Health Sherpa

I have had many friends contact me in the past few weeks about that mess of a website, healthcare.gov - yes, it is frustrating.  Yes, they botched the roll-out and yes I am extremely disappointed.  There is no way I can defend this.

So I have to at least share a story covered in an NPR broadcast a few days ago when I was out in Seattle.  Apparently, 3 guys from Silicon Valley have created a super-easy to use website called Heath Sherpa that will tell you what insurance plans you are eligible for based on your income and location.  It's extremely fast and user-friendly.  One of its creators, Ning Liang, said on NPR that the goal was to have visitors get an "answer" in 5 seconds or less of visiting the homepage.

While the site does not have the ability to verify income or allow visitors to actually purchase plans, it is at least a starting point for those in the individual market to understand what plans may be available for them (and their costs) once the government site is working.  Link here:  http://www.thehealthsherpa.com/

Reducing Health Care Disparities

Update, 9/2/13:
My guide has been referenced in Beckers and Fierce Healthcare. Exciting.  Sophia and the Chua family would be proud.

****
Had a great opportunity to take a short leave from the consulting gig this summer and work at the Health Research and Educational Trust (part of the American Hospital Association). They were kind enough to publish the guide I wrote during my time there - if you're bored enough, here it is:

http://www.hpoe.org/EOC-real-data

Abridged version: While many providers are collecting some form of race, ethnicity and language (REAL) data, many data sets are not comprehensive nor standardized for ease of analysis.  Given changing demographics (minorities will become the majority by 2043), a more empowered patient population (the internet!) and changing reimbursement mechanisms, reducing health disparities through data-driven interventions will only increase in importance.  The guide provides a high-level approach to ensuring good data collection efforts, and ways to use the data meaningfully in reducing disparities. It is intended to point readers to existing resources that will support both the use and collection of REAL data and provide a business case for doing so.

Insurance premiums to fall 50% for New Yorkers due to Health Reform

On the homepage of NY Times today.

Highlights:

• Health insurance exchanges established via ACA (online health insurance shopping), are driving transparency in pricing and competition, leading to more affordable premiums
• The exchange will offer a choice of 17 plans, including one offered by North Shore Long Island Jewish health system, who is just entering the health insurance market 
• UHG and Wellpoint will be on the exchange
• Initial estimate of 615K New Yorkers signing up within first few years

Will this be sustainable?  Will these plans be generous enough?  Didn't we already see this play out in Massachusetts?

The Decline of the Physician Private Practice

CNN released an article today noting that "the number of physicians unloading their practices to hospitals is up 30% to 40% in the last five years." Cost pressures, myriad policy changes and the shifting reimbursement landscape are forcing health care practices to become more efficient in the way they do business - and for a small physician practice, managing business expenses and operations is not an easy task. For many physicians, it's becoming easier to sell their practices (or even outsource their administrative functions to entities like University Hospital's UH Physician Services in Cleveland) so they can focus on patient care. Are the days of the private practice coming to an end?  I'm all for efficiency in operations and the benefits of scale - and maybe this will become more and more appealing to the next generation of physicians. Said one physician in the article, "my hours are better. I'm not spending hours on administrative work or worrying about my business."

You know, I would totally throw a fit if my favorite local coffee shop was ever pushed or bought out by a larger chain - but when it comes to health care?  Put me in the cheapest and most efficient setting, no problem.  As long as I can still see my doctor...

Setback for ACA?

The White House announced today that the ACA employer mandate, which requires companies with 50 or more employees to offer health insurance or face penalties, will be delayed one year to 2015. What will happen to these individuals?  Will they purchase coverage through the health insurance exchanges, which are supposed to "go-live" October of this year?  And is this really an indicator for the law's eventual repeal, which many Republicans are hoping for?  You can read more here.

Hospital Price Variation, Front and Center on New York Times

When Steven Brill's Time Magazine cover story, "Bitter Pill" was published back in March, it bought to light both the often inexplicable charges and wide variation in hospital billing.  While this fact is no surprise to those working in the industry nor patients who have been hit with heavy hospital bills (especially the uninsured), what Brill did was pull together several examples and personal stories into one article to garner attention.  He accomplished what he set out to do, receiving responses from the American Hospital Association, several hospitals and health systems, and was even invited to be a guest on Jon Stewart's The Daily Show.

