Tag: Healthcare reform

Affordable Healthcare: How to make it work

Posted on | by SOS Blog | Leave a Comment on Affordable Healthcare: How to make it work

I live in Florida. As I read the newspaper today, I was appalled to see that Florida Tea Party members were testifying before the state legislature encouraging them…no insisting…that they flaunt the Federal Affordable Care Act insisting that it is illegal in spite of the Supreme Court decision to the contrary.

Then I read a new issue of FierceHealthPayer, an industry newsletter for Healthcare Plan Executives. This issue had two separate articles and a commentary that made me wonder how we will possibly get to affordable healthcare in this country.

The first article reported that the American Medical Association (AMA) has reviewed health plans across the country and opined that 70% of commercial insurance markets are anti-competitive. This means that in 70% of the locales in this country, the vast majority of the health insurance is provided by one company. One of the primary arguments of the insurance industry and their Congressional supporters against a single payer national health plan is that competition is necessary in order to achieve quality and control costs. If that is so, we will not get to affordable care or adequate quality given this current anti-competitive situation.

The second article discusses the trend toward self-insurance on the part of large employers. There has been a steady increase since 2006 in the number of large employers who are managing administrative costs and avoiding variable state laws by self-insuring. In 2011, approximately 60% of workers were covered in a self-insurance program run by an employer. Small employers generally do not have this option. The risk of self-insuring for a small group is much greater than the outrageous cost of group coverage through one of the major insurance companies. Self-insurance often tries to control costs by limiting benefits.

The final item that grabbed my attention is a commentary in this same newsletter. The editor reported on the confused state of smoking cessation coverage among private insurers. She pointed out the requirement in the Affordable Care Act for such coverage and the indications by surveyed insurers that they do include smoking cessation coverage.

Yet when Georgetown researchers studied 39 health plans, they found that none of them took all of these vitally important steps: clearly stated that tobacco cessation treatment is covered; provided coverage for individual, group and phone counseling and tobacco cessation medication; provided treatments with no cost-sharing for members; and provided access to treatment without members having to meet prerequisites.

Read more: Why wouldn’t insurers cover smoking cessation? – FierceHealthPayer

These are the factors that are most likely to result in successfully quitting the use of tobacco products. You would think that insurers would want to have this particular benefit in their plans and that it be used. After all, the direct medical costs and productivity losses caused by smoking-related illnesses each year is almost $200 million.

The juxtaposition of these four items today reminds me of my personal conclusion…we need a single-payer national healthcare system if we are ever going to get our costs under control and provide quality healthcare services to most U.S. residents. Just by removing the 22% growth in earnings posted by the five major insurers in 2010, we might get a start on controlling some of the costs involved. Standard benefits across the country would make the system easier and more consistent for employers with workers in multiple states. And real implementation of preventive measures like smoking cessation would make all of us healthier.

And now I will wait for the comments….

New IOM Report: Best care at lower cost

Posted on | by SOS Blog | Leave a Comment on New IOM Report: Best care at lower cost

In early September, the Institute of Medicine published its most recent report on the state of healthcare in the U.S. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, identifies three major “imperatives for change: the rising complexity of modern health care, unsustainable cost increases, and outcomes below the system’s potential. You can download a free, prepublication .pdf version of this 450 page report before it is out in print.

The committee explored in detail some of the pressing needs of the system. They are convinced that we must move toward a healthcare system that learns from itself as rapidly as possible or the system is likely to self-destruct. We must learn how to incorporate research results more quickly, we must learn to change delivery systems that cost too much, we must move the system closer to its highest potential. In short, we must develop a culture of “continuous improvement to produce the best care at lower cost.”

FierceHealthFinance focused on the reported waste of $750 Billion a year (about 30% of the cost of healthcare in the U.S.) as one of the most important things to change. While that number is appalling, the fact that the figure reported was from 2009 is the most striking thing about it to me. Our system has become so complex that it takes three years before we know what it costs. We are constantly behind the curve, and must find ways to speed up the process of information assessment, dissemination, and implementation for change.

