Baseball analysts who can actually add value to most discussions of prospective value strongly discount the Triple Crown triple slash numbers of batting average, home runs and RBIs. They also discount the pitcher slash of wins, ERA and strike-outs. Both sets of numbers are traditional short hands to indicate quality play but better data and a deeper understanding the game has made the respective baseball triple slashes highly misleading. A pitcher who surrenders 7 runs in five innings has pitched worse than a pitcher who surrendered a single run in nine innings but the win metric rewards the first pitcher for a good offense that scored eleven runs in five innings with a win and punishes the second pitcher who had an anemic offense with a loss.
The health insurance company triple slash of plan design, deductible amount and out of pocket max is also an obsolete view of the qualities of an insurance plan. PPO 2500/5000 was useful shorthand to describer a plan’s basic contours a decade ago. However that short-hand is still limited as it did not indicate whether or not mental health coverage was provided, it did not indicate what type of prescription drug coverage was included and it did not indicate how many physical therapy appointments I could make a year. But it was a useful shorthand.
Things have gotten complicated in the past decade. The first round of complication was the proliferation of high deductible health plans and their attendant health savings accounts. This was a single add on so an HDHP PPO 2000/4000 was still comprehensible and reasonably straight forward as deductible applied to the well baby visit as well as the emergency room visit.
Now,the insurance triple slash is almost useless and a new language needs to be developed. How do we desciber a HIA HSA embedded deductible limited network PPO with non-cost share EHB 2000/4000 in a manner that makes any sense to a consumer at a glance?
PPACA has made the landscape far more cluttered. The major changes from PPACA is the creation of non-cost sharing preventive benefits which includes contraceptives, vaccinations, annual PCP and ObGyn check-ups, pediatric dental and basic screenings for a number of chronic diseases. The second major change is the nature of deductibles and out of pocket maxes. Previously prescription drugs and dental/vision services tended to have their own counters seperate from the medical out of pocket dollar counters. Now all medical costs for prescription, major medical and essential health benefit vision/dental are blended together into a single out of pocket dollar counter. This change is not as descriptively disruptive as the creation of the non-cost sharing services.
Non-cost sharing preventative services are the major change as it is quite plausible for a person to use, in the first week a policy is active, $978.24 in contracted rate services (what the insurance company pays out) and have a total of $33.18 apply to deductible and out of pocket maximums. This is a good thing if a person gets a number of catch-up vaccinations, an annual PCP and OBGyn visit and several screenings performed. It should improve their long run health and decrease long run system cost, but the language of plan design, deductible, out of pocket max fails.
This is a problem because the short hand applied to both Exchange plans and group sponsored plans implicitly discourages utilization of the non-cost sharing but high value added services as it implies that all services are cost shared services. This is most notable on Bronze plans where the argument (rightly in my mind) is a $5800 deductible is a massive incentive against either buying insurance in general OR using it for anything short of getting hit by a bus is strong but misleading because that deductible only applies to cost shared services and not the preventative services.
I’m not sure how to fix this problem.
raven
Always so informative!
Now, in regard to this post all I can say is “Good Golly Miss Molly” and happy 81st Lil Richard!
satby
I think the problem could be that “preventive” and “cost shared” don’t seem to be clearly defined. Vaccinations are clearly prevention, but are the blood tests that usually a part of a yearly exam? Without a clear idea of what is defined as preventative vs maintenance, and whether maintenance care is cost shared I have a lot of confusion myself about which kind of plan would be best for me, and for my 31 year old healthy son (who I’m encouraging to sign up).
NonyNony
I don’t know how to solve it either, but once I figured out that THIS PART IN BOLD was true, suddenly the huge deductible on the Bronze plans both a) made some sense (instead of just looking outright INSANE it looks more like we need more subsidies and/or cost controls to push the cost-sharing portions of those plans down – which makes more sense) and b) made me wonder why every journalist and blogger on the planet was either lying or ignorant about what was going on with the Bronze plans with high deductibles (thanks Richard for pointing us here towards a better understanding of what was going on with this).
I think a lot of folks (including and especially folks in the administration and Congress) have done a piss-poor job of communicating exactly what people should expect to be included in their insurance for no additional copay/co-insurance/cost-sharing/whatever-you-want-to-call-it charge. I cannot, for example, find linked obviously and easily on the front page of healthcare.gov a summary of EXACTLY what benefits you receive from buying health insurance, what you should expect to pay cost-sharing for, and what you should get basically as “free with purchase of an exchange plan BY LAW.”
