Walgreens announced that it was pulling out of Washington state's Medicaid program because the state was paying prices that did not cover the actual cost of many of the program's medications.
For many years the government programs (Medicare and Medicaid) have paid lower prices than other payers. They are able to do this because of the hidden subsidies that other payers pay to make up for short falls in government program payments.
With health reform upon us, we will need to closely watch these trends. Part of the reform package brings Medicaid payments up to Medicare levels. But will this create even more pressure to further lower Medicare rates?
On top of the hidden subsidies, the private payers will now pay a premium tax too.
Does this ultimately push the private insurers out of business and leave us with a single payer option? Or does the government v. private pay differential grow enough that we end up at a two tiered system?
Time will tell, but as providers refuse to deal with certain payers, politicians and the markets will react.
We welcome the provider feedback (Walgreens as an example) that incentives can change provider behavior. If politicians and the markets would incorporate more consumer incentives, then maybe we will end up with a value based system that patients will embrace.
Monday, March 29, 2010
Sunday, March 21, 2010
Health Reform and Consumerism
Regardless of your position on the current health reform, it will soon impact consumerism movements that have been shaping the healthcare landscape and helping to hold prices down.
Consumerism provides individual patients with some economic responsibility as they make decisions regarding their healthcare; hoping to strike a balance between making care affordable but also making sure those paying for care are getting value for the resource they spend.
The reform legislation will probably change over time, but as of today, based on the Senate's bill; here are some of the impacts on consumerism:
Promoting consumerism:
Linking payments to hospitals to providers based upon quality of care instead of volume of services (2012).
Linking payments to physicians to providers based upon quality of care instead of volume of services (2013).
Taxing high cost insurance plans (2013).
Increasing the threshold for claiming itemized deductions for medical expenses (2013).
Limiting Consumerism:
Eliminating Lifetime Limits and Restricting Use of Annual Limits (2010).
Covering Preventive Health Services at 100% (2010).
Reducing the Part D “Donut Hole” or Coverage Gap (2010).
Limiting Health Flexible Savings Account Contributions (2011).
Eliminating Annual Limits on health insurance coverage (2014).
It will be interesting to see how the final legislation changes over time and what its ultimate impact will be on consumerism.
Based upon patient usage of the Healthcare Blue Book, we know that many patients are very capable of finding high quality care at reasonable prices when they have an incentive to do so.
Consumerism provides individual patients with some economic responsibility as they make decisions regarding their healthcare; hoping to strike a balance between making care affordable but also making sure those paying for care are getting value for the resource they spend.
The reform legislation will probably change over time, but as of today, based on the Senate's bill; here are some of the impacts on consumerism:
Promoting consumerism:
Linking payments to hospitals to providers based upon quality of care instead of volume of services (2012).
Linking payments to physicians to providers based upon quality of care instead of volume of services (2013).
Taxing high cost insurance plans (2013).
Increasing the threshold for claiming itemized deductions for medical expenses (2013).
Limiting Consumerism:
Eliminating Lifetime Limits and Restricting Use of Annual Limits (2010).
Covering Preventive Health Services at 100% (2010).
Reducing the Part D “Donut Hole” or Coverage Gap (2010).
Limiting Health Flexible Savings Account Contributions (2011).
Eliminating Annual Limits on health insurance coverage (2014).
It will be interesting to see how the final legislation changes over time and what its ultimate impact will be on consumerism.
Based upon patient usage of the Healthcare Blue Book, we know that many patients are very capable of finding high quality care at reasonable prices when they have an incentive to do so.
Thursday, March 11, 2010
Save Big
Elisabeth Leamy who is the Consumer Correspondent for the Good Morning America show has a new book out called Save Big.
In addition to tips on expenses around housing, transportation, loans and grocery shopping, she has an entire section devoted to healthcare costs.
It is definitely worth reading and can help consumers with health insurance suggestions as well as suggestions for finding care and prescriptions.
Not surprisingly she recommends negotiating with your doctor.
We were glad to see that she suggested using The Healthcare Blue Book as a great place to find out how much your care should cost. As Leamy reports, the Healthcare Blue Book's fair price is "a great starting point for discussion- and negotiation."
In addition to tips on expenses around housing, transportation, loans and grocery shopping, she has an entire section devoted to healthcare costs.
It is definitely worth reading and can help consumers with health insurance suggestions as well as suggestions for finding care and prescriptions.
Not surprisingly she recommends negotiating with your doctor.
We were glad to see that she suggested using The Healthcare Blue Book as a great place to find out how much your care should cost. As Leamy reports, the Healthcare Blue Book's fair price is "a great starting point for discussion- and negotiation."
Sunday, February 28, 2010
Why do we pay more money without getting better quality care?
Value is one of the most important missing topics in the health reform debate.
We might not be so concerned with how much health care costs or how much of our national budget gets devoted to health care, IF we felt we were getting good value for our money. But the fact is that we all know we aren't getting a good value. We see prices continue to rise faster than inflation and very often that is accompanied with lower levels of service, less time with our doctors, etc.
There have been some studies focused squarely on this issue. I have commented before on the Health Affairs article last year.
