Archive for category Health Care

What’s the Right Primary Care Model?

Wellpoint announced on Friday, a major new initiative in the way primary care providers(PCPs) will be paid.  Sara Kliff highlighted the importance  of PCP payment reform but are Wellpoint’s reforms the right way to pay PCPs?

Broadly, the difficulty with PCP payment is that it is very difficult to measure PCPs effectively.  PCPs basically do three things: provide basic services, coordinating more advanced services, and manage chronic conditions.  Most PCP payment methods to date have targeted one of these functions but aren’t quite able to ensure that all of the roles are compensated. Read the rest of this entry »

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Time for Insurers to Put Their Money Where Their Mouth Is

With large scale health insurance reform looking doomed with Nancy Pelosi’s claim on Friday that she doesn’t have the votes to pass the Senate health care reform bill, it is time to return to the black board for incremental reforms.  One of the most promising areas could be payment reform, particularly Medicare payment reform.

Payment reform was the unspecified part of the bill that was supposed to provide long term cost control.  Unlike some backroom deal for the Nebraska Medicaid population, there was a valid reason for payment reform to be unspecified:  nobody has a clear idea about what will work.  The key problem is how do you measure non-events?  How do you reward care providers for not having to perform services in the first place? Read the rest of this entry »

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Not so simple Teresi

While I believe a healthy dose of the free market is necessary for a well functioning health care system support a system,  Amanda Teresi’s arguments miss a fundamental point: the free market can never solve the health care crisis.  This does rest upon some concern about health care as a special moral good, although that certainly holds as well. No just by its very nature free market health insurance does not work.

The central contention in Teresi’s argument is if people will be able to purchase portable insurance in a free market than many of the current problems including coverage of preexisting conditions would disappear. What would be a free market in health insurance? Given some of Teresi’s arguments it seems to fair to suppose that a government regulatory agency would ensure the solvency of the insurance company.  In addition I doubt that she would argue against a regulatory system that requires rates to have some basis in fact.  For instance if a carrier wants to charge more to women than men it must provide data to support this.  No mandates in the type of benefits offered.  No restrictions on underwriting methods used.  No limits on the rates offered.  In other words a basic set of regulation to make sure that a carrier can keep its promises and isn’t discriminate bases on non-economic factors.

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A Public Option for Failure

Up until this week, I had been rather agnostic about the public option.  Before looking at the philosophical issues: should the government set prices in the health care market place? What level of competition should there be in the health insurance marketplace?  Should a massive government entity be involved in the health insurance marketplace? There was always a basic question: would it work?
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Lost in the Humana Outrage

What has been lost in the outrage over Humana writing to Medicare Advantage members is that this type of dilema will happen more often if anything close to the current reform packages.  One problem with public private partnerships is that corporations have not only the usual marketplace levers of competition prices, quality, and customer service, but also the levers of politics and lobbying as well.  Will plans in the exchange need to sign gag orders to prevent them from informing members when subsidies are going to reduced?

Disclaimer: I am employed by Ingenix a subsidiary of United Health Group and these are my views and not the views of Ingenix or United Health.

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