Insurers Once on the Fence Plan to Join Health Exchanges in ’15 - NYTimes.com

 

In a sign of the growing potential under the federal health care law, several insurers that have been sitting on the sidelines say they will sell policies on the new exchanges in the coming year, and others plan to expand their offerings to more states.

“Insurers continue to see this as a good business opportunity,” said Larry Levitt, a health policy expert at the Kaiser Family Foundation. “They see it as an attractive market, with enrollment expected to ramp up in the second year.” Eight million people have signed up for coverage in 2014, and estimates put next year’s enrollment around 13 million.

In New Hampshire, for example, where Anthem Blue Cross is the only insurer offering individual coverage on the state exchange, two other plans, both from Massachusetts, say they intend to offer policies next year. Harvard Pilgrim Health Care, a nonprofit insurer with 1.2 million members, said it expected to participate in the exchanges in both New Hampshire and Maine for the first time and to add Connecticut to the mix in 2016.

Insurers Once on the Fence Plan to Join Health Exchanges in ’15 - NYTimes.com

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BBC News - Do doctors understand test results?

Don’t cheat!

But it's not just that doctors and dentists can't reel off the relevant stats for every treatment option. Even when the information is placed in front of them, Gigerenzer says, they often can't make sense of it.

In 2006 and 2007 Gigerenzer gave a series of statistics workshops to more than 1,000 practising gynaecologists, and kicked off every session with the same question:

A 50-year-old woman, no symptoms, participates in routine mammography screening. She tests positive, is alarmed, and wants to know from you whether she has breast cancer for certain or what the chances are. Apart from the screening results, you know nothing else about this woman. How many women who test positive actually have breast cancer? What is the best answer?

• nine in 10
• eight in 10
• one in 10
• one in 100

Gigerenzer then supplied the assembled doctors with some data about Western women of this age to help them answer his question. (His figures were based on US studies from the 1990s, rounded up or down for simplicity - current stats from Britain's National Health Service are slightly different).

1. The probability that a woman has breast cancer is 1% ("prevalence")
2. If a woman has breast cancer, the probability that she tests positive is 90% ("sensitivity")
3. If a woman does not have breast cancer, the probability that she nevertheless tests positive is 9% ("false alarm rate")

In one session, almost half the group of 160 gynaecologists responded that the woman's chance of having cancer was nine in 10. Only 21% said that the figure was one in 10 - which is the correct answer. That's a worse result than if the doctors had been answering at random.

The fact that 90% of women with breast cancer get a positive result from a mammogram doesn't mean that 90% of women with positive results have breast cancer. The high false alarm rate, combined with the disease's prevalence of 1%, means that roughly nine out of 10 women with a worrying mammogram don't actually have breast cancer.

I’ve often argued, when consumer choice and consumer driven health care are brought up as the solution for our health care woes, that doctors don’t even know how to make reasonable decisions so how can we expect lay people to do it?

 

BBC News - Do doctors understand test results?

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Patients’ Costs Skyrocket; Specialists’ Incomes Soar - NYTimes.com

 

CONWAY, Ark. — Kim Little had not thought much about the tiny white spot on the side of her cheek until a physician’s assistant at her dermatologist’s office warned that it might be cancerous. He took a biopsy, returning 15 minutes later to confirm the diagnosis and schedule her for an outpatient procedure at the Arkansas Skin Cancer Center in Little Rock, 30 miles away.

That was the prelude to a daylong medical odyssey several weeks later, through different private offices on the manicured campus at the Baptist Health Medical Center that involved a dermatologist, an anesthesiologist and an ophthalmologist who practices plastic surgery. It generated bills of more than $25,000.

“I felt like I was a hostage,” said Ms. Little, a professor of history at the University of Central Arkansas, who had been told beforehand that she would need just a couple of stitches. “I didn’t have any clue how much they were going to bill. I had no idea it would be so much.”

Ms. Little’s seemingly minor medical problem — she had the least dangerous form of skin cancer — racked up big bills because it involved three doctors from specialties that are among the highest compensated in medicine, and it was done on the grounds of a hospital. Many specialists have become particularly adept at the business of medicine by becoming more entrepreneurial, protecting their turf through aggressive lobbying by their medical societies, and most of all, increasing revenues by offering new procedures — or doing more of lucrative ones.

Patients’ Costs Skyrocket; Specialists’ Incomes Soar - NYTimes.com

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The Affordable Care Act And People With Disabilities - Forbes

 

“ACA changes the world for persons with disabilities and funds who will now have a choice between public or private health insurance. For significant financial as well as health reasons, we believe that private health insurance, not Medicaid, will be soup d’jour for the vast majority of (Special Needs Trusts) SNT clients. We cannot know for certain, but I would not be surprised to see persons with disabilities leaving public health insurance (Medicaid) for the private market in January, 2012.

The most obvious and most significant health industry reform important to our SNT clients is the elimination of pre‐existing conditions as a bar to purchasing private health insurance. However, ACA also eliminates annual or lifetime caps, rescission of insurance policies, non‐renewability, and higher premium costs for persons with pre‐existing conditions. For individuals with significant medical problems, elimination of cost‐containment ceilings is just as important as access to the door of private medical care. It is not unusual to see clients who have maxed out their lifetime cap and are now seeking public health insurance.

