AHP Announces a Health Care Reform Initiative and Tells All of the Other Stakeholders What They Ought to Do
I'd like to propose a new health care reform rule.
You can't announce health care reform proposals unless Part 1 of your plan first tells us just what it is your side is going to sacrifice for the effort.
I don't know about you, but I am getting tired of one vested interest after another in the health care system telling the others what it is they have to do to fix the system. Everyone has to sacrifice to fix the system and each side should start by outlining what it is they are throwing in the pot before they get to play.
Last December, the health insurance industry trade association, AHP announced its plan for ensuring everyone has access to a health insurance plan even if they have a preexisting condition:
Under this plan, states should establish Guarantee Access Plans to provide coverage for uninsured individuals with the highest expected medical costs. If an individual is not eligible for coverage through the Guarantee Access Plan, health plans would then provide coverage to that individual on a guarantee issue basis with premiums capped at one-and-one-half times the standard rate.AHP's idea for making sure everyone has health insurance is to take the healthy ones and leave the sick to the states.
Today, they announced a cost containment plan. They talked a lot about what others need to do but I didn't see a lot aimed specifically at what insurers are willing to sacrifice to bring costs down.
Here are AHP's five principles from their "Proposal to Reduce Health Care Costs:"
There's nothing wrong with their five principals. They are, perhaps with the exception of legal reform, fairly non-controversial--at least til you get into the details. They are also incremental since much of this is going on in the market anyway.
AHIP Proposal: Access to information that compares the effectiveness and cost of treatments: Give providers, patients and purchasers access to a trusted source where they can find up-to-date and objective information on which health care services are most effective and provide the best value.
AHIP Proposal: Health information technology: Encourage widespread adoption of tools such as electronic health records (EHRs), personal health records (PHRs), secure e-visits with physicians, and e-prescribing.
AHIP Proposal: Reforming the legal system: Replace the current medical liability system with a dispute resolution process consisting of an objective, independent administrative process to provide quick and fair resolution to disputes while promoting evidence-based medicine.
AHIP Proposal: Build health care reform around quality improvement by rewarding safety, value and effectiveness: Work for the broader adoption of value-based reimbursement mechanisms and provide consumers with more actionable information about health care value.
AHIP Proposal: Enhanced disease management, care coordination and prevention programs: Deploy a new generation of strategies that emphasize prevention, improve chronic care and tailor healthcare for patients to help them live longer and stay healthier.
AHP says that fully implemented our health care expenditures could be $145 billion less than they would have been in 2015 without these things. Since we're already over $2 trillion and likely headed to more than $3 trillion in the next seven years at this rate, that would be a savings of 3% to 5% of overall 2015 costs. Big money at one level but hardly a rounding error in the overall scheme of things.
It's hard to understand why AHP sees that kind of savings as a big deal. One has to believe a whole lot of bad things would already have happened to America's health care system--and maybe the private health insurance business--well before the $3 trillion mark.
And I don't think state run risk pools will help their cause a lot either.
It's going to take a lot more than this to fix the system and a lot more sacrifice.
5 comments:
I wonder if AHP has made any recent alliances with some of the other industry organizations who are proposing similar ideologies. Many of which are creating distractions in the face of actually providing value, access and service to the end-user, that being the patient.
I agree with you on the idiocy of the Guaranteed Access plan as I blogged in december.
One thing which would assist me in managing my own chronic illnesses would be the removal of pharmacy benefit caps. To put it simply, $1500 barely covers 5% of my annual prescription costs. Coverage in the individual market equal to the protections afforded the group market would help me stay healthy.
AHIP's proposal puts me in mind of the press release WellPoint issued a year or so ago about how to deal with the uninsured. Their solution? Sell the uninsured more insurance. And that was the end of that.
I would like to say, health insurance does not equal health care. Until this country understands this concept, no one but the insurance industry will benefit.
Preventative Care sounds really nice and I guess that I should be glad the AHP is for it.
Unfortunately I am not really sure that they really are, as it seems that most preventative benefits are specifically written so that anyone with even minor symptoms that might indicate that they have a particular condition is required to pay the full charges for testing. See:
http://wonksanonymous.com/2008/04/20/making-the-most-of-your-preventative-care-benefit.aspx
for details.
Also the various tests covered are really not the essence of prevention. People really only learn to manage their own health as a result of an ongoing relationship with a caring and competent health care provider.
This relationship requires regular contact and the ability to see the provider for so called "minor" conditions. Most insurance companies are converting their subscribers to high deductible plans that require payment on the order of $75 to $100 per doctors office visit until an deductible of $2,000 to $4,000 is met. This effectively prevents many people from seeing a doctor about a problem until the problem becomes major.
This of course prevents the formation of a doctor patient relationship and forces postponement of care further driving up costs.
Chris Martin
“You can't announce health care reform proposals unless Part 1 of your plan first tells us just what it is your side is going to sacrifice for the effort.”
Bob, I agree with you 100% on this point.
In that spirit, as a consumer, my proposed contribution is that we consumers / patients should give up the favorable tax treatment currently afforded to employer provided health insurance. Instead, Congress should increase the standard deduction, adjust the Earned Income Tax Credit if necessary, and reduce the marginal tax rates in the two lower income tax brackets to keep the overall tax changes budget neutral at the population level.
My proposed sacrifices for other stakeholders are as follows:
Hospitals – Embrace price and quality transparency, P4P, and episode pricing, especially for expensive surgical procedures. Downsize or close surplus capacity.
Doctors – Embrace price and quality transparency, P4P, and shared decision making. Move away from the fee for service payment model.
Government – Provide leadership on setting limits fairly recognizing that resources are finite. A Comparative Effectiveness Institute that could provide guidance on the relative merits of new (and existing) drugs, devices and surgical procedures vs. alternatives would be helpful. Subsidize the implementation of interoperable electronic medical records by doctors and hospitals. Aggressively encourage individuals to execute living wills and advance medical directives.
Lawyers – Embrace a sensible alternative to the current jury based medical dispute resolution system. Health Courts should be worth a try.
Insurers – Embrace price and quality transparency including disclosure of actual insurer reimbursement rates as well as Medicare rates to members upon request.
Drug and Device Manufacturers -- Provide all data necessary for comparative effectiveness analysis, disclose any and all conflicts of interest that reviewers and endorsers of your products may have, and eliminate DTC advertising.
The bottom line is that anyone can recommend reforms that only call for sacrifice by others while their own position is either unharmed or enhanced. That won’t cut it. It’s time for all healthcare stakeholders to put up or shut up. Everyone has to be prepared to give up something in money and/or power in the short term in exchange for a better, more efficient and more sustainable healthcare system in the long term.
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