Posts filed under 'Healthcare'
State House News Service (subscription required) reports that the Commonwealth Connector, the state authority that oversees the health care exchange envisioned in the 2006 reform, is “launch[ing] a new health insurance product designed for businesses with 50 or fewer employees.”
That’s fast. Pioneer’s report, Drawing Lessons, which compared the Utah and Massachusetts “exchanges” found that, in author Amy Lischko’s words,
“Some decisions made while implementing the exchange model in Massachusetts, for example, have meant that the Connector has not met the needs of small employers in Massachusetts well.”
Small businesses wanting to know more, can go to www.MAhealthconnector.org, or call Connector customer service at 877-623-6765.
And, good on you, Dr. Kingsdale. We’re pleased to see it and will look over the new products!
February 23rd, 2010
Check out Amy Lischko’s latest paper in the Interim Report Card Series on Massachusetts Health Care Reform focused around Equitable and Sustainable Financing.
She finds that although much of the evidence is positive, the rate increases for small groups, and the data on medical bankruptcy and financial sustainability are reasons for concern. Lack of current data is also an important issue, as some of the most recent data trend toward deterioration.
Click here for Amy’s recommendations.
February 18th, 2010
While the Democratic party “commentariat” has had afield day with the AG’s campaign for US Senate, a funny thing happened. Ten days after the election, her office released an intriguing Investigation that showed nuance well beyond the campaign talking points on why health care is so expensive.
A. Prices paid by health insurance companies to hospitals and physician groups vary significantly within the same geographic area and amongst providers offering similar levels of service.
B. Price variations are not correlated to (1) quality of care, (2) the sickness or complexity of the population being served, (3) the extent to which a provider is responsible for caring for a large portion of patients on Medicare or Medicaid, or (4) whether a provider is an academic teaching or research facility. Moreover, (5) price variations are not adequately explained by differences in hospital costs of delivering similar services at similar facilities.
C. Price variations are correlated to market leverage…
E. Price increases, not increases in utilization, caused most of the increases in health care costs during the past few years in Massachusetts.
F. The commercial health care marketplace has been distorted by contracting practices that reinforce and perpetuate disparities in pricing.
Oh, yeah. Almost forgot “D,” which I found most intriguing. The AG also found limits on the benefit of reforms like “global payments,” all the rage these days in policy circles.
D. Variation in total medical expenses on a per member per month basis is not correlated to the methodology used to pay for health care, with total medical expenses sometimes higher for globally paid providers than for providers paid on a fee-for-service basis.
Coakley’s office is to issue the final report on March 16th, the day of hearings on health care cost containment. Looking forward to that if this is any indication of the seriousness of her direction on the issue.
February 8th, 2010
When I read the informative report released by DHCFP and reported on in the Boston Globe today, I was struck by how well this insurance seems to meet the needs of most students.
Less than 1% of students reach the caps that are imposed by the plans. That seems like a small number to me. And, the Safety Net Pool will wrap around these plans if the services that exceed that amount are sought in a hospital or community health center.
So, what’s real beef here? I think some legislators cannot stand that insurance companies are a business and like any other for-profit business need to make a profit. Is the solution to require every student have coverage equivalent to MCC? I don’t think so. Students can barely afford the tuition and fees they are required to pay now.
The State is correct to think more about this situation and to recommend a solution that fits the problem.
December 3rd, 2009
So, I’ve heard about the increase in Americans seeking expensive surgery abroad but today’s Wall Street Journal coverage of Dr. Shetty’s 1000-bed cardiac hospital in Bangalore, India was absolutely fascinating reading: (http://online.wsj.com/article/SB125875892887958111.html?mod=WSJ_hpp_MIDDLETopStories)
Cardiac survey averages $2000 at Dr. Shetty’s hospital compared to between $20,000 -$100,000 here in the US. And it’s not just that India is a less expensive place to run a hospital. It’s because Dr. Shetty has such high volume that he is able to achieve economies of scale unheard of in the United States. He’s also able to drive hard bargains with manufacturers of cardiac supplies and equipment and his staff are incredibly productive. What’s the quality like you ask? Well, it has been well established that most surgeons do better when they do more of a particular type of surgery. Dr. Shetty’s hospital has a 30-day mortality rate for CABG of 1.4% compared to 1.9% for the US average and 1.35% for MGH. According to the most recent report by the Massachusetts Health Care Quality and Cost Council, the average cost of a CABG surgery at MGH is $51,500. So, for the same outcome we could comfortably have the surgery and pocket close to $50,000! No wonder we’re seeing an increase in overseas surgeries, from 750,000 thousand Americans in 2007 to nearly 6 million by next year. Now that’s something for hospitals here to worry about.
