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Thread: Health Insurance That Doesn’t Cover the Bills Has Flooded the Market Under Trump

  1. #381
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    Re: Health Insurance That Doesn’t Cover the Bills Has Flooded the Market Under Trump

    Quote Originally Posted by TU Curmudgeon View Post
    Since all of the healthcare insurance companies are buying healthcare services for $X.xx and selling them for "$X.xx" + $X.xx * (1+z), the more that you can reduce the "z" the less expensive the healthcare services are going to be for the people who end up buying them. This does increase competition as the healthcare insurance companies can only compete by reducing the "z".
    No. Finding administrative efficiencies is one way insurers can compete on premium. But the point of using marketplaces is to push them to work on the others as well.

    Namely:

    1) Smarter benefit design

    E.g., Fast-Tracking Value-Based Insurance Design on Exchange Marketplaces

    “By eliminating or reducing cost-sharing for high-value services, VBID [value-based insurance design] holds promise in reducing financial barriers to needed medical care, improving adherence to prescribed treatments, and achieving better health outcomes,” AHIP explained in their recent post about the study...

    The goal of the study was to keep deductibles and premiums the same while encouraging use of cost-effective treatments over wasteful ones. In doing so, the plan not only incentivizes effective healthcare spending but also makes treatments with stronger results more financially accessible.
    2) Population health management

    E.g., Insurers deploy data to advance population health management
    The managed-care organization achieved that by not only providing behavioral health screenings and faster referrals to mental health services, but by addressing some nonclinical factors like poverty, food and housing insecurity, and environmental exposures such as homes with lead paint...

    “We actually did things like buying air conditioners and delivering meals,” said Dr. Seth Feuerstein...

    For-profit Magellan isn't alone in addressing problems that previously were not tasked to healthcare organizations. In an effort to lower spending and improve patients' lives, payers and providers are becoming increasingly responsible for a community's overall health...

    And now, more insurers are leveraging that information to help their bottom lines. According to a recent Change Healthcare survey, 42% of payers are adding community programs and resources to their population health efforts. Another 34% of payers said they use census and socio-economic data along with clinical data to create new programs.
    3) Aggressive provider contracting/network design to get price concessions from providers or offer access to lower-cost provider networks

    E.g., Hospital prices drop for the first time
    “This appears to be a combination of the public sector pressure, but an even more fierce change on behalf of the private payers,” said Paul Hughes-Cromwick, a senior health economist at the Altarum Institute's Center for Sustainable Health Spending.

    “Insurers are more aggressively bargaining with hospitals and more aggressively investing in programs that lower hospital utilization rates,” said Neraj Sood, an associate professor in health economics and policy at the University of Southern California. . .But the pressure on insurers to compete on price in the Affordable Care Act-created insurance exchanges may have better positioned them to wring price concessions from hospitals, Hughes-Cromwick said.
    4) Smarter contracting to encourage providers to re-design care delivery

    E.g., Changing The Way Doctors Are Paid Made Patients Healthier And Saved Money, Study Finds
    The program, called the Alternative Quality Contract, works in two key ways. . .

    The second part of the program changed how doctors, hospitals and other providers are paid. In a typical health payment system, providers receive payments for each service they perform, but Blue Cross Blue Shield’s new program uses a different system, known as a global payment model.

    In this system, primary care providers receive a spending target from Blue Cross Blue Shield for their members’ care. If they spend less than the target amount by the end of the year, the providers and the health insurance company split the cash. If the doctors overspend, they and insurer split the extra cost. The theory is that this will encourage physicians to take extra steps to avoid expensive care like emergency room visits and hospital stays.

  2. #382
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    Re: Health Insurance That Doesn’t Cover the Bills Has Flooded the Market Under Trump

    Quote Originally Posted by Greenbeard View Post
    It should come as no surprise that the Trump administration has made enabling predatory actions by bad actors and promoting junk insurance the centerpiece of its health care agenda, such as it is. Junk plans--"short term" health plans, despite the fact that they're now available for the entire year--are on the verge of becoming a bonanza for hucksters no longer bound by consumer protection rules.

