Today, the Obama administration released newly revised rules for “accountable care organizations” (ACOs) that are designed to persuade hospitals, doctors, and other health care workers to collaborate in providing better value for our health care dollars. In an ACO all providers involved in treating a particular patient or condition share a single flat fee. That fee will be higher if they succeed in achieving better outcomes for less, lower if they fail. In other words, providers are being asked to share in the risk that patients and payers now face when they agree to undergo treatment—or to pay for it. The lump sum payment creates an incentive for hospitals and doctors to work together to achieve the best possible results. They will win the wager only if they co-ordinate care.
Why Are Customers of This Health Insurer So Happy?
The following post originally appeared on the TIME Moneyland blog.
Kaiser Permanente’s stand-out performance in Consumer Reports’ national rankings of some 830 insurance plans raises an obvious question: What makes Kaiser so different? In a word: collaboration.
Patients Prefer HMOs (And Other Healthcare Surprises)
The following post originally appeared on the TIME Moneyland blog.
Are health insurance plans with big brand names better than smaller insurers that most people have never heard of? “Not usually,” says Nancy Metcalf, senior program editor, at Consumer Reports. Unless, that is, the plan’s name is “Kaiser.”
A CLASS Act Failure
Sen. Orin Hatch (R-UT) called it a “Ponzi scheme,” President Barack Obama held it up as a testament to the work of Ted Kennedy who wanted to ensure that the elderly and disabled would be able to afford help with simple activities of daily living; Rep. Phil Gingrey (R-Ga.) simply called the program “insolvent.”
Health Insurers in the Spotlight
Consumer Reports Publishes Quality Rankings; HHS Makes Rate Increases Public; They Can Run, But . . .
Are health insurance plans with big brand names better than smaller insurers that most people have never heard of? “Not usually,” says Nancy Metcalf, senior program editor, at Consumer Reports. Unless of course, the plan’s name is “Kaiser.” As Metcalf points out, Kaiser Permanente, a non-profit that insures some 8.8 million Americans nationwide, stands “head and shoulders” above the other large insurers. In general, smaller plans outranked the well-known names, and surprisingly, when it comes to patient satisfaction, Health Maintenance Organizations (HMOs) received higher marks than Preferred Provider Organizations (PPOs) even though HMOs require that the patient remain “in network.”
FDA Behind The Curve In Monitoring Safety of Approved Drugs
Over the past decade or so, there have been at least 20 prescription drugs removed from the market, including several cases of high-profile blockbuster drugs that were found to be harmful only after millions of patients had taken them. Vioxx, the pain reliever sold by Merck is one example; taken by an estimated 20 million Americans, it increased the risk of heart attack and stroke in some patients. The company ended up paying out a $4.85 billion settlement after the drug was pulled from the market in 2004. The diet drug Meridia, also linked to a higher risk of heart attack and stroke, was on the market for over 12 years before it was withdrawn last year. According to the watchdog group Public Citizen, drugs taken off the market since 1993 were sold for an average 4.1 years before being pulled.
“Essential Benefits” that Insurers Must Offer Under Health Care Reform
Will Universal Coverage Mean “Medicaid for All”?
Often, I refer to the health care reform bill that President Obama signed into law in March of 2010 as “the Affordable Care Act” or ACA. Friday, as I read the Institute of Medicine’s (IOM’s) report on the “Essential Health Benefits” (EHB) that private insurers will be required to cover under reform, I resolved never to make that mistake again.
Medical Industrial Complex Announces $3 Million Campaign to Maim Health Care Reform
A new group that calls itself “Partnership for America” has announced that it will be spending $3 mllion on a campaign to “freeze, investigate and replace’” the Affordable Care Act (ACA).
The “Partnership” didn’t come up with this idea on its own. It is backing a bill introduced by Rep. Sam Johnson (R-Texas) that would freeze implementation of the Patient Protection and Affordable Care Act until its full impact can be investigated. Johnson introduced the “Freeze and Investigate Affordable Care Act” (H.R. 3095) on Wednesday. If enacted, the Act would immediately suspend implementation of President Obama’s health care law and require Congress and the President to appoint aAffordable Care Evaluation Commission to study the measure’s impact on patient care, the economy and private-sector job creation.
Health Care Reform: The Next Stage, Part 1
Free Market Competition Cannot Make Heath Care Efficient: Why Health Care Should Be Regulated, Not By Government, but By Science
Not a few politicians and pundits continue to believe that free market competition offers the best solution to creating a health care system that offers good value for our health care dollars. House Budget Committee Chairman Paul Ryan, for one, argues that if we just give every American a tax credit, and let each person shop for his or her own insurance, consumers would pick the insurance network that offered the best care at the lowest price.
Court Action Is Necessary To Maintain Medicaid’s Integrity
Should private citizens be allowed to sue their state Medicaid programs for imposing rate cuts on doctors and other providers? That’s the question the Supreme Court is currently considering in Douglas v. Independent Living Center of Southern California, a case that pits California’s Medicaid program against providers and beneficiaries who charge that rate cuts force so many doctors, hospitals, pharmacies and other health care providers to drop out of the program that the poor, elderly and disabled no longer have adequate access to necessary medical care.