Workplace Wellness: The Cost of Unhealthy Behaviors in America is $623 per Worker

Jane Sarasohn-Kahn

Posted 11/14/11 on Health Populi

The health status of the American workforce is declining. Every year, unhealthy behaviors of the U.S. workforce cost employers $623 per employee annually, according to the Thomson Reuters Workforce Wellness Index. People point to smoking, obesity and stress as the 3 most important factors impacting health costs.

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Holding Hospital Costs in Check: How Maryland Regulators Do It

Merrill Goozner

First posted 9/15/11 in The Fiscal Times

President Obama’s health care reform bill is filled with experiments on how to hold down health care costs.  There will be bundled payments for episodes of care and extra payments for raising quality standards. It calls for the reorganization of hospitals and physician practices into “accountable care organizations,”  which will share in savings if their costs fall below previous levels.

What’s not in the legislation is old-fashioned hospital rate regulation, which only one state in the nation uses. The latest results from Maryland suggest rate regulation works.

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Health Plans Enter A New World of Retail

Jane Sarasohn-Kahn

First posted 8/26/11 on Health Populi

Health plans are more aggressively managing medical costs, leaning out administrative inefficiencies, and looking for new customers. Plans are undertaking these strategies as they face uncertainties over the next couple of years leading up to the full implementation of the Affordable Care Act, according to a paper from Boston Consulting Group (BCG), Innovation, Diversification, and a Focus on Fundamentals, looking at how health reform will change the insurance landscape.

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Health Costs Haunt the US’ Long Term Budget Outlook

Jane Sarasohn-Kahn

First published 6/24/11 on Health Populi

“With the aging of the population and growing health care costs, the budget outlook, for both the coming decade and beyond, is daunting,” reports the Congressional Budget Office (CBO) in the2001 Long-Term Budget Outlook report. If you read between the lines and into the future scenarios on health spending and budget deficits, it’s clear that as Baby Boomers age, America’s fiscal outlook gets bleaker by the year.

Spending on Medicare, and health care as it’s paid for today, is unsustainable. The pie chart shows that 22% of spending on health was for Medicare in 2009, 17% was allocated to Medicaid and CHIP for children, and 11% of spending was for other public health programs provided by state and local governments, the Department of Veterans Affairs, the Department of Defense, and workers’ comp.

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Health Care Reform Revisited – The Elephant in the Room: Part 1

Sean Sullivan, JD

First published 5/17/11 on the Institute for Health and Productivity Blog

I had the pleasure week-before-last of attending one of my favorite health care events – the CAPG 2011 Annual Conference in Palm Desert, California (just a few hours’ drive away from IHPM’s headquarters in Scottsdale, Arizona).

CAPG stands for the California Association of Physician Groups, considered by many the most significant physician-based organization in the country and IHPM’s partner in a new initiative aimed at harnessing the power of the nation’s most advanced medical groups to proven worksite health improvement programs to produce even better outcomes in the working population.

Continue reading “Health Care Reform Revisited – The Elephant in the Room: Part 1”

Paradox Glossed

Jim Hufford

First published 4/27/11 on Organon

I’ve always been a little unsure about the policy ramifications of regional variations in medical care. The Dartmouth Atlas project’s findings—famously noted in Atul Gawande’s New Yorkerpiece comparing health outcomes and utilization in McAllen and El Paso, Texas—suggest an inverse relationship between the amount of care provided and the quality of health outcomes resulting from that care.

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The Patent Cliff, Coupled with Value-Based Purchasing, Make For A Declining Branded US PhRMa Market

Two mega-trends are driving down branded pharmaceutical sales in the U.S.: switches from branded to generic prescription drug products for major chronic conditions; and, the lack of new-new branded Rx products that (could) command higher prices.

A down-market picture emerges from The Use of Medicines in the United States: Review of 2010based on market data analyzed by the IMS Institute for Healthcare Informatics (IMS). While U.S. market growth for pharma overall ranges from 3% to 5%, IMS says, protected Rx brands were negatively impacted through the switch to cheaper generic substitutes. Generics now comprise 78% of pharma market share.

The key sentence in the report that underlies this dark snapshot is: “The number of patients starting treatment for a chronic therapy was down 3.4Mn from 2009 levels, and increasingly these patients are starting therapy with a generic drug.”

Continue reading “The Patent Cliff, Coupled with Value-Based Purchasing, Make For A Declining Branded US PhRMa Market”

Changing the Game on Health Care Costs

Robert Laszewski

First published 4/10/11 on Health Policy and Marketplace Review

Last week, I posted that I was disappointed in Paul Ryan’s health care budget proposal because it lacked cost containment ideas other than the usual conservative reliance upon the market and defined contribution health care.