Now, CMS (Centers for Medicare and Medicaid Services) has published further proof of price variation. "Data being released for the first time by the government on Wednesday shows that hospitals charge Medicare wildly differing amounts — sometimes 10 to 20 times what Medicare typically reimburses — for the same procedure, raising questions about how hospitals determine prices and why they differ so widely," reported The New York Times today, on it's homepage.

Yet another argument in support of moving towards bundled payment.  To read more about this exciting new healthcare trend, click here.

Uwe Reinhardt vs. MD

Uwe Reinhardt's latest blog post discusses quality of care under traditional vs. Managed Medicare plans - snooze! (but kinda interesting - conclusion was slightly better under Managed care.  You can read more here.)

But the dialogue between himself and a physician who posted commentary after the article is great fun...sharing with you, here:

• Van Gross, MD
• Miami, FL

People did not enter medicine to become Uwe Reinhardt chess pieces. If someone had asked the late great Stan Musial if he would have liked certain "recommendations" if not constraints placed on him so he could have better outcomes, he would have taken a left handed swat at said individual and tatooed his health care challenged body into the right field bleachers.
I know the analogy is imperfect but so is medical care. As a result, Reinhardt style comparisons of plans falls apart when individual variations for any given disease are acknowledged which prevent draconian pronouncements re: optimal care strategies for many different patients with diverse co-morbidities and cultural exigencies. Next year is 2014, not Huxley's 1984. If the idea is to begin the roll out of an army of "pawn medics" marching to the dictates of King Reinhardt, let the Medicare Advantage drum beat begin.

• Uwe Reinhardt
• Princeton, NJ

To Van Gross, MD:

I find it ironic that you mention Stan Musial, who played his game subject to many, many rules that constrained his game and whose game was judged by umpires he played it. Musial also undoubtedly got many recommendations over the years on how to improve the outcomes from his the way he played the game. In a sense, he played "managed baseball," although within the constraints of the game he still had enough leeway to play the game as best he knew how -- just as physicians under managed care still have enormous leeway on how to practice medicine. So I thank you for the analogy, Dr. Van Gross.

I recall debating the merits and demerits of alternative health systems with a physician some years ago when I asked him: "To make it short, describe to me your vision of the ideal health system." More physicians should be asked that question.

His response at the time was: "Physician and patient should be free to decide on the therapeutic response to a given medical condition, and the insurer should respect that and pay for it without questioning these therapeutic decisions."

The see the footprints that kind of apporach leaves behind, I encourage you and other readers to click on

http://www.dartmouthatlas.org/

and rummage around that website a bit.

Don't you love it??  Got to remember to read the commentary sometimes.....

Population Health in the US Pretty Much Sucks, at Least Relatively Speaking

The Institute of Medicine recently published a 378-page study comparing US health measures against other developed countries.  While similar studies have been done in the past, they have been largely focused on older populations.  The IOM's recent study focused on younger Americans as well - and the findings are just as bleak.

The study found that "Younger Americans die earlier and live in poorer health than their counterparts in other developed countries, with far higher rates of death from guns, car accidents and drug addiction" (this includes adults <50 years of age).  A particularly scary statistic:  the rate of firearm homicides was 20 times higher in the U.S. than other countries.  Oh, and by the way, we still have the highest rates of infant mortality and teen pregnancy.

The reasons for our poor health statistics can be blamed on a host of factors - both driven by our public health and health care system.  It's critically important to understand how both play a role; how it's just as important to reduce fragmentation in healthcare as it is to make sure people have health insurance, as it is to make sure people have access to healthy foods - and not guns.

One other interesting find:  "Americans who have not graduated from high school die from diabetes at three times the rate of those with some college." So our education system completely has a part to play....see how it's all coming together?  And how it's all falling apart?

When addressing our health problems, we need to look at things holistically, expand our thinking about what can be addressed with potential solutions.  For example, should we consider patient education sessions in a bundled payment for cardiac surgery, to promote healthy behaviors?  Public Health education in school?  Gun trade-in programs?  Or we could just move to Japan - and eat sushi with Jiro.

Read more here.

Goodbye, Pete Stark

Congressman Pete Stark is leaving the 113th Congress after 40 years of public service.  He is a bit of a health policy legend, probably most well-known for COBRA (which allows you to stay on your employer's insurance after you've left your job) and EMTALA (can't ditch the uninsured when they show up in the ER).

You can read more here.