Tag Archive: health care utilization

No matter who’s in charge, rising health care cost curve must be broken

Don Berwick

Don Berwick

Health costs continue to grow faster than the economy’s ability to pay for them. Partly as a result, high deductibles — what patients pay before insurance kicks in — have become widespread in employer and individual plans alike. Neither have much to do with the health law, said Don Berwick, who was acting Medicare administrator early in the Obama administration.

Republicans “managed to make the public think Obamacare was causing all the trouble. That is absolutely wrong,” he said. “They could repeal it tomorrow and still have a broken delivery system and costs would continue to go up.”

Source: Obamacare ‘Replacement’ Might Look Familiar

Berwick nails it: dead bang on. Health care reform no matter which administration is in charge cannot succeed unless it bends the cost curve of inexorably rising utilization costs. It’s not enough to expand insurance coverage. We have to move away from a culture that conflates health care (something individuals can only provide for themselves by leading healthy lifestyles) with the consumption of medical care (the point of health care is to avoid the need for it to the maximum extent possible).

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

An unvirtuous combination: Prevalence of chronic disease and consumer expectations spawned by decades of managed care

The prevalence of chronic illness and the expectation built up over decades of managed care that health plans should cover office visits with no or little out of pocket costs are combining to drive up America’s health care costs – and health insurance premiums. People are visiting physician offices more often and want their wallets protected from paying for those visits.

Case in point is California’s health benefit exchange, Covered California. Its benefit standards for participating high deductible health plans require them to offer low, set co-pays for office visits at $35 for primary care doctors and $70 for specialists. The goal, as Covered California Executive Director Peter Lee told the Los Angeles Times, is to take the sting out of high deductibles that require people to pay the full cost of an office visit until they are reached. “No patient I know wants to pay $2,500 to see the doctor,” Lee told The Times, referring to a $2,500 high deductible plan. But there’s no proverbial free lunch. There’s a tradeoff involved. More office visits equal greater utilization and administrative costs — which in turn lead to higher premiums.

The thinking here appears to be to avoiding creating an economic disincentive for people to see a physician in order to catch a health problem before it develops into a more serious, costly condition. For some people, that may apply. But not for all if not most. The great majority of people are blessed with the ability to maintain good health by leading healthy lifestyles that include adequate exercise, sleep and a healthy diet. Unlike motor vehicles that require regular maintenance to stay road worthy, human beings do not require ongoing preventative maintenance in a doctor’s office. If the current policy that health coverage is to be an insurance product – and all indications it will remain so for most working age Americans barring a collapse of employer-sponsored health benefits – that policy should treat it as insurance.

Insurance is for large, unexpected costs. It’s not for maintenance. That’s why most insurance policies exclude coverage for losses arising out of neglected maintenance. That’s why they won’t pay a claim for a roof collapse if the roof not properly reshingled or for a blown engine due to missed oil changes.

Health insurance isn’t really something that can be purchased. It’s something all people can give to themselves by respecting their ability to maintain their own health in order to avoid needing medical care. That’s true health maintenance. It can’t be legislated via public policy. It must become a widespread cultural ethic that respects it and the need for people to invest in their own health.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

More study needed of schedule control as promising “worksite wellness” strategy

As organizations increasingly seek ways to improve the health status of their workforces and reduce burgeoning waistlines and health care utilization costs, they must look to new approaches that hold potential for achieving meaningful results.  A strategy previously discussed on this blog is affording workers more control over when and where they work – known as schedule control – in which work is seen as an activity and not a destination.

In a 2011 study, schedule control showed promise among knowledge workers who thanks to today’s information and communications technology (ICT) are able to be productive independent of time and place.  The study of 659 knowledge workers found that affording them schedule control can promote employee wellness, particularly in terms of prevention behaviors.  Another study published in 2007 found a positive association among workers who perceived greater control over their work schedules with hours of sleep and the frequency of physical activity.  It concluded schedule control may play an important role in effective worksite health promotion programs.

