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14 posts categorized "Health Insurance"

November 20, 2014

Health Wonk Review: The Turkey Edition

Turkey-palace.png Welcome to Health Wonk Review, the bi-weekly blog carnival featuring the latest and greatest blogging by a staggeringly wonkish agglomeration of health care policy nerds. The last edition of Health Wonk Review was hosted at Wing of Zock. The story behind the name of that blog seems (to this health wonk, at least) oddly relevant to this edition's theme, given the recent news that the construction costs of the new presidential palace in Turkey seem to have doubled ... again.

Well, our frame this week is the other turkey, the turkey that will lull many of us into a stupor late next week, and the health care policy decisions (and decisionmakers) that sometimes make us wish we were in more of a stupor ... so as to lessen the pain. Top of mind in that department this week is #GruberGate:

Continue reading "Health Wonk Review: The Turkey Edition" »

October 02, 2014

mHealth Fitness Trackers Have a Long Way to Go

10123541544_80f31e218d_oA report on a survey regarding wearable fitness trackers arrived in the HealthBlawger's mailbox this week. An interesting dose of reality, after spending a few days in Silicon Valley recently with a cadre of early adopters.

Here are the highlights:

>> 74.9 percent of adults do not track their weight, diet, or exercise using a fitness tracking device or app
>> The most commonly cited reason for not tracking fitness or health is a general lack of interest (27.2 percent), followed by concerns over device cost (17.7 percent)
>> 43.7 percent respondents did not have a specific reason for not tracking their fitness
>> 57.1 percent of non-tracking adults said that the possibility of lower health insurance premiums would make them more likely to use a fitness tracking device
>> Less than half of respondents (44.3 percent) said that better healthcare advice from their physician would be an incentive to use a fitness tracker

Continue reading "mHealth Fitness Trackers Have a Long Way to Go" »

August 07, 2014

Solving Sovaldi: David Harlow Talks Value-Based Payment with Cyndy Nayer

6793824321_398d881757_mWe have been deluged with stories about the $100-a-pill medication for Hepatitis C. Is it really worth $87,000? (Well, it's cheaper than a $600,000 liver transplant.) I had the opportunity to speak with Cyndy Nayer, of the Center of Health Engagement, about the issues surrounding this drug and its use, value-based approaches to payment, and the question of whether we are able to solve this problem in our current environment at all.

Continue reading "Solving Sovaldi: David Harlow Talks Value-Based Payment with Cyndy Nayer" »

May 23, 2014

The Affordable Care Act: How Provider Organizations Can Succeed Under Health Reform

The Affordable Care Act has triggered many changes in the health care delivery system. Learn about the health reform-inspired approaches to redesigning care that work (or don't work) for management of chronic conditions, including diabetes -- from ACOs to bundled payments to patient centered medical homes.

I recently had the opportunity to present to the domestic affiliates of Joslin Diabetes Center on this topic.

Continue reading "The Affordable Care Act: How Provider Organizations Can Succeed Under Health Reform" »

March 12, 2014

How do you get Young Invincibles to buy health insurance?

C480x270_48President Barack Obama is pushing his signature domestic program, enrollment in a health insurance plan via healthcare.gov by March 31, by shilling for it on the "Funny or Die" Zach Galfianakis mini talk show satire, "Between Two Ferns." I think it's hilarious, though not everyone thinks the humor involved befits a sitting president. Whether or not you appreciate the humor, I think you have to doff your cap to the Commander in Chief, because he is living by the maxim that you've got to fish where the fish are -- and choosing this website over network television, over White House-hosted online media, using video, using authority-subverting humor, has gotten the message out (including a clickable link) to the Young Invincibles in a way that other media just could not have done. The video was posted yesterday; it has already been viewed over 13 million times, and was associated with tens of thousands of click-throughs to the exchange website by the close of business yesterday.

Continue reading "How do you get Young Invincibles to buy health insurance?" »

December 02, 2013

Narrow Networks and Medicare Advantage: The True Meaning of Managed Care?

Narrow road signUnited HealthCare and other Medicare Advantage plans are dropping numerous providers from their networks, to the consternation of members given short notice of the changes. Predictably, the story is presented as big bad insurance co. vs. grandma, but the real story is less clear-cut.

For years, Medicare Advantage plans have benefited from a regulatory structure that pays them more than the average Medicare fee for service cost for parallel populations and asks the plans to provide some addtional services to beneficiaries in return for the bonus payments. The reimbursement has been attractive enough to keep numerous insurance companies involved in Medicare Advantage.

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November 12, 2013

Health Exchange Enrollment: Speed of Light or . . . Molasses

Mass_enrollment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Much has been said and written about the dearth of new commercial health insurance plan enrollees on the federal and state exchanges and, by contrast, the excessive numbers of Medicaid expansion enrollees, the death spiral signified by the absence of Young Invincibles from the exchanges, etc.

The HealthBlawger suggests: Cool your jets.

Continue reading "Health Exchange Enrollment: Speed of Light or . . . Molasses" »

October 30, 2013

Mobile Health Apps: Pass the Secret Sauce

6029363903_0e9abdceab_mThe IMS Institute for Healthcare Informatics released a report on the ecosystem bloody mess of 40,000+ mobile health apps that are available today. Hat tip to Jane Sarasohn-Kahn for writing about it today at Health Populi.

From the executive summary:

Over time, the app maturity model will see apps progress from being recommended on an ad hoc basis by individual physicians, to systematic use in healthcare, and ultimately to an end goal of being a fully integrated component of healthcare management. There are four key steps to move through on this process: recognition by payers and providers of the role that apps can play in healthcare; security and privacy guidelines and assurances being put in place between providers, patients and app developers; systematic curation and evaluation of apps that can provide both physicians and patients with useful summarized content about apps that can aid decision-making regarding their appropriate use; and integration of apps with other aspects of patient care. Underpinning all of this will be the generation of credible evidence of value derived from the use of apps that will demonstrate the nature and magnitude of behavioral changes or improved health outcomes.

(Emphasis supplied.)

We are nowhere near this endpoint -- integration of the use of health apps into health care management -- right now, due to a number of factors.

Continue reading "Mobile Health Apps: Pass the Secret Sauce" »

August 27, 2013

Health Insurance Company Member Engagement Index: The EveryMove 100

There's a new index in town. Today's entrant is the EveryMove 100, a ranking of health plans across the US "based on how they engage with and empower consumers to manage their own health." according to the presser. (EveryMove is a health rewards based marketing and incentives company that provides opportunities to consumers to earn benefits by engaging in healthy behaviors.)

Consumer engagement and empowerment in the health care sphere are a good thing, so I asked EveryMove CEO Russell Benaroya for a little more information on these rankings, as the website was short on detail. He filled me on on the initial metrics, and suggested that the metrics will be revisited on a quarterly basis by the team and advisory board (which at present includes Matthew Holt, Aman Bhandari and Garrison Bliss).

At the outset, health plans are ranked by these five categories of consumer engagement and interaction:

Continue reading "Health Insurance Company Member Engagement Index: The EveryMove 100" »

June 18, 2013

Alternative Quality Contract with Blue Cross Blue Shield of Massachusetts: A model for ACOs?

Managed Care Magazine recently ran a story on the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract (AQC), which serves as a model for the ACO program under the Affordable Care Act. Check it out: Bay State Blues Combine Global Payment With Quality Metrics. The author of the piece, Joe Burns, contacted me as well as others in Massachusetts for comment.

My take, drawn from the story:

David Harlow, a health care lawyer in Newton who writes the HealthBlawg, agrees [that the early findings are encouraging], calling the AQC a significant development for two reasons. First, it is an alternative to fee for service.
“That’s appropriate because there is a need to change the incentives of health care providers in the system,” he adds. Second, the AQC is important because it has served as a model for the federal Centers for Medicare & Medicaid Services’ accountable care organizations.
“The problem with past attempts to control health care spending is that adequate quality standards were not in place,” Harlow says. “It was all about keeping costs down. While this model represents an improvement over other models, the amounts at risk are relatively trivial and, standing alone, will not bend the cost curve.
“Nevertheless, the AQC is different because no provider group can earn a quality bonus unless the physicians and hospitals achieve or exceed the quality standards.”

As I've written before, I think the focus should be on long-term planning for a wholesale shift away from fee-for-service medicine rather than trying to expose and rationalize payment levels. Global payments (a euphemism for that dirty word, capitation), a bonus structure tied to performance against quality benchmarks pegged at a level sufficient to change provider behavior, and dedicated funding within the global payment system for nurse case managers and other elements of the medical home model, are the key elements of the solution we are looking for.

The AQC is a good start. 

David Harlow
The Harlow Group LLC
Health Care Law and Consulting