A Business Lesson for Health Care Reform
In the often contentious but vital debate over health care reform, one issue unites patients, doctors, business owners and workers alike: the need to reduce how much Americans pay for the care they receive.
As our nation's population ages, staggering increases in the cost of providing health care threatens to bust budgets from Main Street to Wall Street, killing jobs and sapping the strength of our economy. Far too many hard working families are priced out of the health insurance market and driven into bankruptcy. Businesses' health costs, in particular, are skyrocketing, meaning impaired bottom lines and depressed wages for workers.
Among the biggest cost-drivers in health care today is treating chronic illness, including heart disease, cancer and diabetes. The Centers for Disease Control reports that: chronic disease treatment accounts for 75 percent of all health care spending in America and 99 percent of Medicare spending. More than half of Medicare beneficiaries are treated for five or more chronic conditions annually. And yet patients who suffer from these conditions still aren't receiving all the treatments that are recommended. A RAND study found that patients typically receive only half of the clinically recommended treatments for their chronic disease conditions.
We can do better. We can no longer afford not to.
The closest thing to a silver bullet to improving efficiency in health care delivery is to focus on disease prevention and management. This requires incentives to control risk factors like smoking and lack of exercise, and to support a more holistic notion of health care delivery. Rather than waiting for people to get sick before paying for their health care, we need to make more up-front expenditures to prevent down-the-line costs.
For example, IBM sponsors an innovative employee wellness program that relies on incentives and care coordination to improve the health of its workforce. Their employees are given access to at least one health plan at no cost. This plan includes coverage for preventive service, as well as a "Healthy Living Rebate" that gives $300 to employees for participating in healthy activities. A Children's Health Rebate program gives IBM families similar incentives.
The result? Between 2004 and 2007, the reduction in employee health risks alone resulted in an estimated health cost savings of $79 million. Meanwhile, employees benefit from improved access to health care leading to more productive and healthier lives.
There are other good examples of the value of prevention and care coordination in catching problems early and thereby helping to reduce long-term costs.
For instance, many states employ a comprehensive care model to cover Medicaid patients. Vermont, North Carolina, Colorado, Pennsylvania, and other states fund Community Health Teams (CHTs), which work with patients to improve their overall health and reduce costly trips to the hospital. Members of a CHT serve as advisers on healthy living and work hand-in-hand with a patient's doctors and hospital to coordinate care. Vermont has seen amazing results with a 30% decrease in emergency room visits in the first year of the program.
The federal health reform legislation winding through Congress offers a big opportunity to lower our nation's health costs by expanding the use of CHTs. Most Medicare patients receive health care through a fee-for-service model, which provides payments to doctors and hospitals based on the number and type of services they provide. If a patient comes back six times for the same problem, the doctor or hospital gets paid six times.
Medicare offers no incentives to prevent over-use of health care services or to coordinate care among a patient's doctors and hospital. Medicare pays for people who are sick, but doesn't do much to keep them healthy.
Community health teams will make the primary care provider the patient's essential quarterback in coordinating delivery of quality care. An abundance of evidence shows that the kind of care coordination that physician-managed community health teams provide for patients improves their health outcomes, while reducing health costs over the long run.
According to a recent survey commissioned by America's Agenda: Health Care for All, 75 percent of voters support reform that will give their primary care or family doctor the support of a coordinated team. We should amend the bill in the Senate to move Medicare in this direction, provide increased support for CHTs and encourage businesses to offer more wellness and prevention services.
Whether it is the amount we pay in premiums or the total contribution made by employer to the company health plan, America must begin to focus this debate where it belongs: on the bottom line. American taxpayers, from consumers to large businesses, cannot and should not be forced to shoulder the burden of a failed system that only accelerates cost and benefits a handful of insurance companies and investment bankers.
It's time for Congress to enact a reform package that provides all Americans with quality, affordable health care for years to come.
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This article is a perfect explanation of the phrase 'throwing good money after bad'. We do not need more agencies to oversee wellness, or any of the things TT wrote about. Those are just programs that also cost and over time their costs will rise, until someone comes up with another agency to find a way to battle those costs... and it goes on and on. All programs need to be scrapped, and a single-payer program needs to be put in place. No business will have to provide health insurance, and no individual will have to pay more than their fair share for healthcare. The only downside would be that insurance industries will have to start competing in specialized areas and they would not be among the richest corporations in America anymore. Did I say down-side?
Health care has got to be made not-for-profit. In the post-Reaganomics culture we live in, no one one wants to admit that; but a for-profit healthcare industry, let alone a for-profit health insurance industry, is fundamentally ruinous, immoral, and unjust.
Public option would be a start - and in the post-Reagan era, it may well end there; but ideally, the goal would be a healthcare system not dependent on economics.
We hang together - stick together as a community - or we hang separately - by our own greedy nooses.
I've notice for years, now, that bottom-line thinking is the major cause of bottoming out.
I had the IBM plan once upon a time. IBM is self-insured. So is Microsoft. The company pays the claims, not the insurance company they hire to administer the plan. Any comparison to the average employer-provided plan or any private plan is completely invalid. The ONLY way to get the IBM plan is to work for IBM. If you or your spouse or child has a long-term medical condition, the IBM plan essentially prevents you from changing jobs. This, in fact, is the reason that large companies provide such benefits. We all know that the benefit package is part of the decision process for hiring new employees. Once you get the benefits, you now have strong reasons not to leave or to work for a customer or competitor. Yep, 50% of the Fortune 100. What about the non-Fortune 50 million?
The wish list presented by TT here is about a year behind current legislative reality.
I recently saw Orren Hatch speaking on a CNN segment stating that accepting a public option would incrementally make it grow until America has "socialized medicine". Not a single reporter challenged this comment. The truth is that accepting a public option will incremenatally lead to socialized INSURANCE, not socialized medicine. None of Congress is looking for any reform to result in socilized medicine. Democrats want socialized insurance for the good of America's future, not to put government in the health care business. Fox News online has a section that purports to define Single Payer, Public Option, and Socialized Medicine. It does a good job defining Single Payer and Public Option. This makes Fox look credible and legitimate. Then the truth goes right out the window under the definition of Socialized Medicine. Where it should define the term as a system wherein hospitals are owned by the government and health care workers and doctors are employees of the government, it instead sneakily defines Socialized Medicine as Obama's health care plan. Wow! And yet other news media are not countering this. Why? Because even Democrats tippy-toe around the word "socialized". This is an appropriate term to use, but only when placed in front of the word INSURANCE. While Republicans openly talk about "socialized medicine" we do nothing to counter the lies. Let's quit tippy-toeing around it. We have socialized insurance right now. It's called Medicare Insurance. Democrats want more socialized insurance, not socialized medicine.
"The closest thing to a silver bullet to improving efficiency in health care delivery is to focus on disease prevention and management
Uh no, single payer is the closest thing to your silver bullet but as we all know, he/she who controls the conversation, controls the outcome.
Blue Cross controls the political prostitutes and the political prostitutes control the conversation.
I still can't figure out why America's small business hasn't been more vocal in the need for health care reform. There are only 2 sectors of the economy that are robust at this time, the health care insurance industry and the drug industry. Does it take an Einstien to connect the dots? We are the only modern industrial nation that does not have a comprehensive health care system in place. It's not a stretch to draw the conclusion that this has a major impact on exports.
Governor Thompson: A pilot program in your own state is making tremendous strides in this area. Please see the Wisconsin Initiative to Promote Healthy Lifestyles, www.wiphl.
IBM got screwed by Empire Blue Cross a few years ago...they had an ASO contract (administrative services only) and they would pay Empire the amount of the claims plus some sort of premium...
If IBM cannot get the straight skinny from Empire, what makes anyone think that we will as consumers.
Anyway, think about this, hospitals are charging over 100,000 for a 3 day stay and less than 5% of that goes to the nursing staff.....
And the government run medicaare and medicaid are better? NO.
Link please....
My wife had Cancer surgery back in june.....3 days stay at Hospital, less than 60,000....
The insurance companies are pricing themselves out of the market. More and more people will continue dropping their health insurance due to the overwhelming price hikes. As they do so, the price for coverage will keep spiraling out of control. It's a vicious cycle they've created due to nothing more than greed. If we don't fix it soon, we're going to see health insurance companies begging for a bailout in the near future. If they do, let them fail. It's their own doing. They sure don't seem interested in fixing it. When the right starts having to pay out of their own pocket for health care like so many others are doing now, even many of their own, they'll finally get it.
You choose to ignore the fact that the increase in insurance premiums, for the last two decades, has mirrored the cost of care. I remain amazed that so many Americans continue to think the two are the same.
Our top priority should have been controlling costs, but we chose instead to focus on boogeymen. This allowed those who want more and more bureaucratic control to get their way.
You're going to get want you want - much more government contol and influence. More bureaucracy, bloat, waste and fraud than you could ever imagine, a trillion dollars worth. Good luck with that.
Did you ever think that the socalled Cost of Care was driven by the hungry CEOs whose justification for their god awful salaries, pensions, bonuses and business expenses was the amount of premiums and claims processed.
fool
OK, lets talk about cost of care.
One portion, about 1/3rd, goes to the facility, doctors, nurses, medications, equipment, etc.
One portion, about another 1/3rd, goes to administrative and billing staff, trying to get the health insurance companies to pay. Needless to say, the health insurance companies don't pay 15% of your premiums to denial of claims specialists for nothing, the hospital billing staff generally have to re-submit claims repeatedly, and often have to get doctors to re-sign paperwork.
The last portion? Well, hospitals are not allowed to turn away someone who needs help, so when someone comes into the ER, the hospital has to recoup those costs. Guess who pays for the uninsured, including illegal aliens? That is right, you do!
Now do you understand why we pay $7000 for $3000 of care?
While much of what you say is true and appreciated, you leave out one factor: companies charge what they do because they can. No one begrudes a company making a profit, but when that profit in in the 100s of percent it's way off base.
There's no reason for a hospital to charge $20 for a box of Kleenex, though they did rename it mucous removal devices. We, as a society, must agree that profit is good, profiteering is bad.
We've been sold the lie, among others, that prices are so high to cover the uninusured. It that were true then why are so many people being sued for medical debt and winding up in the bankruptcy courts?
Healthcare in this country is expensive because capitalism has run amok.
Generally hospitals sell their debt to third party collection agencies. They can get as much as 40 cents on the dollar for this. If they do keep the debt, and sue someone into bankruptcy, they don't get much money for it (squeezing a turnip for blood comes to mind).
And part of the reason they charge $20 for kleenex is to cover the cost of the billing staff they have to hire to deal with the insurance companies!
We'd love to focus it on our bottomlines. Just how much is a mandated policy going to cost each individual annually, and what is included as a covered services by that policy. Will this include dental and visual coverage? Will policy prices be regulated so that we aren't looking at 50 to 100 percent increases every year? Will these policies include deductibles and co-pays? Will we have to use only doctors on a certain list? Will we have to wait for insurance industry approval before we receive care or procedures the doctor deems necessary? Will drug prices be regulated, will other health care expenses be regulated?
Will the Amish be forced to purchase insurance?
Change we can believe in is too important for business considerations.
Oh, and that includes health care reform.
I get that right, DNC?
EAT IT.
I am from Wisconsin and I was all ready to lambaste Tommy Thompson for his bad ideas as just reflective of his Corporate obsessed governance.
However, I detect a lot of compassion and urgency in his post. Not too many great ideas, and some real misguided thinking, but at least he is not toe-ing the normal republican line of obstruction and defeatism.
I agree with most of these other posters...
But to disagree with Thompson on one main point....w
yes and Bush as one of us and see how much damage he did....
Dick - with all due respect, i believe you are missing one point. I haven't been to a doctor, had a test, taken a drug or missed a day of work (when i have work) for many years, and i have coronary artery disease and a zipper on my chest.
The ONLY facet of this debacle that we as individuals and families can control is our own NUTRITION.
I have worked in this area for two decades and i can tell you, for real, that everyone's health will dramatically improve, visits to doctors will go down a lot, tests will virtually be unnecessary, most annoying sickness will dwindle to a trickle or less, energy and strength will increase if we spend a bit more money and time on NUTRITION and exercise.
Chronic sickness will improve in almost every case. You are correct that this systems dumbs us down, stresses us out, drugs us up and malnourishes us. But that is not a good excuse for futility. It is a personal call to action, and if i can do it, anyone can.
Raw foods, organic foods, pesticide-free foods, high-quality herbs, proper food combining, knowledge of what foods are toxic or just food artifacts, techniques on how to break addictions to food artifacts, simple exercise, yoga, stretching, walking in sunlight for a hour a day, and the literature to find out how and when to use these things is virtually free and readily available, and there are millions of professionals.
I went to my doctor a few days ago, and asked "While I am here, can I ask a dumb question?"
It was kind of like that Marx Bros skit, "Doctor, it hurts when I do this," "Well, don't do that, that will be $50."
When I don't take my vitimins for a while, I get these weird foot problems (cracked feet, to the point that the cracks cause pain and bleed). When I take my vitimins, I don't have problems. I wanted to make sure it wasn't some deeper problem. The doc said "You probably are low on zinc, and the vitimins are providing it."
A vitimin a day keeps the doctor away?
You can eat as healthily as you like, but if you're genetically pre-disposed to an illness like hypothyroidism or another auto-immune disease, all the free-range, gluten and lactose free products aren't going to help.
Dick - To continue, Thompson is no role model for any of this, but emphasizing and educating individuals on clearing their bodies of toxic goo is the first and best method of clearing the brain and allowing clearer and more critical thinking to occur. This is not a fiction, but sound nutritional science, and it actually works that way.
The core principal of natural selection is 'selecting naturally' those natural foods and herbs that animals have used forever to stay alive against powerful odds.
This is the BEST part of Thompson's piece, and it is not for sale by health insurance thieves. But if they have their way it will be. If you want to avoid rationing care and criminalizing the ill, take the illness out of the patient, who then is no longer a patient. This can only be done by empowering people to be healthy people, not victims of the corruptions or patients of corporate-generated attacks on health and wellness.
Personal behavior is ALL we have, but we need to encourage and support each other, and stick with it. There is one other POWERFUL healthcare system, and it is called community. This costs no money, but it takes tremendous effort to re-institute. But we really have no other choice. Thanks for your post.
`Thanks for yours too, and I agree with everything you say.
I merely am pointing out that we are killing our planet. That alone is enough to kill us. In addition, the human population and especially americans are the lab rats in a giant game of who can mine the mass of humanity for the most profit. This isn't new, but our reach and technology and mass-brain
When your parents are brainwashed corporate fools, and so are your neighbors and your teachers and your role models and every single character on TV, you don't have much of a chance coming up. It takes herculean efforts and you must swim against the current every bit of the way. Just living the NUTRITION life that you do takes almost the same herculean effort, even though it should be so simple. That is just one stream you are swimming against, but basically all the waters of the earth are going the wrong way, as a metaphor of the human dilemma.
Continued -to mickthebiologist
Anyways I agree with personal healthcare. I think physicians could do amazing things to help promote and educate people with that knowledge, but instead we have a pay to play, fee for service health industry which is more interested in bleeding your wallet and hoping you die without catching on to what they did to you.
Your antidote is basically heal thyself and avoid the ravening beast of healthcare, and I can't say I disagree. But as long as we are going to have healthcare and people with conditions (many of which they have little control over) then we shouldn't be bankrupting ourselves, our industries, and our government by bowing to a health system which is based on profit, incorrect assumptions and money grubbing procedures, denying care and avoiding lawsuits.
It is true that we need to redirect our consumer-culture into a culture of personal responsibility -but of course then the profitc of luxury commodity providers will go down and our general economy will be weakened. No, that's not going to happen any time soon.
Greed has altered America for the worse, but our responsibilities as a community remain unchanging.
The bottom-line of health care is healthcare, not money. Not only do we ned to regulate the insurance industry, but the healthcae industry itself - a for-profit health care system is immoral.
If we can change the healthcare game to non-profit status, perhaps then we can actively work towards a culture of personal responsibility, by insisting that people live better with less - and corporations, too.
"This requires incentives to control risk factors like smoking and lack of exercise..
Essentially, that means charging more for certain pre-existing conditions, such as obesity. I do think in the case of "controllable" per-existing conditions, that it will be necessary to charge for these conditions to provide incentives to reverse these conditions. However, I don't know how that would work with those with low incomes, that would be exempt from paying any premiums.
Your ideas are fruitless, at best . There is a better way of doing this.
Why not just arrest them and have the state control their lifestyles, through an enforced regime of diet and exercise.
Smokers already offset with increased premiums and taxes the amount they cost the system. I thought in this country there still existed the right to personal choice. Or do you plan on telling me what to eat, what to wear, when to get up and when to go to bed, who I can have sex with, how many times a week, ect.? But you'll have to check with Wall St. and the insurance industry first. They'll tell you what's right and just.
I must have read a different article. I read something about rebates for healthy living and having nutritionists and wellness coaches support your family doctor...
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