1) The high price of health care; 2) Obamacare priorities

this blog covers

1) The high price of health care and possible solutions

2) Obamacare priorities

I.   The high price of health care and possible solutions
 
A complex ecosystem of costs in health care

this article was in the washington post on 3/14/13

points out the incredible variations within a region on health care prices for MRIs, doctor visits, and many other aspects of the health care system.  The article is based on the work of Gio Colella, CEO, Castlight Health

This paper fits in very well with a program sponsored by the Center for American Progress (CAP) entitled

 

The High Price of Health Care

A Conversation with Steven Brill

This program builds on Brill's special issue in Time Magazine

 Bitter Pill: Why Medical Bills Are Killing Us

The program included Brill, Colella, and Ezekiel Emanuel who contributed key parts of the Affordable Care Act. 

Brill papers discusses both the wide variations in prices, and also the large profits and salaries for executives and practitioners in the medical care field.  Further these prices are increasing in health care while other prices remain constant. 

The speakers proposed the following key solutions to reducing these inequities:

• Expand competitve bidding based on price and quality

• Increase transparency as to price and quality.  The above articles drive this point very well re prices.   

• The health exchanges will put pressure on the providers to control prices.  

• An all payor system

  Other ideas that were discussed

• Malpractice reforms

• Limit self-referrals

• Improved care for chronically ill

• More prevention through public health systems

• More consumer education

  
  

  Here are my thoughts

• Test and evaluate accountable care organizations

•  Test and evaluate integration of services such as post acute services

• Examine options for alternatives to the high costs to the last year of life and end of life care. 

• Expanded use of electronic health records and greater integration of the different systems.

• Integration of payments and services for dual eligibles

  Here is an earlier blog that I wrote on this topic. Particularly see the CAP paper. 

  Medicare and Deficit Reduction, Health Reform Strategic Plan 

  II. Obamacare priorities 

   I would be very interested in thoughts from each of you as to the next key steps to implementing Obamacare.  My guess would be how well the Health exchanges get off the ground is one key. Obviously there will be successes and failures in terms of getting the information out, enrollment, and the quality of the plans.   What other keys are there that the administration and the health care field need to focus on.  

Medicare and Deficit Reduction, Health Reform Strategic Plan

This post covers the following:

1) Various proposals on Medicare as to deficit reduction
2) My thoughts on strategic planning on health reform

1) Deficit reduction

here are several reports that contain proposals from various organizations on Medicare's possible role in deficit reduction. 

a) see 

http://www.healthinsurance.org/blog/2013/01/25/is-pain-free-medicare-reform-possible/

 b) center for american progress

http://www.americanprogress.org/wp-content/uploads/2012/11/SeniorProtectionPlan-3.pdf

c) 

Real Help for Medicare and the Deficit

http://www.medicareadvocacy.org/hidden/so-what-would-you-do-real-solutions-for-medicare-solvency-and-reducing-the-deficit/

  d) LCAO

http://www.lcao.org/files/2013/02/LCAO-Dual-Eligible-Principles-040512.pdf 

  e) Kaiser Family Foundation: Policy Options to Sustain Medicare for the Future

http://www.kff.org/medicare/upload/8402.pdf

this has many useful options considered, not all of which would I recommend.  

f) Any others? 

Please let me know which options you support.
  

  2) Strategic Plan

here are my thoughts on an overall strategy going forward re health reform

a) Communications plan

what mystifies me are findings by American Cancer Society Cancer Action Network (acscan) and focus groups that show that when explained the public supports Obamacare. [see Polling: Public Wants States to Use Federal Funds to Cover Uninsured Through Medicaid

http://www.acscan.org/content/media-center/medicaid-poll/
this is an important article that shows that given the right info the public supports provisions of obamacare.]

Yet we have not done more to communicate with the public. The herndon alliance and HHS have certainly tried but the key players in the field, the white house, congress, and other key orgs have not done enough.  I think acscan's findings need wide exposure.  I welcome thoughts about how to engage more of these key players.  My guess is the white house felt it was better not to pay too much attention to the issue during the campaign. Obama did discuss some of the key points in Obamacare and did address medicare to some extent.  perhaps in 2014, press about those provisions being implemented will get more attention which will help.  I hope that someone will develop a strategic plan on how to get the most mileage from the 2014 changes which start taking place when the HIEs start to promote their programs probably sometime before october.  see my posting about this

https://www.facebook.com/NationalHealthReformTeamForObama

and/or
http://tinyurl.com/c8puojl

 Such efforts should include partnerships with foundations such as kaiser, rwj, commonwealth, etc., think thanks such as brookings, urban institute, rand, and others such as medicare rights center, alliance for health reform.