Now comes a nice report from Massachusetts that examined the costs of healthcare and how they relate to quality.
What did they find?
Their preliminary review revealed serious system-wide failings in the commercial health care marketplace which, if unaddressed, imperil access to affordable, quality health care.
Their investigation has shown:
- Prices paid by health insurance companies to hospitals and physician groups vary significantly within the same geographic area and amongst providers offering similar levels of service.
- Price variations are not correlated to (1) quality of care, (2) the sickness or
complexity of the population being served, (3) the extent to which a provider is
responsible for caring for a large portion of patients on Medicare or Medicaid, or (4) whether a provider is an academic teaching or research facility. Moreover, (5) price variations are not adequately explained by differences in hospital costs of delivering similar services at similar facilities.
At The Healthcare Blue Book our work with employers reveals this fact frequently. We routinely see employees paying 500% more than necessary for common services while getting no better (and sometimes lower) quality of care. These are prices paid to in-network providers; and prices that ultimately are paid for by the employer under their health benefit costs.
The more research the better, but each study points in the same direction: there is a lot of opportunity for employers and employees to lower costs and raise quality.
We might not be so concerned with how much health care costs or how much of our national budget gets devoted to health care, IF we felt we were getting good value for our money. But the fact is that we all know we aren't getting a good value. We see prices continue to rise faster than inflation and very often that is accompanied with lower levels of service, less time with our doctors, etc.
There have been some studies focused squarely on this issue. I have commented before on the Health Affairs article last year.
Now comes a nice report from Massachusetts that examined the costs of healthcare and how they relate to quality.
What did they find?
Their preliminary review revealed serious system-wide failings in the commercial health care marketplace which, if unaddressed, imperil access to affordable, quality health care.
Their investigation has shown:
- Prices paid by health insurance companies to hospitals and physician groups vary significantly within the same geographic area and amongst providers offering similar levels of service.
- Price variations are not correlated to (1) quality of care, (2) the sickness or
complexity of the population being served, (3) the extent to which a provider is
responsible for caring for a large portion of patients on Medicare or Medicaid, or (4) whether a provider is an academic teaching or research facility. Moreover, (5) price variations are not adequately explained by differences in hospital costs of delivering similar services at similar facilities.
At The Healthcare Blue Book our work with employers reveals this fact frequently. We routinely see employees paying 500% more than necessary for common services while getting no better (and sometimes lower) quality of care. These are prices paid to in-network providers; and prices that ultimately are paid for by the employer under their health benefit costs.
The more research the better, but each study points in the same direction: there is a lot of opportunity for employers and employees to lower costs and raise quality.
Saturday, February 20, 2010
If Air Travel Worked Like Health Care
People are always comparing the health care system to other industries.... Well now you can watch the movie.
Check out this video, you may not know whether to laugh or cry.
Of course they highlight the issues of transparency and the challenges faced by consumers in having to work with multiple providers to get a single service.
The Healthcare Blue Book is working to solve both of these problems. Maybe if all the CEOs working in the healthcare system would watch this video, they could find a little motivation to cooperate in solving these issues.
Check out this video, you may not know whether to laugh or cry.
Of course they highlight the issues of transparency and the challenges faced by consumers in having to work with multiple providers to get a single service.
The Healthcare Blue Book is working to solve both of these problems. Maybe if all the CEOs working in the healthcare system would watch this video, they could find a little motivation to cooperate in solving these issues.
Thursday, February 4, 2010
How Much Will Your Surgery Cost? Hospitals Can’t Tell You
Press Release regarding Healthcare Blue Book Survey: How Much Will Your Surgery Cost? Hospitals Can’t Tell You
Washington, DC. -- Patients are the losers in both the Democrat and Republican versions of the health care reform bills. Proposed health care reform won’t help patients find out how much health care costs before they get care and many hospitals aren’t set up to help.
A new research paper from The Healthcare Blue Book (www.healthcarebluebook.com) entitled Surgery Pricing Secrets: The Challenges Patients Face, shows that it is almost impossible to get prices ahead of time if a patient plans to have surgery in a hospital.
Healthcare Blue Book researchers found that:
• It took three times as many phone calls and four times as long to get pricing information from a hospital.
• Hospitals would not provide guaranteed prices and price ranges often varied by more than 100%.
• ASCs were more likely to discount prices for cash customers; regardless of the patient’s financial status.
• Facility fees are 3-4 times higher in a hospital than in an ASC.
Healthcare Blue Book researchers contacted hospitals and ambulatory care centers (ASCs) in three markets: Raleigh-Durham, NC; Denver, CO; and Portland, OR. Hospitals and ASCs were asked to provide the costs of an anterior cruciate ligament surgery of the knee for a patient without health insurance.
Queries were primarily about facility fees, but researchers also asked respondents about other fees associated with the surgery.
It’s almost certain health care expenditures, which totaled about $2.5 trillion in 2009, will continue to climb by at least 6% a year. Hospital costs are 31% of the total according to the Centers for Medicare and Medicaid Services. So what are health care consumers going to do?