Why would clients opt to pay for private health insurance rather than “free” Medicaid? The two major reasons are first, securing health insurance without a payback on death and second, access to significantly better medical care…

Change makes most of us uncomfortable, but change is a constant in our lives. This is one time when special needs attorneys can both lament the negative impact of national legislation on our personal financial well‐being, but rejoice in the concomitant good fortune of our clients with disabilities who can now join the private health insurance market with the rest of us as equal citizens with their dignity intact.”

The Affordable Care Act And People With Disabilities - Forbes

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Market, insurers will keep premiums low, analysts say

Just how much premiums will change depends on the state you live in, Kingsdale said.
Individual premiums decreased when Massachusetts' health care took effect, he said, because the state already had high-priced and insurers were not allowed to turn away the sick and could not charge large premium differences based on age, gender and health.
"Other states will see exactly the opposite happen," he said. "Their premiums tend to be quite low, but they're getting skimpy insurance."
In Oregon, Ario said, large differences in premium prices have already appeared.
In one case, a 40-year-old non-smoker in Oregon could buy a low-cost or bronze-level plan for $162 a month from one company or the same plan from another for $400 a month, Ario said. Anti-trust laws prevented the insurers from comparing pricing before developing their premiums.
When the companies with the higher rates saw their competitors' lower premiums, he said, they asked the state to allow them to file for reduced premiums.
"The good news is that in most marketplaces, there will be some carriers that will be bold and price competitively to get more market share," Ario said.

Market, insurers will keep premiums low, analysts say

For a quick rundown on what the "gold, silver, and bronze" plans will cover, go here.

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Study: When health insurance costs rise, productivity drops

Study: When health insurance costs rise, productivity drops

A new working paper from Truven Healthcare’s Teresa Gibson, Harvard’s Michael Chernew and the University of Michigan’s A. Mark Fendrick find that as co-payments go up, productivity drops — most likely as a result of employees skipping out on care altogether.

The team focused on those with chronic pain such as arthritis. They then looked at how much employees had to pay for prescription medication under their various benefit structures. Previous research has shown that as the cost of health-care services increases, usage decreases — workers simply don’t fill as many prescriptions when prices get higher.

On average, employees with chronic pain had 76.7 hours absent from work. But with every $5 increase in cost-sharing for pain medications, they saw an increase in absenteeism somewhere in the ballpark of 1.3 to 3.1 percent.

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Navigating the Labyrinth of Medical Costs - Your Money - NYTimes.com

Navigating the Labyrinth of Medical Costs - Your Money - NYTimes.com

Hospital care tends to be the most confounding, and experts say the charges you see on your bill are usually completely unrelated to the cost of providing the services (at hospitals, these list prices are called the “charge master file”). “The charges have no rhyme or reason at all,” Gerard Anderson, director of the Center for Hospital Finance and Management at Johns Hopkins Bloomberg School of Public Health. “Why is 30 minutes in the operating room $2,000 and not $1,500? There is absolutely no basis for setting that charge. It is not based upon the cost, and it’s not based upon the market forces, other than the whim of the C.F.O. of the hospital.”

And those charges don’t really have any connection to what a hospital or medical provider will accept for payment, either. “If you line up five patients in their beds and they all have gall bladders removed and they get the same exact medication and services, if they have insurance or if they don’t have insurance, the hospital will get five different reimbursements, and none of it is based on cost,” said Holly Wallack, a medical billing advocate in Miami Beach. “The insurers negotiate a different rate, and if you are uninsured, underinsured or out of network, you are asked to pay full fare.”

With the exception of Medicare and Medicaid, experts say, the amount paid for services — or the price your insurers pay — is based on the market power of the insurance company on the one side and the hospitals and providers on the other, and the reimbursement agreements they ultimately reach. So large insurers that command a lot of market power may be able to negotiate lower rates than smaller companies with less influence. Or, insurers can place hospitals or providers on a preferred list, which may help bolster their business, in exchange for a lower reimbursement rate. On the other hand, well-regarded hospitals may command higher prices from insurers.

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RAND | (Technical) Reports | Possibility or Utopia?: Consumer Choice in Health Care: A Literature Review

RAND (Technical) Reports Possibility or Utopia?: Consumer Choice in Health Care: A Literature Review:

This literature review examines consumer choice in health insurance plans against the background of the German health system in order to inform the questions: What are models of consumer choice and their effects?, and: If consumers want lower cost health care, what instruments can insurers use to provide it and what are the likely effects of those instruments? The review looked at experiences in other industrialized countries, especially the United States, for consumer choice options such as co-payments, reimbursement/bonuses, and deductibles, as well as organizational designs such as gatekeeper systems and selective contracting. In addition to cost-containment measures, the review also examined what was known about effects on health status, satisfaction, fairness and the macro-economic situation. The review describes the health economics theory of consumer choice, the methodology for the literature review, the German health system, and studies on consumer choice of insurers and providers, and reflects on their relevance on the German system. This literature review examines consumer choice in health insurance plans against the background of the German health system in order to inform the questions: What are models of consumer choice and their effects?, and: If consumers want lower cost health care, what instruments can insurers use to provide it and what are the likely effects of those instruments? The review looked at experiences in other industrialized countries, especially the United States, for consumer choice options such as co-payments, reimbursement/bonuses, and deductibles, as well as organizational designs such as gatekeeper systems and selective contracting.

The full document is here.

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