Health care: Price Confusion
Note to readers: The role of an editorial page is not simply to present opinions, but to moderate thoughtful discussions on important issues. That happened last week. Reader Thomas Diekmann, a retired aerospace engineer and manager from Jacksonville, sent us a letter on health care. Were his scenarios realistic? We forwarded the letter to Brian Klepper, an Atlantic Beach consultant. Klepper's response was so interesting that we decided to share this package with the readers.
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Use waste in the health care system to increase access for the uninsured
Brian Klepper and David C. Kibbe
Congress' health care reform debate has highlighted how American governance is broken and the difficulty of addressing our national problems.
Take, for example, whether health care is in crisis at all. Conservative commentators argue that America's health system is fine, that our excellent care simply costs more than other countries' poorer quality, and that most uninsureds can afford coverage. They ask why we should revamp a great system for the 3 percent of Americans who get less.
This misrepresents reality, though. Care and outcomes are often superior in other developed nations.
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First Coast Leaders Describe Their Health Care Priorities
BRIAN KLEPPER
Principal of Healthcare Performance Inc., of Atlantic Beach
We can improve America's health care system by correcting four deep flaws in its structure. First, we should get rid of lobbying contributions that influence lawmakers to favor special interests over common interest.
Next, re-empower primary care. In America, 30 percent of doctors provide primary care and 70 percent are specialists. In other developed nations, the ratio is reversed. Their costs are half of ours and their quality is often superior.
Third, publish cost and quality data - like Consumer Reports does - on doctors, hospitals, health plans, drugs, devices and treatments so health care can finally work like a market. Performance information will help purchasers understand value and will favor those who consistently deliver high quality at low cost.
Last, stop paying for procedures. Instead, pay for results. Many doctors are paid for every service they provide, so they deliver lots of unnecessary services. To get better quality care at lower cost, we need to change the way we reimburse for care.
The health industry has vigorously opposed these measures. But many experts agree they would make health care higher quality and more affordable.
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Carrots and sticks shape healthier employees, save money
Employers asking workers to take a health risk assessment (HRA) can come to grips with a harsh truth: Most employees don’t bother to participate.
HRAs are lifestyle surveys that evaluate an individual’s likelihood of having debilitating, expensive health conditions. But employees often view them as a hassle. Or worse, they’re the employer sticking his nose into the employee’s private life.
But they are more than that. They are about who owns the risk. If the employer agrees to be financially responsible for the risks associated with an employee’s health, shouldn’t the employee be accountable to help the risk-bearer understand those risks?
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Minimally invasive surgeries offer cost and time savings for employers
In early 2008, Maine-based Hannaford Bros., the largest supermarket chain in the Northeast, announced that if a surgery could be done appropriately with a laparoscopic or minimally invasive procedure (MIP), the company’s health plan would not pay for performing that same operation using the more traditional open surgical technique, in which an incision slices open the body to reveal the surgical site.
MIPs can be used for hysterectomies, appendectomies, gastric bypasses and a growing list of other procedures. The surgeon drills one or two small holes that are used to see the surgery inside the body, and two small holes for “arms” that do the actual surgery.
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Don't Like the Bill? Tell Health Industry to Change
From the outset, the new administration has focused on driving significant changes in health care — $19 billion in the stimulus package, for example, to facilitate a national information technology infrastructure. And President Obama has publicly linked the health care cost crisis with our ability to reverse the larger economic downturn.
So it seems clear that health care will become a priority. That process will entail much more difficult changes: how we pay for care; the public reporting of the pricing and performance of our doctors, hospitals, drugs, devices and treatments; and whether primary care continues to be undervalued in our system.
It's Time To Empower Employers On Health Care
It’s time to empower employers on health care
Originally published in the Jacksonville Business Journal
Lynn Jennings, a longtime health care professional who helps employers manage their costs, recently told me:
“When an employer sits at the table with his health care relationships — brokers, health plans, doctors, hospitals — everyone else in the room wants it to cost more, and they’re all positioned to drive the cost higher.”
It’s true. Many employers feel that the health care cards are stacked against them, and that it is impossible to positively impact their health plan costs. This is especially true for smaller employers who are limited to buying health insurance with a predefined benefit structure.