This beautifully written letter was forwarded after an interview with me on health care cost appeared in a Florida newspaper.
Many of us with coverage often think in abstract terms about working families that do not have access to employer-sponsored coverage, and that must shoulder the overwhelming burden of costs on their own. As Mrs. Doss describes, health care costs dominate her family’s economic life and drive many of their most important decisions.
Continue reading “The Reality of Health Care Cost”
Posted 2/15/13 on Medscape Connect’s Care & Cost Blog
Health care’s purchasers crave certainty. But complexity – and therefore uncertainty – rules. Assurances are hard to come by.
The most common question asked by prospective clients of my onsite clinic/medical management firm is how much less their employee health benefits will cost if they deploy our services. They often expect that we’ll review their claims history and nail down what their health care will cost once we’re involved. Looking in the rear view mirror can inform the future, but it isn’t foolproof.
The Complexity of Health Care Risk
The challenge here is that so many different mechanisms contribute to the need for care, the ways care is accessed, the ways care is delivered, and the ways it is priced. Even mechanisms that, in isolation, are strong, often are inadequate in the context of larger cost drivers.
Continue reading “A Broader Approach To Managing Health Care Risk”
Published 12/09/12 in the Eau Claire, WI Leader-Telegram
Note from Brian: This piece appeared last weekend in the Eau Claire, WI newspaper, and was written with the encouragement of employers in that community who, rightly, believe they’ve been raked over the coals on their health care costs.
This argument is mainly directed at other employers, as a way of explaining that there are alternatives. That said, the dynamics described here occur in almost every community in the country.
Even compared to national health care cost growth that has skyrocketed nearly 4 times as fast as general inflation for more than a decade, Wisconsin stands out and northwest Wisconsin stands out more. Eau Claire’s health care cost burden is a whopping 16 percent higher than the national average. This is pricing many individuals and employers out of the coverage market and sapping the region’s economic vitality and competitiveness.
As Robert Kraig meticulously details in Citizen Action’s Wisconsin Health Insurance Cost Rankings 2012, Eau Claire is Wisconsin’s second-highest cost health care market, with 2011 monthly premiums of $750.46, 9.1% higher than the state average of $687.68. (La Crosse is 1st, only a hair higher at $756.70.)
Continue reading “When Employers Collaborate To Manage Health Care Costs”
Posted 7/31/12 on Medscape Connect’s Care and Cost
Several years ago I had dinner with a woman who had served in the late 1990s as the national Chief Medical Officer of a major health plan. At the time, she said, she had developed a strategic initiative that called for abandoning the plan’s utilization review and medical management efforts, which had produced heartburn and a backlash among both physicians and patients. Instead, the idea was to retrospectively analyze utilization to identify unnecessary care.
This was at the height of anti-managed care fervor. A popular movie at the time, As Good As It Gets, cast Helen Hunt as the mother of a sick kid. When someone mentioned an HMO, Ms. Hunt’s character let fly a flurry of expletives. America’s theater audiences exploded in applause.
Continue reading “Why Medical Management Will Re-Emerge”
Posted 5/9/12 on Cracking Health Costs
Discussions about covering “pre-existing” health conditions occur frequently among health policy people. One frequent thread is that health insurers should not be allowed to deny coverage to people with pre-existing health condition. After all, aren’t those the people who need health insurance the most? Sounds reasonable, doesn’t it? Problem is that proposition is really not reasonable.
Let me explain. For any kind of insurance to work right, the “contingent event” can not have already happened before you buy it. In life insurance, the contingent event is the death of the policyholder. You can’t buy life “insurance” on someone who has already died. For homeowners insurance, you can’t buy fire insurance after the home has burned.
Continue reading “Whatever It Is, It’s Not Insurance”