November 21st, 2009
Many people have received coverage via health care reform and that has been good for the Commonwealth. However, it’s clear now, that there have been losers too— small businesses. The Globe article yesterday highlighted the situation for small businesses today: http://www.boston.com/business/articles/2009/11/15/blue_cross_rates_for_small_businesses_to_surge?mode=PF
The state is holding hearings to examine the cause of these increases and to assess whether changes should be made to how small businesses purchase insurance. We should examine what has caused these increases in rates, was it the merger with the non-group market (something that can only explain a very small increase, by my accounting), increases due to benefit mandates (like the Rx coverage decision made by the Connector), or simply health care trends (as the BCBS representative posits)? Whatever the reason, this situation is simply unsustainable.
The Connector could have moved on this issue earlier and by implementing a bolder plan for small employers. A defined contribution plan for small employers with full choice of plans for employees similar to that being tested now in Utah would have been a fine start. Instead, they implemented a “pilot” contributory plan (which at last count had only 145 employers with an average size of 3 enrolled). This plan is certainly not the answer small employers were looking for.
All is not lost though. There is something small employers can do right now without any further state action. Drop coverage, pay the $295 per employee fee to the state, raise employee salaries accordingly, and set up a 125 plan. Employees can go to the Connector for the purchase of health insurance. The employee can use pre-tax dollars to purchase health insurance, have a full choice of plans (bronze, silver or gold) and the employer can start worrying about his/her business and stop worrying about this uncontrollable cost.
November 16th, 2009
On Friday, my old agency released a report entitled “Measuring Health Care Quality and Cost in Massachusetts.” The report can be found here: http://www.statehousenews.com/qualitycost.pdf. This report is full of really useful information on quality and costs for various procedures at hospitals in Massachusetts. Unfortunately the report received very little press and consumers probably don’t even know it is available. The information can also be found on the consumer website, developed by the Health Care Quality and Cost Council.
This new report allows you to see a profile of a hospital’s indicators on one page and allows you to compare all hospitals in the state (compared to the website which only allows you to compare 4 hospitals at a time). This is particularly interesting with costs which have huge variation from one hospital to the next. Transparency has clearly been on the backburner for awhile now……but it’s time we shine a light on the variability present in the system.
November 8th, 2009
Robert Levy, chairman of the CATO Institute, is a brilliant guy. He was talking today in Asheville about the fact that conservatives and liberals both abuse the interstate commerce clause in the US Constitution, for their own purposes. Liberals have used it to clamp down on everything from growing your own produce (in FDR’s time) to promoting any number of regulations on businesses, even those that only operate within a single state’s boundaries.
Conservatives have been pushing, and continue to push, tort reform through federal action. Levy’s argument is that both abuse the commerce clause. But then he noted something I hadn’t thought of:
What allows the federal government to establish a mandate to purchase health care insurance? Even though the federal government has allowed states to erect all sorts of nasty barriers on the insurance market, rendering insurers unable to market their wares nationally (ostensibly not, ahem, in line with the interstate commerce clause’s spirit…), we will see the feds point to the interstate commerce clause as the justification for a federal mandate.
What is especially striking, however, is that it will be the first time the clause is used to force individuals to buy a product.
A republic of laws when supreme law (the Constitution) is this abused? I would prefer to see experiments such as our own continue, and see us at the state level continue to try and fix them so that they work.
November 2nd, 2009
On the drive in this morning I heard an interesting idea being tested in Fort Worth Texas (isn’t that one of the highest health cost cities in the country?). See the link here
http://www.nbcdfw.com/news/local-beat/Call-An-Ambulance-Get-a-Taxi-66723887.html.
They are using EMTs as triage agents for patients who call 911 for an ambulance. In many cases, the EMTs are telling patients, “you don’t need to go to the hospital.” If the patient insists on visiting the ER, and it is not an emergency, the EMT calls a cab.
Policymakers should re-think how EMTALA (the Emergency Medical Treatment and Active Labor Act) gets operationalized and whether it needs some updating to encourage appropriate use of our scarce resources. With the flu season upon us, there’s no better time to act than now!
November 2nd, 2009
(Editor’s Note: Pioneer welcomes our Senior Fellow on Healthcare, Amy Lischko, to the blog. Amy will be writing on healthcare here from time to time, as well as working on research for Pioneer. Welcome.)
It’s worrisome when the state tells us what kind of provider network we need.
Today’s Globe article “Insurer told to hold off in Mass.” highlights one of the reasons behind our increasing health care costs.
Carriers have often remarked that they have difficulty creating both tiered provider networks and narrow provider networks that offer lower costs. Why can’t the state (via the Connector or DOI) allow Centene to offer these plans to consumers and let the consumers vote with their feet? If no one signs up, Centene will have to adjust its strategy.
Of course, consumers should be made aware of the network that is in the plan and let them decide if it is adequate and reasonable for the premium charged. This isn’t the first time I’ve heard of the state micro-managing the plans to protect the consumer. When I buy an airline ticket with a layover instead of a direct connection, I do so with this knowledge but I do have a choice in the matter.
October 31st, 2009
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