While everyone is focusing on whether or not Healthcare.gov is going to work, there are other significant issues about access that must be addressed. A critical issues is who is in the networks offered in the insurance exchange products.
What is at issue in these network restrictions is cost–and consumers could unknowingly be getting the short end of the stick. As reported in The Seattle Times:
“Premera, for example, limits annual out-of-pocket costs for in-network care at $6,350. But out-of-pocket expenses for care outside the network are “unlimited.” (emphasis mine).
Posted in business, consumer protection, Economy, emergency rooms, Health Care Reform, health insurance, hospitals, Medicare, policy and politics
Tagged affordable care act, business, business leaders, complexity of care, Congress, Democrats, doctors, drugs, economics, health care, health care costs, health care quality, health care reform, health policy, hospitals, medical care, Medicare, physicians, politics
My apologizes for being remiss in sending regular stories and updates. I have been working on a major writing contract with a series of tight deadlines this month and next. These recent stories caught my attention, and they should yours.
Washington State ACA enrollment update: As of November 78,000 people have enrolled through the state exchange and another 55,000 have completed applications.
Health Care Costs are Slowing. Could provisions of the ACA already have a positive impact on health care costs? See chart and story.
Posted in consumer protection, Economy, Health Care Reform, policy and politics
Tagged affordable care act, Congress, Democrats, economics, health care, health care costs, health care reform, hospitals, income, medical care, politics, Republicans
Please read the important article below about pricing of pharmaceutical products. The issue, however, is not just pharmaceutical products. We ran a story in this blog in April about the high costs of some other therapies and how venture capital firms were building the treatments, as well as setting the prices for their products and services. It is not just cancer facilities, such as the Proton Cancer treatment facilities and medical devices we reported on (Health Care Technologies, Part I. Go to search on this site and ask for Proton Cancer therapy or Health Care Technology, Part I). It is the high costs of pharmaceutical products as well.
This article in The Seattle Times is an excellent example of how pharmaceutical companies are setting their prices and what those families who have rare disorders face financially for potentially life-saving drugs. While this article focuses on pharmaceutical companies, they are not the only group that does this.
Posted in business, consumer protection, health insurance, technology, technology and pharmaceutical costs
Tagged accountability, drugs, economics, health care costs, health insurance, illness, income, medications, price setting, price transparency, terminal illness
Washington State was just awarded a $3.4 million grant to fund a public/private partnership to examine health care price transparency.
Specifically, the Washington State Office of Financial Management, the Health Care Authority, and the Office of the Insurance Commissioner are working with the Puget Sound Health Alliance (Alliance) to develop a statewide data center. The project will begin in October 2013 and end in September 2015.
The state will use the federal funds to establish a voluntary or mandatory reporting for all public and private purchasers by building upon claims data information already submitted to the Alliance. The grant will also be used to create an inventory of medical cost data sources in the state; improve IT infrastructure; establish protocols on data access; and develop strategies to disseminate information to consumers.
Posted in business, consumer protection, Health Care Reform, health insurance, hospitals
Tagged accountability, affordable care act, business, business leaders, complexity of care, health care, health care costs, health care quality, health care reform, health insurance, hospitals, medical care, price transparency
While health care costs have been slowing, drugs are becoming increasingly expensive. This article raises troubling questions about how we set our pharmaceutical and medical device costs. Even agencies that are supposed to police medicines and devices let the manufacturers set the price.
I am including this article on fast-tracking drugs. This abstract deals with the new move to fast track ‘biosimilars.’ I did an earlier article on some of the problems with fast-tracking other medications. Clinical trials are relatively short; most of the people in the trials are healthy; most trials include only 1,000′s of people. When the approved drugs go to market, they are used by hundreds of thousands people, many of whom will have other health issues—which has led many health insurers to not use new medications until they have been on the market for five years.
Posted in business, consumer protection, Economy, Health Care Reform, health insurance, hospitals, Medicare, policy and politics, technology
Tagged accountability, affordable care act, biologics, business, business leaders, ceo compensation, complexity of care, Congress, doctors, drugs, economics, GMOs, health care, health care costs, health care quality, health care reform, health insurance, health policy, hospitals, medical care, Medicare, medications, pharmacy, politics
Now here is a terrific idea thanks to ConsumerReports! Demand warranties of medical devices, such as knees and hips, just as we do for dishwashers, refrigerators and cars. Isn’t something in our bodies, or robots doing things to our bodies, every bit as important as warranting a refrigerator? You can buy a new refrigerator; it is not as easy if faulty hips need replacement or shredded metal in your body. This would be an excellent idea to hold the FDA more accountable!
An intriguing idea for hospitals with uninsured patients who are in and out of hospital ERs: http://www.healthleadersmedia.com/content/HEP-296819/Can-Hospitals-Pay-Patients-Health-Insurance-Premiums
Posted in business, Economy, Health Care Reform, health insurance, hospitals, Medicare, policy and politics, technology
Tagged ACA, business, chamber of commerce, economics, health care quality, health care reform, health insurance, health policy, hospitals, insurance, physicians, politics, small businesses
False Notices: Some health plans in Washington State are sending letters to their current individual policy subscribers to tell them their current plan will end and they will be transferred to another one at the end of the year. Some suggest simply calling the insurance company and not referring enrollees to the health insurance exchange. See press release from the Insurance Commissioner’s Office:
CONSUMER ALERT - Do you have an individual health plan? Know your rights and options
OLYMPIA, Wash. – Thousands of consumers who buy their own health insurance will soon receive letters from their insurance company telling them their old health plan is going away and that they will have to pick a new one. Knowing your rights and options will help you get the best plan to meet your needs.
Posted in consumer protection, fraud, Health Care Reform, health insurance
Tagged affordable care act, fraud, health care reform, health insurance, health insurance exchanges, insurance, Medicare, scams
In a major turnaround of allowed charges, the Feds want to change how hospitals are paid for ER and related care: http://www.publicintegrity.org/2013/09/13/13420/feds-propose-shakeup-emergency-room-billing?utm_source=email&utm_campaign=watchdog&utm_medium=publici-email
A first research study on the impact of the upcoming ACA Cadillac Tax coming in 2018: http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=99
Franciscans expand virtual health care. We are just beginning to see the potential future impact of digital health care and all the apps that may be on a phone. This could potentiall have a major impact on how we get certain aspects of care, how we monitor our health and how we pay for some services. http://www.bizjournals.com/seattle/blog/health-care-inc/2013/09/the-doctor-is-in-my-smartphone.html?ana=e_ptl_hc
Posted in budget cuts, business, Economy, emergency rooms, fraud, Health Care Reform, health insurance, hospitals, Medicare, policy and politics, technology
Tagged affordable care act, business, complexity of care, Congress, doctors, drugs, economics, health care, health care costs, health care quality, health care reform, health insurance, health policy, hospitals, medical care, Medicare, politics, taxes
I ran into this earlier when doing some research on health insurance exchanges in Florida for a friend. Scams are going to abound, especially in states where the Governors do not like Obamacare:
Want to win a video contest? HHS is making awards for videos that promote enrollment in Obamacare:
Posted in consumer protection, Economy, fraud, health insurance
Tagged ACA, contests, enrollment, insurance, insurance scams, obamacare, scams, video
Posted in Economy, Health Care Reform, health insurance, hospitals, Medicare, policy and politics
Tagged bundled payments, business, complexity of care, economics, health care costs, health care quality, health care reform, health insurance, hip and knee surgeries, hospitals, insurance, Medicaid, medical homes, Medicare, real estate, spine