    Think of these plans as the Trump University of health insurance. Beyond failing to offer the basic protections and coverage people have come to expect in the age of the ACA (pre-existing condition protections, no caps or limits, etc), short term plans on average spend an absurdly low 39 cents of every premium dollar they collect on actual medical care. By contrast, ACA-compliant plans are legally required to dedicate at least 80-85% of premiums on actual care.

    Health Insurance That Doesn’t Cover the Bills Has Flooded the Market Under Trump




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  3. #383
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    Re: Health Insurance That Doesn’t Cover the Bills Has Flooded the Market Under Trump

    Quote Originally Posted by Greenbeard View Post
    No. Finding administrative efficiencies is one way insurers can compete on premium. But the point of using marketplaces is to push them to work on the others as well.
    Actually the answer is "Yes.". "Finding administrative efficiencies is ANOTHER way insurers can compete on premium, as is reduction in advertising.

    Both of those produce greater results the FEWER insurers there are.

    Quote Originally Posted by Greenbeard View Post
    Namely:

    1) Smarter benefit design
    Agreed, having an insurance policy that covers less would enable premiums to be reduced.

    Quote Originally Posted by Greenbeard View Post
    2) Population health management
    Agreed, treating medical conditions BEFORE they cost a lot of money to treat would enable a reduction in premiums. Of course that would also mean a vastly expanded network of healthcare service providers and vastly increased advertising in order to ensure that the insured people actually went and received the prophylactic treatments that they were supposed to receive AND followed the life-style regime they were supposed to follow AND (naturally) if the insured people did NOT do what they were supposed to do, that would mean that their healthcare coverage would be voided for a contractual breach on their part, AND that would mean that the insurance companies simply wouldn't have to base their premiums on calculations that included the costs which were (naturally) no longer covered or on the services which were not being used.

    Quote Originally Posted by Greenbeard View Post
    3) Aggressive provider contracting/network design to get price concessions from providers or offer access to lower-cost provider networks
    Indeed, if someone has 10 cars to sell and there are 20 people bidding on those cars, the only logical conclusion is that the vendor will sell the cars to the 10 LOWEST bidders. Unless, of course, you are talking about a consortium of healthcare insurance providers negotiating as a monolithic bloc and telling the health care providers things like "Unless you reduce your charges for CCU stays to $50.00 per day we simply are no longer going to be providing insurance for stays in CCUs and then you won't have any patients in your CCUs.".

    Quote Originally Posted by Greenbeard View Post
    4) Smarter contracting to encourage providers to re-design care delivery
    What you are actually talking about is "intelligent design" and that means that the healthcare providers actually have to know what it is costing to provide each and every service.

    ALL of your suggested improvements can be met by using rational planning and reducing the number of competing insurance providers to the minimum. That minimum is - 1.
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  4. #384
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    Re: Health Insurance That Doesn’t Cover the Bills Has Flooded the Market Under Trump

    Quote Originally Posted by TU Curmudgeon View Post
    Actually the answer is "Yes.". "Finding administrative efficiencies is ANOTHER way insurers can compete on premium, as is reduction in advertising.
    Sounds like we agree, "insurance companies can only compete by reducing the 'z'" is false. There's lots they can and are doing beyond htat.

    Agreed, having an insurance policy that covers less would enable premiums to be reduced.
    That's not what "benefit design" means.

    Agreed, treating medical conditions BEFORE they cost a lot of money to treat would enable a reduction in premiums. Of course that would also mean a vastly expanded network of healthcare service providers and vastly increased advertising in order to ensure that the insured people actually went and received the prophylactic treatments that they were supposed to receive AND followed the life-style regime they were supposed to follow AND (naturally) if the insured people did NOT do what they were supposed to do, that would mean that their healthcare coverage would be voided for a contractual breach on their part, AND that would mean that the insurance companies simply wouldn't have to base their premiums on calculations that included the costs which were (naturally) no longer covered or on the services which were not being used.
    Maybe I wasn't clear. The reason I included links is because everything I'm talking about is already starting to happen, this isn't theoretical stuff. We're in Year Six of the ACA's new incentives. And one of the ways to win under the ACA is for payers and providers to get serious about helping people get and stay healthy.

