Tradition is important, and it has become a Health Wonk Review tradition to have a theme for each edition. Usually, the edition’s host organizes content by topic or finds some overarching theme to propel the issue forward.
In the spirit of innovation, the entries this week are organized according to the order in which they arrived in my inbox. This relieves me, as the host, of the awesome responsibility of finding a compelling theme. First in, Dr. Bradley Flansbaum.
The Early Bird
Dr. Bradley Flansbaum offers a birds-eye view of the physician relationship with the pharmaceutical industry at The Hospital Leader: the Official blog of the Society of Hospital Medicine. Dr. Flansbaum details his interactions with the pharmaceutical industry – from a young hospitalist receiving speaker’s honoraria to a pharma-sponsored researcher. If you want to know about the relationship between the pharmaceutical industry and the medical profession, this is a good primer. Dr. Flansbaum has chosen to opt out of all relationships with pharma, and he is eloquent in explaining his professional position. At the risk of taking the suspense out of his story, in part, here is his conclusion:
“Remember why we call industry, industry. It’s a business. They sell, and we buy. That’s my message so do with it what you will.”
Healthcare Economist Asks “Is P4P doomed to fail?”
The way pay-for-performance and quality incentive programs are currently structured, the conclusion one draws from Jason Shafrin’s question is, “Yes, P4P is doomed to fail.” Jason bases his discussion on a referenced article in Health Economics that calls out a “fundamental design flaw in P4P design” which is, simply, a provider chasing too many quality metrics that result in rewarding competing measures. For providers and health care organizations looking to be reimbursed based on this model, the ensuing confusion can be hazardous to your patients’ health and the health of your bonus payment. Read the detail at Healthcare Economist.
Tracking ACA Enrollments: Figuring Out How Many Grandfathered/Grandmothered Plan Are Still Around
In this week’s entry, Charles Gaba of ACASignups.net gives us a breakdown of a tally of Grandfathered and Grandmothered plans in the individual market. He did, in his own words, a “back of the envelope” calculation and, with input from Louise Norris of healthinsurance.org, came up with an estimate of those old plans still hanging around. Charles says, “My Conclusion? There should be roughly 1 million people still enrolled in Grandfathered policies and perhaps 1.5 million in Transitional/Grandmothered plans today.” If you want to know the difference between Grandfathered and Grandmothered health care plans and the detail, click here.
Dare Roy Poses Suggest: Healthcare Leaders Should Come From Healthcare
Roy discusses a New England Journal of Medicine article describing “Immersion Day” during which members of the board of a non-profit hospital system who had no healthcare background were given a one-day exposure to life in the hospital. Roy Poses poses (sorry, I couldn’t help myself) an interesting hypothesis: “True health care reform would put more health care professionals back in control of health care, or failing that, would at least promote leadership by people with some knowledge of health care who would support health care values and would be willing to be accountable for doing so.” Read the detail about the NEJM article here.
ObamaCare Wear: Gasoline Pants
Hank Stern’s InsureBlog is on top of the dish on ObamaCare. Blogger Mike Feehan writes this week that we have more bad news about the ACA. ObamaCare Co-ops are going the way of the dodo bird, according to Mike. In fact, I can’t improve on Mike’s description of the status quo, so here it is, in his own words: “As Nipsy Russell might have observed, the Obama administration’s health policy is running thru Hell in gasoline pants.” Read More Bad News About ObamaCare Co-Ops – Part CCIX – at InsureBlog.
Health Plans Need to Consider the UX
Just as Apple figured out that computer users needed an intuitive interface to finally integrate computing into their daily lives, Joe Paduda of Health Strategy Associates says that the health plans that figure out how to give their members a good user experience will be winners. “Members do NOT want to wade thru fine print stuffed with SAT-test words and jargon that’s murky at best. Blaming the consumer for misunderstanding a benefit plan is just nuts; write the plan so it’s understandable for everyone” Read more at JoePaduda.com.
California Is the Harbinger of Things to Come
California often leads the way in trends that work their way across the country. Anthony Wright at Health Access Blog writes out of the state capitol in Sacramento from Health Access California where he and co-blogger Bethany Snyder tell us “Covered California produced a report about potential 1332 waivers, and gave a greenlight to one proposal to allow undocumented Californians to buy into the exchange with their own money.” Yes, insurance is governed at the state level, but keep your eye on California’s move to allow undocumented people to buy into the healthcare system and the implications it could have for the future of health insurance. Read Opening Up Covered California here.
The CMS Innovation Center and Next Generation ACOs
Writing for Health Affairs, Chris Dawe, Nico Lewine and Mike Miesen discuss the recent CMS Innovation Center announcement saying ACOs can share in 100 percent of the savings they create for the payer’s largest book of business, theNext Generation ACO. In Today’s Most Attractive National ACO Model is Offered By…CMS, the authors write, “Would-be Next Gen ACO participants must grapple with two primary hurdles: risk exposure and a closing decision window.” Read more about the tension created by being exposed for full risk for spending in excess of targets and opportunities to enjoy capturing savings at the Health Affairs blog.
Another Medicare Pilot: Medicare Comprehensive Primary Care
If you’ve read this far, you know that Dr. Jaan Sidorov is not the only HWR contributor this week who wonders if government should get out of the way and let healthcare do its job of caring for patients. In this entry at Disease Management Care Blog , Dr. Sidorov explains that Medicare has just launched a multi-year primary care initiative aimed at improving care, but that might not be as good as it sounds. Dr. Sidorov tells us that it is based on a two-year-old pilot that hasn’t shown improvement in costs or quality. He asks, “Should CMS get out of the care management game and let others handle the work of caring for populations with chronic conditions?”
Lack of Transparency or Just Plain Greed?
David Williams at Health Business Blog writes about healthcare’s version of the military’s $10,000 toilet seat: in this case, a $427 hospital charge is reimbursed at $22. He wonders what could be wrong. Is the hospital overbilling to begin with? Is the health insurance company underpaying? Or both? In Urgent Care Billing: Eyebrows Raised , David discusses the implications of this type of billing/reimbursement discrepancy.
And Finally, A Little Education from Worker’s Comp Insider
Julie Ferguson takes time to educate about occupational medicine and its unique place in healthcare. At Workers’ Comp Insider, Julie writes about how occupational medicine differs from other specialties, and she offers an informative video, “Introduction to Occupational and Environmental Medicine (OEM)”. Check out this training at Workers’ Comp Insider here.
Blabbin’ with the Wonkers at Health Wonk Review On Air with David Harlow
If our biweekly dose of health policy leaves you wanting even more detail about things like QALYs and risk corridors, please join us live, online, every other Tuesday for Health Wonk Review On Air with David Harlow. David is joined by other HWR contributors to discuss details of the most recent edition and whatever else is on their minds health policy-wise.
Blab is interactive, so it is a good place to ask questions and join the discussion. If you miss the session, you will be able to view the recording later. David posts the link at HealthBlawg.com.
The next edition of Health Wonk Review On Air Blab is Tuesday, April 26 from 1 to 1:30 p.m. Eastern.