Transparency. The basic requirements of consumer-directed health plans (CDHPs) are price transparency and outcomes data. The foundational concept underlying CDHPs is that consumers will ask how much services cost, and providers will be able to tell them.
Oh were it only possible. It looks like the six million folks who have bought CDHPs from an insurance industry eager to tout them as the second coming of (pick a deity) are having a tough time getting the pricing info they need to make informed decisions.
Aetna is ahead of the rest of the industryin providing information about phyeicians and pricing; they have been providing actual reimburement amounts for specific procedures in selected markets for some months. Humana is also doing this on a limited basis in at least one market (southern Wisconsin).
Here’s a quote from the Chicago Tribune article:
” But basic data about what services cost generally aren’t available. Medical providers and insurers consider this to be highly sensitive competitive information, and their contracts require that it remain secret.
That leaves consumers with more financial responsibility for their care but without the tools to manage these expenses.
“The market just isn’t ready yet to deliver on the promise of these new insurance products,” said Larry Boress, president of the Midwest Business Group on Health…”
While recent legislation will require hospitals and some other facilities to disclose their prices, the “prices” will be the list prices, and not the discounted rates. Thus this requirement may not be terribly helpful for consumers looking for useful information.
What does this mean for you?
Another (very large) hiccup on the way to consumer-driven nirvana.
Thanks to FierceHealthcare for the tipoff to the Trib’s article.

United Healthcare’s stock plunged yesterday after it reported it could not file its second quarter financials on time due to difficulties dealing with stock options for Chairman Bill McGuire and others.
UHC’s stock has dropped 22% this year, largely due to regulatory scrutiny of UHC’s practice of backdating stock options for McGuire, who now holds options valued at about $1.6 billion. At least that was the options’ value before the stock’s slide.
This is not the only issue UHC is facing. It’s management of HMO Medica has come under scrutiny of late as well. There are allegations that the management contract was much too lucrative and UHC’s performance was substandard.
UHC grew in large part due to McGuire’s visionary leadership, business acumen, and focus on building value. The dark side of the McGuire era, one that may now be ending, is now showing itself, and it isn’t pretty. It looks like outright greed from here.

From Hank Stern and Bob Vineyard at Insureblog comes a note that they posted about a problem a CIGNA HSA aka High deductible health plan (HDHP) client had that looks remarkably similar to the now-well-known “colleague”.
Turns out that the CIGNA HSA plan, which is supposed to help insureds be more sensitive to their expenditures by giving them a financial stake in their care, does not appear to allow insureds to access CIGNA’s contract discounts if the insured has yet to meet their deductible.
Evidently other HDHP/HSA plans have similar provisions. While this may make sense in the ivory tower in Edina (home of UHC) or Philly (CIGNA), it makes no sense to a mom with a child screaming due to an apparantly terminal earache, adverse drug reaction, or profusely bleeding head wound. And it will…anger…her immensely, leading her to switch plans (and wonder why this is so complicated and unfair and timeconsuming and stupid).
A reader asked what my opinion of HSAs is.
I believe that getting patients involved in their care, their health, and the financial implications of same is an excellent idea. Twenty years ago I worked for a firm that was trying to do just that – demonstrate to individuals and companies that many health care conditions were due to bad choices. We actually developed a rough algorithm that linked health behaviors, conditions, and attitudes to future health care expenditures. And no one bought it.
So, I still believe in the concept.
What I don’t believe is HSAs as a panacea. I’m not going to get into all the reasons for this; if you‘re interested read here. It also makes me nuts when pundits and politicians and “economists” claim that all we have to do is add a healthy dose of “consumerism” to health care to fix it. What morons.
I do believe that this focus on HSAs and consumerism is largely a waste of time. We should be working to fix our system, not tweaking around the edges. And all this tweaking does is postpone, and make much more expensive and painful, a real solution.