In my last post, Why ACOs Won’t Work, I argued that the latest health care silver bullet solution, Accountable Care Organizations (ACOs), are just a tool in a big tool box of care and cost management tools. But, like all of the other tools over the years like HMOs and IPAs, they won’t be used as they were intended because everybody—providers and insurers—can make more money in the existing so far limitless fee-for-service system.

How do you make the American health care system efficient?

You change the game.

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Reform At Year One: The Economist’s View

Roger Collier

First published 3/31/11 on Health Reform Update

Sometimes, in the middle of a hotly-argued partisan battle, it can make sense to look at the opinions of more distant and possibly more objective observers. When the battle involves American politics, the international press sometimes offers valuable—and possibly more realistic—perspectives than those available to readers and viewers of domestic media.

Accordingly, on the first anniversary of the enactment of the Affordable Care Act, it was particularly interesting to look at health care reform’s coverage in the influential Economist magazine.The Economist, in its March 19-25 edition, was less than positive about the present status of reform or either the hopes of its backers or the allegations of its opponents.

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Demythologizing the High Cost of Developing New Drugs

Merrill Goozner

First published 2/21/11 on Gooz News

Press Release: Pharmaceutical companies continue to claim that high research and development (R&D) costs make it necessary for them to charge high prices and retain long ownership of patents to recoup costs. But a new study (subscription required) co-authored by health economists Rebecca Warburton and Donald W. Light demonstrates that high R&D estimates have been constructed by industry-supported economists to support the companies’ claims.

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Pimping for Physician-Owned Hospitals


First published 2/16/11 on Gooz News

The Medicare Payment Advisory Commission couldn’t have been clearer in its 2009 report to Congress. “Although physician ownership of facilities may improve access and convenience for patients, evidence suggests that physician-owned hospitals are associated with a higher volume of services within a market.” A recent study from Georgetown University that looked at states like Oklahoma, Kansas, South Dakota and Arizona, where the number of such facilities has surged, found sharp jumps in back surgeries in Medicare patients after orthopedic surgeons opened their own hospitals compared to similar patient populations in the northeast, where such facilities are prohibited.

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Catharsis is Not Policy-Making


First published on [Not] Running A Hospital

If you ever needed an indication of why the public remains confused about the issue of health care costs and insurance premiums, look no further than a story in today’s Boston Globe entitled, “Insurers seeking smaller rate hikes.” It is not that the reporter has done a poor job. Quite the contrary. The structure of the piece is good, and the story is fair and accurately reported. It is just that the current exigencies of newspaper production make it impossible to devote sufficient space in a daily story to portray the whole picture. So, in an understandable effort to give equal time to divergent viewpoints, the story ends up as a “he said-she said” exposition, leaving out underlying facts and context that might help the public understand why we are where we are.

So, let’s deconstruct and expand the story to give more insights.

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The Politics of Scarcity


First published 2/11/11 on Kaiser Health News

Medicaid, along with debt and shortfalls in public pension funds, is driving state and local governments toward budgetary disasters. The ways we cope with this fiscal crisis will test our political system and our national character. Political expediencies could further compromise the lives of the sick and the disadvantaged, and risk unnecessary human suffering and social turmoil.

The politics of scarcity demand leaders with a long term vision of a sustainable society who are able to sort through complex issues, competing interests and ideologies. In a poorly managed economic crisis, the vulnerable, with no strong political voice that can influence funding or public policy, are hit hardest. By contrast, successful solutions will shore up the safety net, protecting the weak while maintaining as much political and social stability as possible.

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Over-Testing, Over-Utilization – Unintended Consequences and Associated “Costs”


Originally published 12/27/10 on The Orthopedic Posterus

We are an over-tested society.  Who is driving this? Are docs ordering more tests because it is easier than explaing the natural history of many injuries? Do patients insist on techno-imaging studies “just to see what’s going on”?   Yes 🙂  Most instances of over-testing in Orthopedics, I venture to say are not due to fear of mal-practice.  It is not the standard of care to image every ache or pain… nor does every ache or pain usually require anything more than a thorough history and physical exam.   Many studies show that a well performed interview and exam is usually more often correct at arriving at the diagnosis— or at least equally successful — than an MRI or CT.

So the next time you go to the doctor’s office… think twice about asking for an MRI, and ask why an MRI is being ordered.

As usual… this is not meant as medical advice… nor does it represent the opinion of my employers…

As requested…. transcript.

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Health Care Brawl: All or Nothing Doesn’t Work

EUGENE STEUERLE Originally published 1/17/11 in The Fiscal Times

In today’s world, health reform succeeds only if it goes hand in hand with reasonable budget constraints on health spending. But the debate beginning in the House today isn’t about benefits versus costs. Instead, it’s a winner-take-all spectacle like the Super Bowl. Vote “Yes” or “No” on rescinding recent health legislation. Yes or no on regulating Medicare. Thumbs up or down on the constitutionality of an “individual mandate.” Continue reading “Health Care Brawl: All or Nothing Doesn’t Work”