Health insurance costs rose by 4.6 percent in 2011, and Ezra Klein writes that it's not because we're excessively using the system. Instead, the price of individual episodes is climbing, a trend that appears to be originating with drug makers and hospitals.
“No insurer wants to be known as being obsessively aggressive against price increases,” said Gerard Anderson, director of the Johns Hopkins University’s Center for Hospital Finance and Management. “If you’re an insurance company, you stand to lose a large client [the hospital] all to gain a small rate reduction.”
Also keep in mind these health care cost increases are occurring in an economy in which overall inflation is well below 2 percent.
In singing the praises of its SmartChoice program, which calls patients with pricing information for imaging services, Cool Springs-based MedSolutions also details a crucial byproduct. Providers who are getting bypassed because they are charging more for the same services are renegotiating their rates. Ah, the disinfectant that is sunshine...
“This program is a natural next step for our company,” said Thorne. “For over a decade, we have been helping health plans ensure that patients get the most appropriate tests to meet their needs, and now, we are equipping those patients with transparent cost and quality information to help them make the best decisions about where to have those tests performed.”
Editor's note: This is the third in a series of posts from the Nashville Health Care Council's Leadership Health Care Delegation to Washington. Click here for other installments from the trip.
The Tennessee delegation and key congressional staff members spoke with members of the Nashville Health Care Council’s Leadership Health Care group during a second day of sessions for LHC’s 10 Year Anniversary trip to Washington, D.C.
Tennessee Congressional Delegation members Sen. Lamar Alexander (R-TN), Rep. Marsha Blackburn (R-TN), Rep. Jim Cooper (D-TN) and Sen. Bob Corker (R-TN) discussed the top health care policy issues they think Congress and the American public should be most concerned. Notably, Rep. Cooper and Sen. Corker discussed the “unsustainable” economics of Medicare, wherein the average American receives two or three times the benefit from the government health care program over their lifetime than the amount of money they pay in.
Sen. Corker gave the example of a two-wage family paying $117,000 into Medicare over their lifetimes and receiving $357,000 out of the program.
“Until we change that formula, everything we care about will continue to diminish,” he said. “What we’re doing is not investing in research and development, not doing the things that make our country more economic and efficient because we’re not dealing with this issue.”
Sen. Alexander said there will “have to be a restructuring of our entitlement programs ... to get it down to some reasonable level of growth.”
Following the discussion with the Tennessee delegation, Andrew Shin, acting director of stakeholder engagement for the Center for Medicare and Medicaid Innovation, talked about the ways in which CMS is working to develop care delivery and payment models that improve quality while reducing costs for the health care system. Specifically, he discussed the Innovation Center’s first active initiative — the Pioneer ACO Program — and the programs in process, including a national patient safety campaign, a comprehensive primary care initiative, a bundled payment for care improvement initiative, and the Health Care Innovation Challenge.
Shin (above in a Bill Burke/Page One photo) said the Center is working to reduce the time it takes to spread nationwide innovative health care delivery and payment models from roughly 17 years to just three or four years.
“It’s an exciting time to do what we do in health care. The opportunities are immense, and the risks and challenges are immense,” Shin said. “But [CMS] can’t create a movement. It’s up to people on the ground, the employers and businesses, the people who know that rising health care costs is not just a business issue, it’s an economic issue.”
The day wrapped up with a panel discussion of key congressional staff, including Elizabeth Falcone, health legislative assistant for U.S. Senator Mark Warner (D-VA); Ruth McDonald, senior legislative assistant for Rep. Cooper; Anne Oswalt, health legislative assistant for Sen. Corker; and Monica Popp, health legislative assistant for the U.S. House Committee on Energy and Commerce. The panel was moderated by Sheryl Coughlin, head of research for the Deloitte Center for Health Solutions, and focused on what Congress is facing in health care policy and the budget.
McDonald pointed out that, even if Congress goes through the budget sequestration process, it will still need to look at further deficit reductions through programs such as health care.
“This is a serious problem that affects all of our bottom lines,” she said of growing health care costs. “It’s not just a Congressional problem, it’s a fifth-of-our-economy problem. There needs to be some realistic discussion about what we need to do to change the system.”
The group also talked about the importance of having individuals in Nashville and beyond reach out to their senators and representatives to share their perspectives and expertise on the health care issues before Congress.
“It’s important to have for-profit, nonprofit, boots-on-the-field advice for how things are actually working and how health care is actually working,” said Falcone, who challenged attendees to be partners and not adversaries in helping Congress make important decisions about health care policy.
Falcone, who is working on the staff level with the bipartisan ‘Gang of Eight’ focused on a creating a resolution to the national debt crisis, added: “Your opportunity is not to just say no, it’s to say ‘No, and here’s why’ or ‘Here’s how you can fix it because I think it will be a better system.’”
“Regardless of the outcome of the upcoming Supreme Court deliberations and the election, unavoidable fiscal insolvency issues must be addressed by Congress next year,” said Council President Caroline Young. “It has been gratifying to hear members of our Tennessee Congressional Delegation voicing a strong willingness to build consensus.”
The Healthcare Transparency Index put out for Q3 by Change:Healthcare found large gaps between the number of people with health insurance and those with dental coverage. Additionally the index shows that even simple procedures can vary wildly in cost. One example:
Preventive Dental Exams: Routine dental exams are the primary way to prevent tooth decay and gum disease. An estimated 75 percent of adults suffer from gum disease, and while tooth decay is the most common and preventable disease in children, a U.S. Department of Health and Human Services study cites that only 48 percent of children entering kindergarten had seen a dentist in the previous year. With cost now a significant barrier to proper care, the Index found that the same preventive exam for adults could cost as much as $240 and as low as $55 in the same area, and pediatric exams ranged from $180 to just $35.
More informartion can be found here.
- ALEX B FRUIN INHERITANCE TRUST; CANDACE F STEFANSIC INHERITANCE TRUST; CANDANCE F STEFANSIC INHERITANCE TRUST; FRUIN, ALEX B TRUSTEE; FRUIN ALEX B INHERITANCE TRUST; STEFANSIC, CANDACE F TRUSTEE; STEFANSIC CANDACE F INHERITANCE TRUST; STEFANSIC CANDANCE F INHERITANCE TRUST
- ROSS, BRIDGETT D
- COOKE, ETHEN LANYARD TRUSTEE; COOKE, ETHEN LEWIS ESTATE
- JACOBS, JESSICA ALEXANDRA; JACOBS, ERIKA BESS