The behavioral healthcare system is often far behind the curve in implementing change that might be more productive. The public health and public behavioral health systems are deep in conversation and pilot programs related to integrating physical and behavioral healthcare. Suzanne Bennett Johnson, Ph.D., current President of the American Psychological Association (APA) identified the need to increase psychology’s role in integrated care as a primary thrust of her presidency; her presidential address also focused on this issue. I wonder how many mental health providers in the private sector are even willing to consider what changes to their work such an integrated system might bring.

Take a look at the very brief summary of the IOM report to see if you would like to read the whole thing. What do you think we need to do in behavioral healthcare to begin to address some of these issues?

Who’s Making Money from Healthcare Reform?

Posted on | by SOS Blog | Leave a Comment on Who’s Making Money from Healthcare Reform?

Before I get too far into this post, let me be clear about a couple of assumptions.

1. I am an advocate of Healthcare Reform. I was disappointed in the bill that finally passed because I believe it was not a strong enough protection for consumers. Given that, I am glad we have a healthcare reform law on the books.

2. I believe that most consumers would benefit in the greatest possible way from a single payer system. This could be modeled on Medicare or utilize some other possibilities, but I think a single payer system is the only way we will ever get a healthcare system that truly meets the needs of most consumers and costs the least.

Given those assumptions, you will understand my reaction when I read a new article in FierceHealthPayer, a weekly newsletter for healthcare plan executives. If you are involved in the purchase of health insurance for your organization, the title of the article, Insurers Profit from Health Reform, will come as no surprise to you. Of course insurers are the primary ones who will profit from health reform in its current incarnation.

After dropping almost $90 million to oppose the health reform law, repeatedly claiming its provisions would raise costs and disrupt coverage, health insurers actually have benefited the most from the law, according to a Bloomberg Government report released Thursday.

The article goes on to explain that most of the increases in revenue are the result of these companies expanding into government programs. You see, even though Medicaid and Medicare are government programs, they are often administered by private insurance companies. With the expected expansion of the Medicaid program mandated by the Affordable Care Act, there should be even more income growth for insurance companies.

So who’s going to lose money on healthcare reform? Guess what….it’s us again. Those of us who purchase insurance in the private marketplace were subjected to 9% increases on average in 2011…increases aimed at covering the costs of the mandates of the healthcare reform law long before required by the law. That way, we absorb the costs and the insurance companies get to go on paying their executives outrageous salaries and making their profits.

I wonder what it will take for people to finally realize that healthcare and health insurance need not cost so much. I don’t expect it to happen as long as corporations control our government and our lawmakers. I know many folks believe the problem is just the opposite. Government should get out of the middle of the relationship between the healthcare provider and the consumer. Competition and market forces would take care of costs.

What do you think? Who will pay for care for the chronically ill . . . and the chronically mentally ill if we don’t all chip in to do it? Is there enough compassion in the marketplace to assure that children, the poor, and those unable to pay for health insurance because of mental illness will also receive good quality healthcare? Please share your thoughts. I would love some help in understanding how we can assure that we will all get the healthcare we need without spending half our income on health costs.

Change in Healthcare is Upon Us…Law or not

Posted on | by SOS Blog | Leave a Comment on Change in Healthcare is Upon Us…Law or not

In 1992, when Bill Clinton was elected President of the United States for the first time, I was a member of the Committee for the Advancement of Professional Practice (CAPP) of the American Psychological Association. CAPP is charged with general governance oversight of the Practice Directorate, the part of APA responsible for promoting “the practice of psychology and the availability and accessibility of psychological services, providing resources and services to practicing psychologists in all settings and to the public.”

Our first meeting immediately after the election was highly charged. Staff had been studying President Clinton’s healthcare proposals, and the notion of controlling cost through “managed care.”