Health professionals would agree that health promoting behaviors take dedication and time – sufficient time for meaningful exercise and adequate sleep. In recent decades, however, time has become a restricted commodity for full time workers, taking a toll on their health status. Indeed, a 1996 study correlated too insufficient time for both work and family obligations to poor health outcomes.  Another study sponsored by Health Canada in 2004 found workers with high levels of work time conflict were in poorer physical and mental health and made greater use of Canada’s health care system.

Schedule control provides a means to take back wasted time and thus offers a potential win-win wellness solution for organizations.  Providing it costs organizations virtually nothing and even offers the possible bonus of saving on office space costs.  For knowledge workers, it frees up time devoted to a no longer necessary daily commute to the office. (Commuting has been shown in a European study to interfere with patterns of everyday life by restricting free time and reducing sleeping time.)  While more study is needed, existing research suggests that perhaps the most promising “worksite wellness” intervention may be to drop the “site” and instead focus on the work and the worker.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

ROWE: The real workplace wellness solution

In today’s business world, there are plenty of things to be sick about. Urgent deadlines (even when some aren’t urgent), constant interruptions (how many times do you need to hear about Steve’s weekend?!), way too many meetings, endless politics that waste precious energy that could be aimed at the actual work – not to mention an all-around lack of sleep. These reasons, and so many more, can lead to workers who are just plain miserable.

So when we say that the workplace is full of “healthcare” issues, we mean a bit more than benefits. The health of any office is tied to a number of factors beyond the doctor’s office, and it would seem that even the best insurance plans can’t protect against the evils of limited vacation time or long commutes.

via Top Health Issues That Affect Your Workplace (and How to Fix Them) | CultureRx.

ROWE presents a true workplace wellness program that can get real results, reducing health care utilization.  It goes beyond gym membership subsidies (not beneficial if people don’t have time to go there) and symbolic gestures like award certificates for serving healthy snacks at meetings.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

New social ethos needed for health care

California as the United States is facing an affordability crisis when it comes to purchasing health coverage and care.  Many argue that the best response to bend the cost curve that’s increasingly placing them out of reach for employers and consumers is revamping the current health care system away from the “auto mechanic” model.  In that paradigm, patients are charged incrementally for each visit to the shop and “repair” they need.  Reformers promote an alternative system that provides incentives for health care providers to keep people healthy and relatively free of the effects of chronic disease that account for a large majority of health care spending, particularly as people age into their senior years.  If they are in less than optimal health in early adulthood and middle age, they’ll end up as very costly medical cases in future years.

“It is not possible to develop a medical system that is adequately efficient to resolve California’s affordability crisis if a large percentage of people are developing diabetes—and conditions that often come along with obesity such as depression—in their 30s and 40s,” argues Micah Weinberg of the Bay Area Council in the organization’s report released this month, Roadmap to a High-Value Health System Addressing California’s Healthcare Affordability Crisis.

“Our current food environments and the individual choices we make are creating a tidal wave of disease that our medical system cannot handle effectively and equitably,” Weinberg asserts. “Californians, therefore, must become much more engaged in improving their own health and taking personal responsibility for bringing down their own lifetime healthcare costs so that resources are preserved for those truly in need.”

Weinberg is essentially promoting a new social ethos relative to health care.  One that regards health care as an expensive, finite resource and not a limitless commodity that can be easily modified to respond to consumer demand and market forces.  If we as individuals over utilize health care as the result of poor lifestyle choices, that collectively incurs a major societal cost and worsens the plight of those who need care for illnesses and injuries they could not have avoided.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Report: Some California employers adopting 50-50 split of health insurance costs

In another sign of the breakdown of traditional, all inclusive employer paid health insurance, the (Santa Rosa) Press Democrat reports today that the now common 75-25 percent employer/employee premium cost share is morphing into a straight split.  “Often we see companies cutting their contributions down to as low as 50-50,” David Hodges, a Santa Rosa insurance broker, told the newspaper.

Marian Mulkey, director of health reform and public programs at the California HealthCare Foundation, is quoted, pointing to a rapid rise in health care costs and utilization that have ratcheted up premiums 117  percent in California over the past eight years.  “We use more services and we pay more for what we use,” Mulkey noted.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

%d bloggers like this: