transition into Medicare.

Medicare spending would be capped to GDP plus one percentage point.

Read the full report:  http://budget.house.gov/UploadedFiles/WydenRyan.pdf

 

News Roundup:

Here’s a roundup of news articles written this week about the Ryan/ Wyden proposal, with reactions and opinions from across the political spectrum.

Bloomberg BusinessWeek: Bipartisan Medicare Plan May Spur More Compromise, Ryan Says

The Washington Post: Interview with Rep. Paul Ryan

Politico: Ryan-Wyden under ‘no illusion’ their plan will pass tomorrow – Looming shutdown? W.H. says to pass a short-term CR – Essential benefits, politically speaking

Boston.com: Clipboard: The “Ryden” Medicare proposal

Chicago Tribune: White House blasts new Medicare plan by GOP’s Ryan

Reuters: Republican Ryan backs new bipartisan Medicare Plan

Forbes: Ron Wyden and Paul Ryan’s Bipartisan Plan for Health Care and Medicare Reform

The Wall Street Journal: A.M. Vitals: Ryan, Wyden to Introduce Proposal for Changing Medicare

Time: Wyden-Ryan: A Move Toward Health Care Sanity

The Washington Post: What Wyden-Ryan hath wrought

The Wall Street Journal: The Wyden-Ryan Breakthrough

Kaiser Health News: Wyden And Ryan Join Forces On New Medicare Overhaul Plan

The Hill: Paul Ryan moves away from controversial Medicare reform plan

The New York Times: Lawmakers Offer Bipartisan Plan to Overhaul Medicare

Visit Extend Health — the nation’s largest private Medicare exchange.

Harvard law professor Einer Elhauge put up this OpEd yesterday in the New York Times outlining an interesting argument for the constitutionality of the ACA’s individual mandate clause. Here’s a snip:

But the argument that the commerce clause does not authorize the insurance mandate is beside the point. The mandate is clearly authorized by the “necessary and proper clause,” which the Supreme Court has held gives Congress the power to pass any law that is “rationally related” to the execution of some constitutional power.

I’ve argued before that the law can work without the individual mandate, given the right conditions including annual enrollment periods, affordable, standardized plans and guaranteed issue among others. I’m looking forward to hearing the arguments on both sides as the Supreme Court date gets closer.

Read my latest post for Fast Company on the opportunity health care reform offers insurance companies to compete for new customers. Can insurers adapt quickly enough to take advantage of this tremendous market opportunity? To find out, read “Can Health Insurance Become Customer-Friendly And Web-Savvy?

Politico reports that the Supreme Court will decide to take on the health care reform case by Dec 10th. But folks — the deed is done. SCOTUS is taking the case. In reaction, AHIP has filed an  amicus brief anticipating the case. Their message? The mandate connects everything. Read it here >

We recently posted this on the Extend Health blog and I thought you might find it interesting.

On Wednesday (10/12), the federal government released its annual review of private Medicare Advantage health plans. In addition, 5-Star quality ratings are now posted along with the plans loaded in “Medicare Plan Finder available on Medicare.gov.

This year health plans are paying much closer attention to their ratings because they stand to make more money if they score higher on Medicare’s 5-star quality rating system. The bonuses could be substantial, even for insurers that only make small increases in their ratings. Carriers with well-rated plans hope that the droves of baby boomers becoming eligible for Medicare will pay attention to the star ratings and choose their plans.

The ratings are based on 36 measures in five categories, covering things like screenings, tests, complaints, service, and other relevant measures. There’s a helpful CMS document called, “Choose Higher Quality for Better Health Care,” that provides a very good overview of the program. We also recommend reading our previous blog post, “New MA star ratings released by CMS.”

For more, check out these very good articles written recently on the subject.
Private Medicare Plans Use Stars To Navigate For Profits” from NPR

Chasing The Stars, Insurers Improve Quality — And Revenue” from Kaiser Health News

Visit Extend Health — the nation’s largest private Medicare exchange.

My latest Fast Company blog post here. A new Kaiser study shows that health care premiums are skyrocketing, but as new provisions of health care reform come into effect, companies can do a lot to make their employees healthier for less money.

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Visit Extend Health — the nation’s largest private Medicare exchange.