The Piper Report has an excellent summary of state health care initiatives. These include plans to encourage employer-based funding of health insurance; reform payment mechanisms for uncompensated care; create better care management for high cost Medicaid patients; and new (and old) pharmaceutical purchasing programs.
States are often the best labs for health care reform, and those states with particularly attractive results (financially and politically, that is) often see their governors move into national roles (see Tommy Thompson and Mike Leavitt, ex governors who went on to run HHS).

In a refreshing acknowledgement of reality, a top Federal official noted that “if there’s one thing that can bankrupt the country, it is health care. It is out of control.” US Comptroller David Walker made this statement while referring to the growing US budget deficit in a speech in New York last Wednesday.
Walker’s comment came during a talk on the budget deficit where he referred to the health care system and federal government health care programs as key contributors to last fiscal year’s $412 billion budget deficit.
Why is this obvious statement of such interest to your author? Because it is the first public acknowledgement by a Bush official of the primacy of health care over Social Security (although Walker did not mention SocSec specifically) as a threat to the economic wellbeing of the nation. It is likely Walker’s comments were not officially vetted, but regardless, they are one of those “emperor has no clothes” statements that may add a level of urgency to the health care debate.

One of the newer ideas to hit employee benefit health plan design is tiering copayments according to the quality of the provider accessed by the insured. United Healthcare and Medica are two of the health plans that have introduced these plans.
The idea is simple in concept – insureds’ copays are higher for those providers deemed to be less than optimal. The issues lie in the criteria and methodology used to determine the rankings.
A critic, Al Eldendary, president of the St. Louis Metropolitan Medical Society, notes that UHC uses bills and claim data instead of medical records, and therefore the assessment of quality is not based on a complete picture of the patients’ situations.
United’s head of clinical strategy noted that the analytics uses survey as well as patient data, and also acknowledged that the criteria also includes some cost data.
Fof those of us who have been criticizing medical treatment guidelines, provider profiles, and clinical pathways for years, this is another piece of evidence casting doubt on the entire process and the results thereof. Few would dispute that medical bill data is rife with errors of accuracy, that diagnosis and procedure data is not only inconsistently coded but reflects a desire to maximize reimbursement and not to accurately represent the actual care delivered to the patient. Moreover, there is no assessment of the patient’s functionality at the end of treatment.
How can any reimbursement system that supposedly focuses on “quality” fail to consider whether the patient got better, died, returned to full functionality, or was partially disabled? After all, is not the goal of health care to ensure the health and wellbeing of the patient?
What does this mean for you?
Be very wary of medical guidelines, provider reimbursement schemes, and profilign activities that do not take into account the patient’s functionality. Without that end point, you are just looking at the left side of the equation, as the result is unknown.

The Center for the Study of Health System Change is a non-partisan organization that is focused on finding intelligent, practical means of improving the nation’s health care system. Under the leadership of Dr. Paul Ginsburg, CSHC provides a forum for discussion of topics ranging from pharmaceutical issues and the problems of uninsurance, to macro trends shaping health care policy.
CSHC has an excellent seminar planned for July in Washington. Here’s the details:
HSC’s Wall Street Comes to Washington Conference Scheduled for July 13
The 10th annual Wall Street Comes to Washington conference will be held on Wednesday, July 13. The conference will feature roundtable discussions with Wall Street health care industry analysts and Washington health policy analysts. A partial list of panelists includes:

An interesting post in HealthSignals New York addresses the “problem” of seniors hiding or transferring assets to qualify for Medicaid reimbursement for nursing home care. According to a study done by Georgetown University, the problem is not nearly as pervasive as one might think, nor does it have much of an impact on total Medicaid expense.
However, the caveats are that the data used are somewhat dated. Nonetheless, this may be less of a problem than politicians’ rhetoric indicate.
To quote HealthSignals New York:
“As they say, “absence of evidence is not evidence of absence.” This report is helpful and it sets a balanced tone, but by no means does it end the argument.”
What does this mean for you?
Probably not much, but it does indicate how important it is to look beyond the rhetoric to the underlying data.

There is an excellent report on the impact of socio-economic class on access to health care in the New York Times. It is a rather extensive article, perhaps best to print and save for that period from just before takeoff until you’ve reached 10,000 feet and can fire up that laptop.

Two articles in today’s press highlight the growing impact of health care costs on US business. One, an opinion piece by Paul Krugman in the New York Times (subscription required) , compares the workforce compensation of GM and WalMart, noting WalMart’s significantly lower per-employee wages and level of health benefits programs. The other appears in the Economist, a publication with a more conservative bent, and notes the impact of health care and pension expenses on the Big Three (well, now that Toyota is one and Chrysler is not, perhaps the Big Two and Number Four) automakers.
Krugman’s comparison of WalMart and GM is illuminating. Here are his main points.
1. GM pays about $1500 per car for health benefits.
2. GM has about 2.5 retirees for each working employee
3. GM used to be the largest employer in the nation. Now, WalMart is.
4. When GM was the largest employer, average wages were equivalent to $29,000 annually in today’s dollars. WalMart employees average $17,000.
5. Essentially all of GM’s workers have incredibly generous health coverage. About half of WalMart’s have any company-paid health coverage.
6. This is not to praise or denigrate either company, just to illustrate how the US economy is changing and the impact on the “average” worker is a reduction in income and health benefits coverage.
The Economist (perhaps the best newsmagazine in existence) has an equally interesting perspective on the US auto manufacturers. Here are the main points from their article on GM and Ford, subtitled Detroit’s car industry and its unions now have to reduce legacy employment costs (available by subscription or free to print subscribers).
1. “GM’s 30-year slide from 60% of the American market has now taken it to 25%; Ford’s share is under 20%: neither shows any sign of arresting this trend, which looks dangerously close to tilting into precipitous decline, at least in their home market (both are now faring better abroad).”
2. “the American transplant factories of their Asian and European competitors have none of these (health care and pension) costs, and have young, non-unionised workforces.”
3. “the really big challenge for GM and Ford is attacking those legacy costs. That boils down to one thing: Detroit must persuade the unions to give some ground on pensions and health-care.”
4. the article goes on to point out that big steel, textiles, and heavy equipment have all weathered this storm and come out stronger, but the storm may well be hurricane-strength.
My conclusion? Health care costs and their attendant drag on American business have become an issue of survival. At long last, big business is recognizing that they cannot compete in the global economy without major reform of the US health care system.
What does this mean for you?
Health care reform is going to happen, and will be driven by both sides of the political aisle (Krugman representing the liberal and big business and the Economist the intelligent conservative). There will be a major effort at health care reform in the next two years. Pay close attention, and seek to understand the underlying motivations, for therein lies the impact on your organization.