Implementing Health Reform – Health Wonk Review reports

Now that health reform is the law of the land, the focus has turned to implementing the law itself. As anyone knows, the real work, and the real impact, is in the details, the definitions, the requirements and operating guidelines.
And that’s what this edition of HWR is all about.
Fundamentals
Let’s begin this edition of HWR with a quick review of the fundamentals – starting with Tinker Ready’s reminder that “All health care is local.” Actually she’s channelling Atul Gawande in her report on his talk at the National Quality Colloquium this week. Gawande’s summary of why that’s the case is a very helpful reminder as we contemplate implementing reform.
My contribution to this edition asks the rather uncomfortable question “Managing health care costs – whose job is it?” WIth health plan associations whining about the lack of cost controls in the reform bill, one has to ask – exactly what function do health plans perform? If they’re asking the government to control costs, what is their purpose?
Friend and colleague Gary Anderberg is guest-posting over at Workers Comp Insider this biweek; Gary’s post is similar to Tinker’s in that his focuses on health insurance, and the services covered by insurance, are really ‘risk management tools’ to help maximize productivity. True True True, and a wonder more don’t think the same way…
On the “Good News’ front,“Congratulations If You Were Born Between 1952 and 1964” takes a look at the recently released report that shows health reform just extended the financial solvency of the Medicare Part A Trust Fund by 12 years. Brad Wright also stresses that we’re not out of the woods with the cost problem–2029 isn’t that far away–and we need to realize that this isn’t a problem we can solve, as much as it’s a tension that we have to figure out how to navigate.
In that vein, the always-insightful Jason Shafrin tells us the real story re the impact of reform on state budgets – not too good, but not too bad, either.
Reactions to reform
The opposition to reform continues to make its case; Anthony Wright documents the ongoing efforts by Anthem Blue Cross of California to stop California’s health insurance exchange. Anthony opines Anthem’s actions “should be a clarion call for California consumers about why we need to advance these bills, this year.”
In a related post, Roy Poses digs deep into Wellpoint’s rate increases, and finds out that the employee tasked with announcing the increases had serious concerns, concerns that may have led to her termination. As always, Roy finds the truth and does some of the best reporting in the blogosphere.
These last two stories are particularly important, because as Aaron Carroll warns us, insurance companies are very good at what they do. Which in this instance is risk selection. Talking in this case about Medicare HMO enrollment, Carroll elaborates:
“Somehow the private insurance HMOs figured out a way to get the healthy people to jump ship out of the another plan into theirs!
Not only that, but people who left the (private) HMOs and went back to the (public) Medicare used 180% more care after leaving than the people who stayed. Somehow the private insurance HMOs figured out a way to convince the sicker people to jump ship back to the public plans.”
Jaan Sidorov notes that “the odds against prevailing against a Presidential veto are..questionable and the waste of political energy would be atrocious.” But Jaan does think that the bill can be improved, and offers serious ways opponents should move.
The always -informed and -informing Maggie Mahar thinks the liberals/progressives who are hoping the anti-reform folks succeed (as it will usher in a single payer system) are basing their hopes on faulty assumptions, namely that Americans will like a Medicare-for-all plan. Maggie notes “A great many Americans have employer-based insurance that they like–particularly if they work for large companies. They don’t want to give it up for an unknown government plan.”
Maggie adds: “we’re all lucky that large companies are covering so many people with benefits that are, on average, rich and comprehensive.”
EHR, benefits, and babies
One of the keys to health reform is widespread adoption of Electronic Health Records; David Blumenthal and Dr Don Berwick (yes, the same Don Berwick who runs CMS) document the significant progress being made in that direction, emphasizing the new regs on ‘meaningful use’. Anyone remotely involved in EHR should read their post…
But before we adopt those EHRs, make sure to shred the patient records – or suffer the consequences described by David Harlow.
Implementation is all about the details – and there are bazillions of them, all critically important to those directly impacted. Jay talks about maternity coverage, and the absence of clarity about same in Colorado – even though all plans are supposed to provide coverage as of 1/1/2011…
Ryan opines that health plans authorized by the Feds should cover birth control, but only because we own the consequences if we don’t.
All carrot and no stick – Innovation in insurance – oxymoronic to some, just plan moronic to others (sorry, couldn’t resist). Our old friend and colleage David Williams writes about the problems realizing the potential of Value-Based insurance Design, noting “in practice most VBID programs encourage the use of high value services but don’t discourage the use of low value services.”
Important in their own way
Kinda-but-not-really related is this piece from Adam Fein of DrugChannels, who broke the story about CMS’s quest for a vendor to survey retail prices, payment, and utilization rates for pharmacy – as well as wholesale pricing. Could this lead to a substitute for AWP? Dare we hope?
Joanne Kenen reminds us why the ER is no place for palliative care, providing insights into what happens there – and more importantly – why.
John Goodman calls Medicaid “the most abusive health plan of all” in his post. Goodman bases his claim on states revising Medicaid enrollment and eligibility requirements, calling them ‘rescissions’. Ed. note – the reason most of these folks lost their coverage is the states where they lived ran out of money to fund Medicaid. Tax increases would’ve solved that ‘problem’…
Finally, over at InsureBlog, Mike Feehan says health plans should keep their reserves, no matter what Consumers’ Union thinks.