All of us should know the quality and cost of health insurers; but this information is especially essential for the 34 million people who will newly shop for plans under the health reform legislation -- essential, but not available.
Should not someone with breast cancer know how current enrollees and their doctors ranked the insurer's responsiveness to people like her and how good their doctors and hospitals are? Why are we not informed about the service risks posed by the insurer's financial situation? Although I have been a member of the Board of Directors of many health care organizations and am an experienced accounting and health care professor, even I cannot easily find the answers to such questions.
The difficulty was dramatized for me recently when I was informed that the Nominating Committee of WellCare Health Plans, Inc. -- a Medicare and Medicaid managed care firm -- had chosen not to renominate me. I resisted this decision -- not because sitting on the Board was enjoyable -- but because of my concern for the welfare of our shareholders and vulnerable enrollees: The company had the lowest Medicare quality scores and the most fines and sanctions recently among its peers and, as the Chair of the Audit Committee. I knew just how fragile its accounting system was.
I was advised that if I quietly sat out the remainder of my term, rather than publicly resigning, nearly $150,000 worth of unvested shares would be mine. Many directors, faced with these circumstances and their exposure to the bottom-feeding bloggers who feed on public disclosures, would accept the advice. But I was so concerned about the firm's shareholders and enrollees that, instead, I spent considerable effort gathering information about the firm's worrisome quality and financial issues which I included in my publicly disclosed resignation.
But wait a second -- why is a public resignation by a fed-up director one of the few ways to publicize information which everyone should have readily available?
If H.R. 4803, the bipartisan Rep. Barton-Green-Burgess-Stupak Patients' Right to Know Act and Rep. Steven Kagen 's (D-Wis) complementary bill, are passed, this kind of information will be readily available to all. The bills' uniquely bipartisan backing indicates that members of the U.S. Congress were willing to rise above their differences when it comes to transparency.
This legislation would force disclosure of which insurance companies and policies provide the most medical-care benefits and best outcomes per dollar, offer the best doctors and hospitals, and hassle sick people and their caretakers the least. If insurers with lackluster scores do not improve, competitors would enter this surprisingly entrepreneurial market. (The leading providers of high-deductible insurance, for example, were formed only nine years ago.)
Transparency's benefits would also extend to our out-of-control health care costs. The U.S. Congressional Budget Office (CBO), for example, estimated billions in Medicare savings, from 2010 to 2019, from the increased utilization of regional centers of excellence for surgery, which transparency would likely spur. Further, the mere act of providing data motivates providers to change, a phenomenon known as "the audit effect." The CBO, for example, estimated that sharing peer-profile scorecards with physicians would also save Medicare billions.
Can transparency be obtained through voluntary efforts? Obviously not. Instead of backing transparency, most health-care participants raise objections, including consumers' lack of interest and the allegation that transparency's costs will exceed its benefits, and that the measurement of quality is infeasible. But the many benefits of transparency trump its costs. And although health-care transparency measures are not as yet well developed, with time they will be.
The problem is not that Americans aren't interested in transparency. They rated it as the number one health care reform they want from the government. The problem is that Americans do not have the health care transparency they need.
I have friends that had a motorcycle accident a while back, he is still recovering and has has 7 or 8 surgeries. H would have topped out the less expensive plan as would some cancers or many transplants. I have opted for the more expensive plan but what was $27 a week in 2002 is now $210 a week for the family.
Not much of a choice.
reporting of quality and costs for health insurances. Also, thanks for sharing your personal
experience with managed care resistance to reporting these essential data for consumers.
Of all of the industries that make money off the sick and injured, insurance stands out as the one that makes the most profit by "denying" treatment. That's a powerful incentive for a basically immoral act.
Why should anyone expect management of this type of endeavor, to be altruistic?
The "for profit" model of health insurance will eventually prove unsustainable. The only question is, how many people will needlessly suffer and die before real changes are implemented? To those politicians that put corporate profit ahead of the good of their constituents, I say Shame. Shame on you. You are no better then the profiteers that run the insurance companies.
Unfortunately, the whole premise behind CDHP is false. Consumers don't have anywhere near the information available that the insurance companies do. This article is a good example of why there is no information available, because the insurance companies and other health providers don't want the information to be readily available.
Consumer directed health plans are nothing more than another method to dump more of the health care costs on the consumer. For 20 years health insurers and consultants implemented more and more health care management by all sorts of required networks and incentives. After decades of failure, now they decide that they will dump the problem (and costs) in the lap of the average American worker and their families.
Not only are health insurance companies one of the most expensive ways to fund for health care costs, their ability to negotiate prices has been very limited in the past decade.
In most states one or two insurance companies dominate the health insurance market. In order to dominate, they need to get most all of the hospital systems under contract. This allows some hospital systems to dictate better terms than they would normally get from the insurance companies. The insurance company passes on the higher rates to their customers.
In Massachusetts, the Attorney General found that insurance companies paid hospitals twice as much as others for the same procedure. This was not due to any efficiency or quality differences, but due to the power that the hospital had in demanding higher rates.
http://fdlaction.firedoglake.com/2010/04/08/failed-private-insurance-middlemen-like-tumors-you%e2%80%99ve-got-to-shrink-them-or-cut-them-out/
http://www.boston.com/news/health/articles/2010/01/29/attorney_general_says_clout_drives_up_health_costs/
http://www.businessweek.com/magazine/content/09_31/b4141022519011.htm
Thank you for taking the less profitable but more humane path to enlightenment.
Maybe someone can remember better than I But it seems like I recall two men that had trouble finding the right doctor for whatever. They found a niche. Started writing books about the best doctors for _________and the best hospitals for ______________. Started covering all major towns. Believe they were sued out of business by doctors, hospitals and maybe a nudge from congress as these people were writing their opinions and those of the people they interviewed so it was considered slander.
Who will stand up and be counted?
Who will start insisting insurance polices be written in language a high school graduate can understand. This should include medicare, medicaid, and social security.
We need warriors. I bet if someone that comes up with a good plan our ole friend Bill Gates might just put up some funding. Maybe the only man in America not scared of insurance companies.