There are links like this one:
https://www.healthcare.gov/what-are-my-preventive-care-benefits/
But of course it’s not on the front page AND that only tells exactly what preventative care benefits are offered, and NOT anything else. Like how many wellness visits is insurance required to cover per year before you have to start cost-sharing? You can track down this information but holy crap WHY isn’t it located on a convenient single page that says “when you buy insurance now THIS is the minimum that every single plan has to offer without you paying a nickel more, no matter what the deductible is”? And if that page exists, why isn’t linked right off the main page?
I understand that what I’m talking about here is basically a failure of marketing, but damn it’s painful to see people make claim after claim about this shit when a single summary fact sheet that you could point them at to say “actually, your insurance company isn’t allowed to charge you more for those things no matter what their deductible is” would quell a lot of legitimate fears (as opposed to ginned-up fears from people who want it to fail and won’t listen to anything you say to correct their “misconceptions” – you can’t fix willful ignorance).
satby
@NonyNony: or what NonyNony says better than I did. And we’ve been following the ACA discussion; imagine how bamboozled someone who hasn’t been is.
RaflW
I’m glad you brought this up. I was thinking about it (and even mentioned it in a comment on some BJ thread yesterday) that the addition of paid-for preventive care is a big improvement to even “catastrophic” plans, and is not obvious enough.
Here’s a crazy idea: run some ads, some youTubes and such that say “Hey, everyone! Preventive care is free when you have insurance, even the most basic, cheapest plans!”
That doesn’t seem complicated. Though it got more so when Obama gave in to pressure and granted a year waiver to the shitty pre-ACA plans. Ugh.
daveNYC
Damn. Some sort of glossary for the alphabet soup portion would help. I know or can guess what HSA and PPO are, but the other two mean nothing.
Maybe they could come up with a pattern of descriptions similar to football plays. FB West Right Slot 372 Y Stick for example. It’s gibberish, but it’s standardized gibberish so people could learn it, or at least go to a damn wiki for it.
Richard Mayhew
@daveNYC: Yep, and that is the problem. To me — that makes a reasonable amount of sense but only because I’ve spent most of my working career in this mileau.
But going to your football example, there are three seperate football offensive “languages” West Coast, Earnhardt-Perkins and Coryell — they all can describe the same exact play but one will take 11 syllabelles, another takes 2 and the final takes 15
MomSense
O/T and I do apologize to Richard because I love his informative posts. I am the only pet lover in my office and I have to share with someone that I just saw the biggest, most magnificent Maine Coon Cat. He is so big that I thought there was a fox standing next to my car. He has orange coloring and a mane. Unbelievable. I wish I had my camera or phone with me to snap a picture of this king of the alleyway.
Will definitely be watching for him. I can’t tell if he is a stray or not but sometimes people do dump cats and kittens near the dumpster behind the deli that is near my office.
MomSense
Testing. Not sure why I’m in moderation. Could be that I went off topic about a cat I just saw?
rikyrah
Exclusive: Arrested Rochester teens speak out
Three teens arrested while waiting for their bus, along with the basketball coach that came to their aid, tell their story to Lawrence O’Donnell.
http://www.msnbc.com/the-last-word/watch/exclusive-arrested-rochester-teens-speak-out-80763971585
rikyrah
December 04, 2013 1:31 PM
The Awful Specter of Perry ‘16
By Ed Kilgore
It’s been apparent for a good while (certainly after he decided not to run for another term as governor) that Rick Perry’s planning another presidential run. At the Daily Beast today, David Catanese confirms this bad news, and discusses why it may not be the best idea.
But Catanese and the political hands he quotes seem to have a bit of amnesia about why Perry’s 2012 originally formidable campaign ran aground, emphasizing his debate gaffes—particularly the “oops moment” (when he couldn’t remember the list of federal agencies he was promising to shut down)—to the exclusion of all other factors.
Actually, Perry’s original “oops moment” was ideological, not stylistic, when he defended his advocacy of a state version of the Dream Act and suggested his critics were lacking in compassion. Mitt Romney ruthlessly exploited this ideological heresy, and partially burst Perry’s balloon before the Texan deflated it entirely with his debate problems. And even the better known “oops moment” was partially ideological: authentic anti-government zealots don’t have any trouble remembering the agencies and programs they want to kill.
.
http://www.washingtonmonthly.com/political-animal-a/2013_12/the_awful_specter_of_perry_16048054.php
Villago Delenda Est
Damn, this stuff is deep.
But Richard, you are so good at explaining it so even chunderheads like I have a chance at grasping it.
Bravo, sir. Bravo.
Villago Delenda Est
@satby:
Blood tests should be classified FIRST as preventative. If they indicate problems, then they transition to maintenance, as they’re used to monitor known issues. But they’re still analyzed, even as they’re used to track things like cholesterol levels that might be problematic and require medication, for other conditions not yet detected.
So keep them in preventative, as they’re still used in that matter even if (like me) you’re a type II diabetic who is monitored for a number of things routinely.