The Healthcare Blue Book, an Internet content provider, offers a free consumer guide to fair pricing for healthcare treatments and services for local markets at www.healthcarebluebook.com.
“One of the main tenets of successful healthcare reform will be patients taking more responsibility for finding out what their care costs as they make treatment decisions,” said Dr. Jeffrey Rice, Healthcare Blue Book CEO, and white paper author. “But until hospitals are able to provide exact pricing, managing out of pocket costs for both insured and self-pay patients is almost impossible.”
For a free copy Surgery Pricing Secrets: The Challenges Patients Face go here.
Washington, DC. -- Patients are the losers in both the Democrat and Republican versions of the health care reform bills. Proposed health care reform won’t help patients find out how much health care costs before they get care and many hospitals aren’t set up to help.
A new research paper from The Healthcare Blue Book (www.healthcarebluebook.com) entitled Surgery Pricing Secrets: The Challenges Patients Face, shows that it is almost impossible to get prices ahead of time if a patient plans to have surgery in a hospital.
Healthcare Blue Book researchers found that:
• It took three times as many phone calls and four times as long to get pricing information from a hospital.
• Hospitals would not provide guaranteed prices and price ranges often varied by more than 100%.
• ASCs were more likely to discount prices for cash customers; regardless of the patient’s financial status.
• Facility fees are 3-4 times higher in a hospital than in an ASC.
Healthcare Blue Book researchers contacted hospitals and ambulatory care centers (ASCs) in three markets: Raleigh-Durham, NC; Denver, CO; and Portland, OR. Hospitals and ASCs were asked to provide the costs of an anterior cruciate ligament surgery of the knee for a patient without health insurance.
Queries were primarily about facility fees, but researchers also asked respondents about other fees associated with the surgery.
It’s almost certain health care expenditures, which totaled about $2.5 trillion in 2009, will continue to climb by at least 6% a year. Hospital costs are 31% of the total according to the Centers for Medicare and Medicaid Services. So what are health care consumers going to do?
The Healthcare Blue Book, an Internet content provider, offers a free consumer guide to fair pricing for healthcare treatments and services for local markets at www.healthcarebluebook.com.
“One of the main tenets of successful healthcare reform will be patients taking more responsibility for finding out what their care costs as they make treatment decisions,” said Dr. Jeffrey Rice, Healthcare Blue Book CEO, and white paper author. “But until hospitals are able to provide exact pricing, managing out of pocket costs for both insured and self-pay patients is almost impossible.”
For a free copy Surgery Pricing Secrets: The Challenges Patients Face go here.
Sunday, January 31, 2010
Cut Your Health Care Costs Now!
Cut Your Health Care Costs Now! is a new book by Brandi Funk, FNP-C that I just had the opportunity to review.
Brandi Funk is a board certified family nurse practitioner and health care advocate. With 15 years of experience helping patients, she as a lot to offer in her book.
Her book begins with suggestions for buying health insurance. Most importantly are the check lists to make sure your coverage will actually cover you.
She next shares useful tips on using your insurance. The book has lots of tips for traditional insurance and also for using Medicare. While many readers may have traditional insurance, they may also be helping their parents with issues involving Medicare.
Healthcare Blue Book is focused on helping patients get quality care at affordable prices. Cut Your Health Care Costs Now! offers many suggestions to patients on how to save on health care expenses and prescription drugs. Of course, one of my favorite tips in the book is "Negotiate Your Price First". As we see every day, once a patient gets care; it is very difficult to lower the final bill. However, patients can save $100's or even $1000's if they know to ask about prices first. Often they improve the quality of their care too.
Cut Your Health Care Costs Now! has many other tips for consumers. It is well worth your time and I imagine that most consumers will save a lot more than the book costs. A book that pays for itself, how can you beat that?
The book is provided as an e-book. One neat thing about the e-book format is the fact that you can directly link to valuable resources provided in the book. Ms. Funk has excellent reference sources, lists, and content links throughout the book.
You can find the book here.
Brandi Funk is a board certified family nurse practitioner and health care advocate. With 15 years of experience helping patients, she as a lot to offer in her book.
Her book begins with suggestions for buying health insurance. Most importantly are the check lists to make sure your coverage will actually cover you.
She next shares useful tips on using your insurance. The book has lots of tips for traditional insurance and also for using Medicare. While many readers may have traditional insurance, they may also be helping their parents with issues involving Medicare.
Healthcare Blue Book is focused on helping patients get quality care at affordable prices. Cut Your Health Care Costs Now! offers many suggestions to patients on how to save on health care expenses and prescription drugs. Of course, one of my favorite tips in the book is "Negotiate Your Price First". As we see every day, once a patient gets care; it is very difficult to lower the final bill. However, patients can save $100's or even $1000's if they know to ask about prices first. Often they improve the quality of their care too.
Cut Your Health Care Costs Now! has many other tips for consumers. It is well worth your time and I imagine that most consumers will save a lot more than the book costs. A book that pays for itself, how can you beat that?
The book is provided as an e-book. One neat thing about the e-book format is the fact that you can directly link to valuable resources provided in the book. Ms. Funk has excellent reference sources, lists, and content links throughout the book.
You can find the book here.
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