My post about a colleague’s unwitting effort to educate the rest of us about the nuances of HSAs and payment policies has drawn a bit of interest amongst loyal readers and a couple of others as well. That requires follow up.
The plan itself is not a full service plan, instead it is a “hospital surgical” plan that covers (among other things) emergency room services but only in a hospital, and does not cover physician office visits. A brochure, entitled “UHC Choice Plus network” was included in the marketing package, and states that “when you use a network provider for medical services you benefit from the special rates offered to covered members…” that my colleague interpreted, reasonably, to mean that s/he would benefit from UHC’s negotiated discounts. And, when the colleague’s dependent needed emergent care, located a UHC-contracted provider, and went to that provider.
Here’s a quote from the colleague:
“it would be really hard to negotiate with a facility given the fact that I was not aware that I needed to as well as that I was attending to an injured child. Actually my spouse was as I was traveling on business. The furthest thing from my spouse’s mind at the time was negotiation of rates. This is why we contracted with UHC…”
Golden Rule is the United Healthcare entity responsible for most of the company’s HSA offerings. Their website has a disclaimer regarding care, quality, medical services, but nowhere is it mentioned that payment for services under a deductible are not subject to the network rate. Here’s what the language says (bolded text is my edit):
“UnitedHealthcare arranges for providers of health services to participate in a network made available to you as a Golden Rule Insurance Company insured. Network health care providers are independent contractors and are not employees of Golden Rule Insurance Company or UnitedHealthcare. Golden Rule Insurance Company makes payment to network providers through various types of contractual arrangements.”
Another part of their website references the “shared savings” program; here’s the language: “When you seek health care in the UnitedHealthcare network, you can take advantage of network benefit levels and negotiated discounts with network providers. Staying in-network will result in the lowest out-of-pocket cost to you.” Seems pretty unambiguous…
But, the site then directs you to go to another site (Multi-Plan), to find providers who participate in the “shared savings program.”
So, technically UHC is more correct than not; the colleague is likely not a “covered member” for that particular service and therefore the health care sought and received is not covered, and therefore not subject to the UHC contracted rates.
But, and this is a mighty big but, UHC’s stance fails, miserably, what my friend Peter Rousmaniere refers to as the “reasonableness” standard. What would a reasonable insurance customer making a reasonable interpretation of the language conclude?”

Health insurers are reluctant to pay for experimental or unproven medical procedures and drugs. And in most cases that makes sense; whether its apricot pits for cancer or artifical cartilage, until there is proof that the treatment will positively impact the condition, obtaining that care could harm the patient, or provide no benefit, while costing the insurance company (and therefore its policyholders) lots of money.
That long standing norm has required insurers to staff medical committees , also known as P&T committees, whose function is to assess new procedures and determine the insurer’s coverage policy. These committees determine if the treatment is covered in all instances, for specific diagnoses, only after other therapies have been tried, or not at all. And in my experience the committees have done their jobs well, diligently, and fairly.
Personalized medicine, aka gene-based therapy, has long stood just outside the committees’ meeting rooms, rarely poking its nose in but nonetheless a very real, and very shadowy presence. The door is about to open, forever altering the size, role, staffing, and reach of these committees. The knock is coming from a beta blocker, Bucindolol, which appears to work quite well for a few people and not at all for others. Early trials were terminated when it seemed the drug did not work nearly as well as others. Now, evidence is emerging that the drug is effective for a segment of the population with a slightly different genetic makeup.
This is the kind of information that will lead to a transformation of the P&T committee, benefit design, medical ethics and likely utilization review. Committees will become larger, require deeper knowledge of genetic medicine, and likely become even more tightly integrated with the medical management department.
And that’s a good thing.

In a presentation to the Global Six Sigma Summit, CIGNA (health plan) CEO Ed Hanway made the link between good health and economic viability. This is one of the few times I have seen a health plan exec directly address the real reason employers should be concerned about health care – its impact on their workers’ productivity and therefore the employers’ success.
Considering that over 50 million workdays were lost due to a failure to receive needed care, and that this information has been out for years, it’s encouraging that a health plan CEO has recognized the role of health care in economic success.
Here’s a quote from Hanway’s speech…
“By improving the health and well-being of individuals, we create a more productive work force…By supporting a more productive work force, we contribute to a more competitive business community. By improving business competitiveness, we create a stronger economy. And by strengthening the economy, we build a stronger nation.”
Hallelujah.