Of course, this is a layman’s perspective on this…some MD may tell me I’m totally out to lunch, and lord knows what some private insurance bureaucrat/death panel member is going to make of it, whose concern seems to be primarily making sure the CEO is swimming in hookers and booze at all times.
marianne19
Richard, I’m a long-time benefits administrator and I have really enjoyed you posts for the past couple months. Our PEO (multiple employer plan provider) has a table that not only gives the “slash line” but also a Preventative Care section that says ” pays 100% of eligible expenses (no copay or deductible).” Most of our employees seem to “get it,” but then, they’ve had insurance and dealt with changes in insurance most of their working lives. Not sure if new-to-insurance clients would get it so easily but if you put the preventive care at the top of the slash line, they should at least understand some services are free. Anyway, here’s the shorthand our providers use:
PPO/ 100% of eligible expenses covered (no copay or deductible): adult physicals, women’s preventative. well baby/child care/Deductibles: $ In network/$ out of network/Out of pocket max: $ In network/$out of network/Emergency room copay: $/Prescription Drug Tiers/Copays
Richard Mayhew
@marianne19:
Yep, the schedule of benefits few pager (my company tends to use a 2 or 3 pager) does a really nice job of explaining 99.7% fo scenarios
But let’s look at your “shorthand”
versus the shorthand I see on HealthSherpa PPO 3600/6350
Health Sherpa is shorthand but misleading as hell. Your’s is informative but not particularly short. My question is how do we describe a plan in 10 words or less that is reasonably informative.
Flukebucket
I have no idea how Cole found you and Kay or how Kay and you found Cole but by God I am glad it happened.
Thank you for these so very informative posts. I forward them on to other folks I know who desperately want actual worthwhile information.
Sometimes that can be awfully hard to find on the internet.
Keith P
IMO the solution is to radically change the pricing structure of health care costs. Currently, it’s sort of a haggling system that allows bigger customs to talk prices down more. So an insurance company that works with a particular hospital can talk a $50k bill down tens of thousands of dollars, but an individual may not know this is even possible when presented with a $50k bill. My dad had a $100k bill with no insurance, but the hospital offered to clear the bill for $10k…in cash. So he wiped out his nest egg in order to save $90k.
I’d really like to see a system where hospitals just charge a flat rate (that is more consistent across facilities) that already has the fluff taken out.
daveNYC
@Richard Mayhew: Ha! Assuming that you read the same wiki article that I did, one could use two of the play ‘languages’ when describing health plans. Erhardt-Perkins type language could be used to describe the general concept of the plan, and then West Coast could be used to nail down the specifics of the plan.
Villago Delenda Est
@rikyrah:
The police who arrested these teens should be working private security now.
If not floating in Lake Ontario.
Randy Khan
Just a baseball geek note – when people talk about slash lines for hitters in baseball these days, it’s batting average/on base percentage/slugging percentage. It’s much more useful than BA/HR/RBI.
Certified Mutant Enemy
@rikyrah:
Perry saying he would reoccupy Iraq as one of his foreign policy objectives doesn’t sound like a winner (at least in the general election)…
Amir Khalid
@rikyrah:
If this presidential run plays out as most would expect, it’s not going to be pleasant for Rick Perry. He was, let’s say, not the brightest Republican running in 2012. And the Serious Contenders who passed on the chance to lose to Obama then will be fancying their chances in ’16. He couldn’t keep up with the feeble 2012 field. Unless he’s had an unreported growth spurt in his brain-cell count, I simply can’t see him keeping up in in 2016.
Villago Delenda Est
OT, mostly…Noisemax stikes again:
McConnell: Obama Knows GOP Has Healthcare Plan
Well, yes, Alan Grayson already informed of us of it. Don’t get sick. If you do get sick, die quickly.
Richard Mayhew
@Randy Khan: Completely agree — but I’m thinking back to my days as a young baseball fan when RBIs were king and wins measured a pitcher’s worth —
Now we have wOBA, isolated power, fWAR, bWAR, UZR, UZR/150 etc — OPS, OPS+, runs created, all better metrics of value than the Triple Crown stats.
Richard Mayhew
@daveNYC: Actually, it was a Grantland article on the Patriots that I had linked to a while back on the constraints of language to reality.
Richard Mayhew
@Flukebucket: send him e-mails, lots of e-mails — that works really well
Fair Economist
You solve the problem by – ta da! – implementing the PPACA.
Within a year people will think of preventative medicine as free (really, duh, it should be) and by another year or two they’ll have a good idea of what’s covered, just like most people know basic traffic laws even if they don’t drive.
Steeplejack (tablet)
@Randy Khan:
What do they use for pitchers now?