President Clinton’s healthcare proposals did not fly, but the industry picked up the notion of controlling costs by managing the care provided to consumers, and psychological practice has never been the same. For private practitioners, “managed care” continues to be a primary obstacle to the practice of psychology. Costs might have been suppressed by managing care, but some would argue that the primary effect of the managed care revolution was the creation of a new industry that made money as the middle-men at the cost of providers. Indeed, after a few years of leveling of the costs of care, the rise has been renewed and expanded.

In mid-November, the Supreme Court of the U.S. agreed to hear an appeal of the Affordable Care Act, our nation’s most recent effort to reform our healthcare system.

The Supreme Court agreed to hear appeals from the United States Court of Appeals for the 11th Circuit in Atlanta, which is the only court to have struck down the individual mandate because it overstepped Congressional authority and wasn’t justified by the constitutional power “to regulate commerce” or “to lay and collect taxes.” FierceHealthPayer, November 18, 2011

According to editor Dina Overland of FierceHealthPayer newsletter, even a complete overturn of the law would have little significant impact. She believes that consumers like the changes the law is mandating and there is no stopping this train.

Mercom Capital Group, in their HIT Report of November 21, 2011, says the same thing about the massive changes in the healthcare arena at large. Basing their conclusions on a report by PwC (PricewaterhouseCoopers, LLC), Mercom reports that health organizations will continue to move forward with changes to their health technology and other innovations because the multiple drivers in the marketplace have finally come to a head. No matter the political or the financial uncertainties, PwC believes this movement will continue. These are changes consumers like, and the movement will continue no matter which market forces might change.

In their HIT Report of November 28, 2011, Mercom reports that Harvard and Aetna will ally to work to improve healthcare costs and quality. The two have formed a research collaborative focused on improving the quality and cost of healthcare. They will use bioinformatics, the interface of computer science and information technology with the fields of biology and medicine, to analyze healthcare data in innovative ways. They will focus on outcomes of various treatments considering quality and cost, factors that predict adherence to medical and drug treatments for chronic diseases, examining how claims and clinical data can be best used to predict disease and follow outcomes, as well as other treatments of data that will emerge over time.

Where is your organization in the midst of this dramatic change in how we manage healthcare? How do you see yourself participating in the sea change that is under way? Where does behavioral healthcare fit into this picture?

Just type in your thoughts below. Thanks for commenting.

Healthcare Reform in 2011

Posted on | by SOS Blog | Leave a Comment on Healthcare Reform in 2011

Count on the National Council to keep us informed about Health Care Reform and how it might impact us as individuals or organizations. On January 6, 2011, The Council sent out their Public Policy Update giving a brief overview of the features of the law that will be implemented in 2011. Even as the new majority in the House of Representatives vows to repeal the law, very popular features go into effect.

Starting in January 2011:

  • States may now amend their Medicaid programs to provide Health Homes and chronic disease management, including behavioral health services;
  • Closing the ‘Donut Hole’: Drug companies will grant a 50% discount on brand-name drugs for Medicare recipients who reach the donut hole in 2011;
  • Free Medicare Preventive Benefits including annual wellness visits are available;
  • A 10% increase in Medicare payments for primary care providers will start;
  • Insurance companies must spend at least 80-85% of consumers’ premiums on paying for patient care rather than administrative costs or profits;
  • CMS will begin to reform itself to accomplish delivery system and payment reforms that will save money and improve the quality of care; and
  • Long-term care insurance for the purchase of home- and community-based services will become available. Community Living Assistance Services and Supports (CLASS) is a voluntary insurance purchase program.

The National Council has established a Mental Healthcare Reform blog that focuses on Healthcare reform. There you can find discussion of all of the changes as they occur along with implications of those changes. Don’t miss out on information your organization may need. Subscribe to the blog today.

Of the items listed above, only the first is likely to affect some behavioral health care providers in any significant way. Please let us know if your state is experimenting with medical/health homes within their Medicaid plan. How do you expect that to affect mental health providers?

Please share your thoughts . . . especially those of you who are participating in one of these pilot projects.