Mar
28

Pay attention!

You’re swamped. I’m swamped. Work, kids, parents, sports, Iraq, vacation plans, tax season, Anna Nicole – there are hundreds of urgently important things filling your time, demanding your attention.
Health care reform is too complicated, too big, too partisan, too much to think about.
It’s also going to affect you, your family, your income, our economy and quality of life more than any other issue on the table today.
Health care reform is the biggest, most influential issue facing America today.

Continue reading Pay attention!


Mar
21

Bush v Wyden v. Americare

A study just released by the Commonwealth Fund supports my contention that in comparison to the other health care reform measures now in Congress, Pres. Bush’s health care reform plan would have minimal impact on health care costs and the number of uninsured..
On the positive side, Sen Ron Wyden’s Healthy Americans Act and the Stark/Kennedy/Dingell expansion of Medicare look pretty good.

Continue reading Bush v Wyden v. Americare


Mar
8

When consumers will shop for medical care

Consumers will price shop for some medical services, and won’t for others. And the times they are most likely to shop are when services are after a diagnosis has been made, the services sought are relatively simple and elective, and the consumer’s insurance plan motivates shopping.
Those are the key points in Paul Ginsburg’s MarketWatch piece in Health Affairs‘ most recent Web edition. (full access requires a subscription to HA)

Continue reading When consumers will shop for medical care


Mar
5

The stock market’s take on health care reform

Big changes are coming to Medicare, changes that are going to dramatically effect health plans, providers, PBMs, and pharma.
Medicare Advantage’s “bonus” payments are going to be cut significantly, Part D sponsors will likely see reductions in their payments from the Feds, and the planned 10% reduction in Medicare’s physician reimbursement is not going to happen.
So why isn’t the stock market reacting?

Continue reading The stock market’s take on health care reform


Feb
27

URAC’s foray into pharmacy benefit management

URAC, the accreditation body that seems to be into every aspect of managed care, is now looking to certify PBMs. In a presentation at the PBMI conference in Phoenix last week, a representative provided an overview of the process, modules, timing and certification levels contemplated by URAC.
While the process is only for health lines today, URAC is seriously looking into accrediting WC PBMs
Brace yourselves.

Continue reading URAC’s foray into pharmacy benefit management


Feb
26

Fixing CDHPs

As I’ve said a few times before, today’s consumer-directed health care plans (CDHP) are not much different from the $100 deductible major medical plans of forty years ago. (That $100 is now equivalent to over $600) Although advocates loudly proclaim CDHPs as a solution to the health care crisis, experience to date indicates that the adoption rate is quite low and the impact on cost is modest at best.
If consumerism is going to have any material effect on health care costs and utilization, it will have to reflect the realities of the health care purchasing decision process and the demographics and health status of the insured population, and recognize the lack of useful data on health care procedure prices and provider quality.
Other than that…

Continue reading Fixing CDHPs