Ms. D. Ranged in AZ
Richard, I have an insurance question. I’ve had a Catastrophic Plan for myself for about 6 months (costs me $68 a month) since no one would accept me for anything else (pre-existing conditions). I finally was able to enroll today in a Bronze plan through the Fed exchange. Should I keep the Catastrophic plan or can I dump it effective January 1st? Thanks!
Richard Mayhew
@Ms. D. Ranged in AZ: My inclination is to dump it effective 11:59PM Dec. 31 local time. Call a navigator for confirmation.
Bronze is PPACA compliant and the catastrophic plan is most likely not compliant (depending on the “fix” to “keep your plan” from last month
Richard Mayhew
Lots of different things. FIPS (Fielding Independent Pitching) analyzes the three things that pitchers control on their own (home run to fly ball ratio, strike outs, walks) as a measure of true talent, xFIPS is an estimated version of FIPs that regresses home run ratio to league average. Those are two common metrics, throw in SIERRA (a similar but not identical system as FIPS), and then looking a little deeper, BABIP (batting average balls in play) tells us whether or not a defense is helping a pitcher or not, and then line drive percentage (higher the percentage, the more hittable a pitcher is)
Southern Beale
FWIW, PolitiFact has opened voting into their “lie of the year.” Most have to do with Obamacare. I’m sure the wingers will be all over the one entry that attacks Obama (“If you like your health insurance you can keep it”) but there are plenty of others far more worthy of the crown. Some I’d never even heard of — Muslims are exempt from Obamacare because of Dhimmitude? WTF?
? Martin
I think it needs to be an education plan that follows the push for signups. There needs to be a marketing campaign that tells americans that if they have insurance of any kind, the following things are free without co-pay. My expectation is that there will be some market innovation specifically around some of those services – clinics that just do contraceptives and vaccinations, do them very efficiently and cost effectively, and get picked up by the majority of insurers. And they’ll market the benefit as well.
We have a mom and pop clinic/pharmacy that has a local reputation like that. We’re in a high income/high number of insured market, but the local clinic/pharmacy is owned by a local couple (husband is a GP, wife is a pharmacist) and provides a high level of service to the community. They are remarkably inexpensive and focus primarily on the kinds of day to day irritations that people have – getting the vaccinations for school, etc. They’ve integrated the two sides of the business to a high degree so it’s very fast and efficient, and over time they’ve built up a decent network of insurance that they can bill to, but are generally cheap enough that people just pay out of pocket. When I was in there a few weeks ago I noticed they were starting to make the shift I noted above and were pitching vaccinations for both my kids and services for my daughter as being free if we have insurance – they have a very good memory for the families that live here. They’ve never done that before, but they apparently know how PPACA will change their business and they’re making the most of it, and will educate a decent bit of the community as a result.
? Martin
FYWP!
Ms. D. Ranged in AZ
@Richard Mayhew: Awesome, thanks!
Randy Khan
@Steeplejack (tablet): On pitching stats: What Richard Mayhew said.
While the BA/OBP/SP slash line actually is pretty useful for hitting – and OBP+SP is a decent approximation of some of the other advanced stats – there’s really no good 3-item way to summarize how well someone is pitching. Maybe something like BABIP/K per 9 innings/HR allowed might work, but nobody seems to do it that way.
KithKanan
@? Martin:
Except that it’s not true “if they have insurance of any kind”.
Grandfathered plans exist — mine just denied coverage for a flu shot last month. I’m not sure, it might have been covered if I had gotten it during my annual physical (were that during flu shot season).
“If you like what you have, you can keep it” confuses things coming and going, I’m afraid.
Yatsuno
@Richard Mayhew: Oh Jeebus. Another sabremetric nerd. :P
johio
I echo the thanks to Richard for these posts. They’ve been really helpful. I’ve been in the individual market since 2005 and until ACA kicked in, had a horrible plan covering no preventive care at all, for ever increasing amounts of money, all because I had something they were able to call a disqualifying pre-existing condition. So it was a matter of take that one plan from that one company or have no coverage at all. Having more than 25 choices of plan now has been a little bewildering. Richard’s posts have helped clarify issues and choices for me. I finally pushed the button and signed up for a plan today. And knowing that I can change it next year if it doesn’t work as I want it to is really nice to know as well. Choices! What a concept.
Darkrose
@Richard Mayhew: It says a lot about how long I’ve been a baseball fan (not very) that I was confused by this post at first. I hear triple slash and I immediately think AVG/OBP/OPS, and I was wondering if there was a different one I didn’t know about.
Richard Mayhew
@Yatsuno: I just want an accurate representation of reality that account for luck and park effects :)
Richard Mayhew
@Darkrose: I probably should have gone Triple Crown instead of Triple Slash
Richard Mayhew
@Randy Khan: I would go FIPS, K/9, WHIP as a quicky summary for a pitcher