Insight, analysis & opinion from Joe Paduda

Aug
9

Bilateral Oligopolies

The increasing consolidation in the health insurance market is beginning to run up against the same situation among health care providers, creating the market condition known as a bilateral oligopoly (few sellers and few buyers). This appears to be happening in Denver, where UHC is battling HealthOne over contract terms, reimbursement and likely other sticky issues.
There are two points here.
First, according to several sources, HealthONE is an excellent system with enviable outcomes; therefore is entitled to ask for better reimbursement than lower-performing systems. One of those sources is UHC itself. Here’s a quote from the press release
“”Interestingly, HealthONE hospitals earned the highest quality rankings among Denver metropolitan hospitals for a majority of procedures evaluated in UnitedHealthcare’s first ever-report card, released in June of this year,” said Patrick Powers, HealthLeaders-InterStudy senior analyst. “These report cards are part of UnitedHealthcare’s new pay-for-performance initiatives, which should translate into improved rates for high quality hospitals.” That’s only half of the story, as we aren’t privy to the rates UHC is offering and HealthONE is demanding. That said, HealthONE seems to have a strong case for strong rates.
Second, while a “bilateral oligopoly” may send you (and certainly sent me) scrambling for the e-dictionary, the net is the big players do battle while the consumers try not to get trampled underfoot. Here we have a very large insurer and a very large provider fighting over rates and access, while the consumer waits anxiously for these behemoths to resolve (or not) their squabbles.
Reminds me of the old joke about what you find between elephants’ toes.
Slow running natives.


Aug
8

CDHP Summit

I’ve received an invite from the folks conducting the Consumer Driven Healthcare Summit to attend the September 13-15 conference as a representative of the blog world, sort of a “press invite”. I applaud their openness in two respects – first, I’ve not exactly kept my skeptical views of consumerism in health care to myself; and second, bloggers are a wierd, strange, new form of media that many don’t yet recognize as important or even worth noting.
So, I’m looking forward to it.
The agenda includes talks by Paul Ginsburg of the Center for the Study of Health System Change (one of the few truly excellent policy/analysis concerns); Jon Gabel on how much consumers are actually contributing to their HSA accounts; Karen Davis of the Commonwealth Fund, Ron Pollack of Families USA and John Iglehart of Health Affairs on the Downside of Consumer Driven Healthcare; and several sessions on results of studies and research into various aspects of CDHP and its cousins.
This should be fun. And I’ll be doing my best to report live from the scene, in the best tradition of Matthew Holt.


Aug
7

Bill Frist, welcome to the health care blogosphere!

Sen. Bill Frist, the senate majority leader and ex-cardiac surgeon and heir to the Frist family fortune (they started hospital firm HCA), has launched a health care blog. A quick perusal indicates posts on med mal reform, Massachusetts’ health care reform initiative, and bioterrorism. There are also copies of articles by the Senator for those inclined to learn more about his opinions.
As a relatively new entrant to the field, we’d suggest a couple of things to the Senator. First, hotlinks are pretty useful, and help provide support for statements such as “Many states have passed laws that attempt to keep frivolous lawsuits from being filed and keep liability premiums down…”
It’s also helpful to be specific and clear when writing. Parsing out the quote above, it is notable that the dependent clause “that attempt to keep frivolous lawsuits from being filed and keep liability premiums down” relates to the “passed laws”, and does not imply that these laws actually do reduce frivolous lawsuits. Kind of nuanced, but readers appreciate the clarity.
At the risk of being accused of being snarky, I’d also point out that the focus on medical malpractice is somewhat bizarre, given the Doctor/Senator’s propensity for refuting other physicians’ diagnoses without first examining the patient.


Aug
7

Health care costs and property taxes

Here’s another way health care costs weave their way into our lives – the town of Richland Hills, Texas is increasing property taxes to pay for a 20% rise in health insurance costs. While the increase in the mill rate (the cents per hundred dollars of property value) will only go up 0.6, it’s another example of the growing awareness of the impact of health care costs on a community.
The same is occuring in communities as different as MIssoula Montana, Boxborough Mass, and the state of New Jersey.
This is a national problem. Today’s NYTimes reports that property taxes have gone up two to three times faster than personal income in the tri-state area. As a resident of Connecticut and eight year veteran of my Town’s Board of Tax Assessment Appeals, I have first hand knowledge of taxpayers’ growing concern, and even anger, over rising property taxes. Now, new laws will require municipalities to report their future health care liabilities, a requirement that had a significant impact on public companies’ valuations and financial reporting.
And may well lead to even more taxpayer unrest; public entities typically provide health care benefits that are considerably more generous than those dispensed by the private sector. One of the stated reasons is these benefits are a form of compensation that makes the jobs more attractive given the wages, which tend to be somewhat below the private sector. While the latter may be true, the rationale instantly brings to mind the disaster unfurling at US auto manufacturers, who used the same logic decades ago to provide very generous health benefits in lieu of salary increases.
And look what’s happened to them.


Aug
3

More on drugs in workers comp

Drugs account for over one-eighth of workers compensation medical expenses, and that number continues to increase. The data from NCCI’s latest research paper on workers compensation drug costs is consistent with the findings of my firm’s research, and provides additional detail on the specific drugs that account for the majority of dollars spent.
NCCI’s report includes results up to 2003; while there have been several significant changes since then (the disappearance of most of the COX-2s, patent expiration on Oxycontin, and the explosive growth of Actiq), the report’s year-over-year trend data is sobering.
Of note, experience indicates that the most sophisticated payers are holding increases in the 2-5% range through the use of clinical management programs, data mining, adjuster training, strong EDI connections, and intelligent third party biller strategies.
Their less-sophisticated colleagues are at the other end of the spectrum, experiencing 15% and higher annnual inflation rates.
What does this mean for you?
If you aren’t working hard on this, you may want to get started.


Aug
2

Cavalcade of Risk is up

Julie Ferguson, the force behind more than a couple health-related blogs, is hosting the latest edition of Cavalcade of Risk at Workers Comp Insider. With only five editions, the C-cade is up to 20 entries, and quality ones at that.
Peruse and ponder the non-purple prose!


Aug
2

Survey of healthcare blogging

Fard Johnmar of Envision Solutions and Dmitriy Krugylak of The Medical Blog Network are working on a survey of health care related bloggers. The survey, which is on-line (natch) covers a variety of topics and is open to any blogger that devotes a third of their time to the health/medical world.
So if you qualify, hop on over and render your thoughts and opinions.


Aug
2

Accrediting Indian hospitals

Assuaging concerns about quality, treatment standards, and outcomes is one of the biggest challenges facing off-shore medical facilities eager to extract a fraction of US health care dollars. That and figuring out how to make a Mumbai hospital look and feel like the one just down the street from the medical tourist’s neighborhood.
Into this business opportunity (the former, not the latter) has stepped an Australian certification body, the Australian Council on Healthcare Standards. Working with two Indian groups, the Quality Council of India (QCI) and the National Accreditation Board for Hospitals and Healthcare Providers (NABH), the Aussies will help revise national credentialing and standards for Indian health care facilities.
The standards are likely to closely parallel those developed by another body, the ISQua, The International Society for Quality in Health Care. ISQua includes board members from URAC, JCAHO, and accrediting organizations from other countries, and is operational in 70 nations.
As healthcare goes global, and American companies and individuals seek to reduce expenses while assuring quality, expect that we’ll hear more about health plans that include first-dollar coverage for services rendered at ISQua certified facilities.
What does this mean for you?
The world is getting smaller, flatter (thanks Tom Friedman) and more competitive, and providers who ignore competition from overseas do so at their peril.


Aug
1

Retiree benefits aren’t sustainable

As corporate profits have surged over the last six months, retiree health care benefits have been reduced at many companies. That’s the headline, but the reality is not so simple.
Large, old-line manufacturers with negotiated benefits and lots of retirees (think steel and autos) are facing bigger-than-huge retiree health care costs, driven in large part by benefit plans that don’t even have deductibles or copays. As these firms continue to get hammered by international competitors with much lower labor expenses, they are seeking ways to reduce their costs.
And retiree health care costs are a very big drag on many of these companies, hurting their ability to invest in new products, new employees, new plants and equipment. Sure, GM, Ford, Kaiser Aluminum, US Steel and other companies made lots of decisions, including trading benefits for labor peace, that don’t look so smart in hindsight. And GM and Ford completely missed the boat on fuel economy.
But all that is beside the point. If American manufacturers can’t reduce their cost of health care, they will be increasingly unable to compete.
Here’s one potential solution.


Joe Paduda is the principal of Health Strategy Associates

SUBSCRIBE BY EMAIL

SEARCH THIS SITE

A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.

 

DISCLAIMER

© Joe Paduda 2024. We encourage links to any material on this page. Fair use excerpts of material written by Joe Paduda may be used with attribution to Joe Paduda, Managed Care Matters.

Note: Some material on this page may be excerpted from other sources. In such cases, copyright is retained by the respective authors of those sources.

ARCHIVES

Archives