Insight, analysis & opinion from Joe Paduda

Oct
11

Direct contracting

A reader asked several excellent questions about when and under what circumstances direct contracting makes sense. That’s when an employer contracts directly with health care providers.
My take is an employer has to have at least 750 lives in one area – plant, school, city government, facility, etc. in order to have any buying power at all. And 750 may well be on the low end.
As to whether a partially self-insured employer, say one with a specific deductible of $50,000, should do this, I’d say yes. The vast majority of bills will come from members with total costs well under the $50,000 limit.
Lastly, direct contracting takes expertise and patience. Knowledge of provider payment mechanisms and expectations, an understanding of the related legal issues, an intimate understanding of the local provider community, and really good employee relations are the bare necessities. Without these, stick with a “regular” health plan.

Continue reading Direct contracting


Oct
10

Welcome to Health Affairs

Health Affairs, my favorite health policy magazine (and perhaps the only health policy magazine) has launched a blog. One of the first posts is by James Robinson, and is a review of Redefining Healthcare by Porter and Teisberg. I haven’t read the book so I can’t comment on Robinson’s commentary.
One of the complaints about Health Affairs is it only appears quarterly; then again, given the weighty nature of the periodical that may have been a blessing in disguise. The new blog will likely remedy that situation, although the blog’s apparent weekly posting schedule will have to be fixed if HA wants to be a meaningful player in the blog-o-sphere.
They’re just getting started, so let’s give them time.


Oct
4

Health Wonk Review – the Harvest Moon edition

Health Wonk Review is up and sprinting. Despite a hint of chill in the air here in New England, the darn thing is growing like a weed. I attribute that to the hothouse conditions that exist in today’s health care policy environment.
Thanks to all who submitted entries; a few did not make the cut as they were not remotely on-topic. Those that did make the cut represent the best of health policy blogging.

Continue reading Health Wonk Review – the Harvest Moon edition


Oct
3

Washington v Ohio

Ohio’s Bureau of Workers Comp (BWC) could take a lesson from the State of Washington’s own workers comp fund. While the two state funds have some similarities, their results are quite different.
How different? Read on…

Continue reading Washington v Ohio


Oct
2

Florida’s State CFO race

Florida is one of, or perhaps the only, state to have as an official elected position a state CFO. The incumbent is supposed to oversee state spending, review state contracts and investigate insurance fraud among other functions. Florida’s CFO is also part of the four person cabinet along with the governor, attorney general, and Commission of Agriculture and Consumer Affairs.
Obviously, the CFO would have a broad and deep impact on the state’s insurance industry, the provision of same, and purchase of insurance by the state. That makes it interesting for we insurance types.

Continue reading Florida’s State CFO race


Oct
2

Drugstore.com’s consumerism efforts

As a drugstore.com customer, I received an email (along with a few hundred thousand other folks) from the company’s CEO last week. The email was their response to the recent announcement by Wal Mart that they were cutting prices to below $4 for a month’s supply of almost three hundred generic drugs.
The net is the folks at drugstore.com claim to provide prices that are already lower than Wal Mart’s for the equivalent supply.

Continue reading Drugstore.com’s consumerism efforts


Sep
29

The feds did it

For readers interested in workers comp, news from Effect Measure to whet the appetites of litigators looking to subrogate workers comp claims.
It seems that the highest levels of the Federal government were intimately involved in publishing information about the safety, or lack thereof, of the air around the WTC in the days after 9/11. And by all accounts they got it wrong.
Liberty Mutual, among other workers comp insurers, was, and is, on the risk for many of the people affected by the clouds of noxious substances resulting from the Towers’ collapse. Perhaps they are already subpoena-ing away…


Sep
28

Matt 1, NYTimes 0

I was going to post a blistering riposte to an amazingly lousy article in the NYTimes (registration required), but Matt Holt beat me to it.
The Times article says words to the effect that the reason health care costs so much is because it makes us live longer. Boy is that misinformed, superficial, ineptly researched, and just plain wrong.
Health care costs so much in the US because prices are high and practice pattern variation prevails and there are too many uninsured and cost-shifting is rampant and Congress and the White House would rather grand stand about Terry Schiavo than address real problems.
Good work Matt.


Joe Paduda is the principal of Health Strategy Associates

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