    Indeed, if someone has 10 cars to sell and there are 20 people bidding on those cars, the only logical conclusion is that the vendor will sell the cars to the 10 LOWEST bidders. Unless, of course, you are talking about a consortium of healthcare insurance providers negotiating as a monolithic bloc and telling the health care providers things like "Unless you reduce your charges for CCU stays to $50.00 per day we simply are no longer going to be providing insurance for stays in CCUs and then you won't have any patients in your CCUs.".
    Sellers in the marketplaces have put out products with a range of network breadth: you can buy broader network offerings that include higher priced providers, or you can buy generally cheaper narrower network products that cut out high-priced providers. The latter have proven to be popular, which has led to price concession from providers in some markets.

    What you are actually talking about is "intelligent design" and that means that the healthcare providers actually have to know what it is costing to provide each and every service.
    Yes, it holds providers accountable for their costs. This has been going on for several years now, it's one of the most important changes to the health care system ushered in by the ACA.

    ALL of your suggested improvements can be met by using rational planning and reducing the number of competing insurance providers to the minimum. That minimum is - 1.
    Perhaps, but the current proposals for single-payer feature no benefit design at all, dismantle most of the payment reforms re-shaping the delivery system and encouraging population health management, and to date don't contain workable mechanisms to determine pricing. Which is to say, they're missing all of the most important ingredients.

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    Re: Health Insurance That Doesn’t Cover the Bills Has Flooded the Market Under Trump

    Quote Originally Posted by Greenbeard View Post
    Sounds like we agree, "insurance companies can only compete by reducing the 'z'" is false. There's lots they can and are doing beyond htat.
    I agree, there ARE other ways, such as "monopoly/cartel formation" and "acting in concert" that the insurance companies can "compete".

    Quote Originally Posted by Greenbeard View Post
    That's not what "benefit design" means.
    The insurance companies will tell you that it isn't what it MEANS, but that is - effectively - what it DOES.

    Quote Originally Posted by Greenbeard View Post
    Maybe I wasn't clear. The reason I included links is because everything I'm talking about is already starting to happen, this isn't theoretical stuff. We're in Year Six of the ACA's new incentives. And one of the ways to win under the ACA is for payers and providers to get serious about helping people get and stay healthy.
    Yes, reducing claims costs without reducing premiums does do rather healthy things for your balance sheet.

    Quote Originally Posted by Greenbeard View Post
    Sellers in the marketplaces have put out products with a range of network breadth: you can buy broader network offerings that include higher priced providers, or you can buy generally cheaper narrower network products that cut out high-priced providers. The latter have proven to be popular, which has led to price concession from providers in some markets.
    Indeed, and you can buy insurance that doesn't actually do very much at all at quite a reasonable price as well.

    Quote Originally Posted by Greenbeard View Post
    Yes, it holds providers accountable for their costs. This has been going on for several years now, it's one of the most important changes to the health care system ushered in by the ACA.
    My father installed one of the very first computer billing systems in the US, that was back in the early 1960s. That system enabled the hospital to bill for every band-aid and box of tissues that the patient used. I don't believe that the ACA was in effect then.

    Quote Originally Posted by Greenbeard View Post
    Perhaps, but the current proposals for single-payer feature no benefit design at all, dismantle most of the payment reforms re-shaping the delivery system and encouraging population health management, and to date don't contain workable mechanisms to determine pricing. Which is to say, they're missing all of the most important ingredients.
    Then might I be so rude as to suggest that the US start looking OUTSIDE of the US to see how other countries manage to make it work (rather than attempting to [a] make it work, and [b] make sure that the private insurance companies don't suffer any diminution in profits?
    I was told that the best things for me were to eat healthy foods, walk up hills, stop smoking cigars, and cut out drinking Scotch.
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