b) 

 In the DC and Maryland areas, several major employers have cut hours significantly and have not restored.  I would like to understand the policy that is driving this and would appreciate any explanation you can provide and also any articles that show things were reversed.. Do you know if Whole Foods or McDonalds have reversed their cuts,
c) Cost curve

 one of the points that might bear highlighting is that the ACA may have already contributed to a significant slowing of health care inflation. 

d) Duals

I think one area that can help considerably is to improve the coordination of care and finances for dual eligibles.  one way to achieve this might be to integrate the medicare and medicaid funds, e.g., turn the medicare funds over to the states so that only one entity is coordinating the care.  there are other steps that can improve services for duals, such as the use of care management teams

 

 

 

 

 

see

Polling: Public Wants States to Use Federal Funds to Cover Uninsured Through Medicaid

http://www.acscan.org/content/media-center/medicaid-poll/

this is an important article that shows that given the right info the public supports provisions of obamacare

what mystifies me are findings by acscan and focus groups that show that when explained the public supports ACA and yet we have not done more to communicate with the public. the key players in the field, the white house, congress, and other key orgs have not done enough.  I think acscan's findings need wide exposure.  thoughts about how to engage more of these key players.  my guess is the white house felt it was better not to pay much attention to the issue during the campaign, obama did discuss some of the key points in ACA and did address medicare to some extent.  perhaps in 2014, press about those provisions being implemented will get more attention which will help.  I hope that someone will develop a strategic plan on how to get the most mileage from the 2014 changes which start taking place when the HIEs and medicaid start to promote their programs probably sometime before october. 
 

Kaiser Health News: 3 important stories: contraception, spending differences, consumer protections

from Kaiser health news either their emails or facebook and website

1)
Administration Issues Proposed Rule On Contraception Coverage Mandate And Religious Organizations http://khne.ws/UJYyAc

2) 

What accounts for the difference in what Medicare spends in different parts of the U.S.?

Fed Economist Steps Into Dispute On Geographic Differences In Health Spending

http://khne.ws/U39URZ 

3)

5. Survey Finds Few States Have Laws To Enforce New Consumer Health Protections

http://smtp01.kaiserhealthnews.org/t/35288/430110/40021/0/

Policy Options to Sustain Medicare for the Future; Hospital Readmissions

This posting covers two reports


1) Kaiser Family Foundation: Policy Options to Sustain Medicare for the Future

http://www.kff.org/medicare/upload/8402.pdf

this has many useful options considered, not all of which would I recommend.  Please let me know which options you support.

2) Commonwealth Fund:  University of California, San Francisco Medical Center: Reducing Readmissions Through Heart Failure Care Management

http://www.commonwealthfund.org/Publications/Case-Studies/2012/Nov/University-of-California-San-Francisco.aspx?omnicid=18

this report shows successful reductions in readmissions. 

A Regional Analysis Of Which Hospitals Got Rewards, Penalties Based On Quality

http://khne.ws/VPpSuu

here is kaiser health news article on which hospitals received bonuses and penalties from Medicare based  on quality performance measures.  Why did all of the Washington D.C. hospitals fare poorly on these measures.?  Is it their patient characteristics? If so, does that raise questions about the measures? 

Rise in health care spending continues to be low

There is quite a bit of press today noting that for the third straight year, health care costs have risen at a fairly slow rate.

here is an abstract of the original article in Health Affairs. It is very hard to reach today due to interest in it. 

http://content.healthaffairs.org/content/32/1/87.abstract

here is link to full article

http://content.healthaffairs.org/content/32/1/87.full


here are some sources of articles published today.

http://www.kaiserhealthnews.org/Daily-Reports/2013/January/08/health-spending-news.aspx

http://www.nytimes.com/2013/01/08/us/health-spending-growth-stays-low-for-third-straight-year.html?_r=0

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/01/07/the-2-7-trillion-question-are-health-care-costs-really-dropping/

I wrote last August about this issue.  There was speculation that the slower rise might be related to Obamacare, but no definitive link has been established.  

Here are three previous blogs. 

http://healthreformaction.blogspot.com/2012/08/deceleration-in-health-spending-full.html

http://healthreformaction.blogspot.com/2012/08/obamacare-may-be-causing-slowdown-in.html

http://healthreformaction.blogspot.com/2012/08/obamacare-may-have-reduced-inlfation.html