The Penguins have the chance to close out their second straight Stanley Cup tonight. However the game is in Nashville. Home teams have dominated this series.
No politics
Open Thread!
I am a student in the doctoral program at the Duke University Department of Population Health Sciences. I am working towards my my doctorate in Health Services Research with a policy focus. I am fundamentally fascinated by insurance markets, consumer choice and the navigation of complex choice environments. I'm currently RA-ing at the Duke Margolis Center for Health Policy.
I used to be Richard Mayhew, a mid-level bureaucrat at UPMC Health Plan. I started writing here and have not found a reason to stop.
Conflicts of interest: Previously employed at UPMC Health Plan until 12/31/16. I also worked full time as a research associate at the Duke University Margolis Center for Health Policy. I have received direct funding from the National Institute for Healthcare Management, and I have been on projects funded by the Rockefeller Foundation, Kate B. Reynolds Charitable Trust, Gordan and Betty Moore Foundation, Duke University Health System, CMMI, and various value based payment consortiums. I serve as a consultant on a grant from the Commonwealth Fund and have acted as a consultant to several ACA insurers.
Research Production is here: https://scholar.google.com/citations?user=zof9b4IAAAAJ&hl=en
David Anderson has been a Balloon Juice writer since 2013.
by David Anderson| 45 Comments
This post is in: Open Threads, Sports
The Penguins have the chance to close out their second straight Stanley Cup tonight. However the game is in Nashville. Home teams have dominated this series.
No politics
Open Thread!
by David Anderson| 46 Comments
This post is in: Anderson On Health Insurance, Fuck The Poor
Delaying massive cuts and eligibility restrictions is still voting for massive cuts and suffering.
Call the Senate
The Senate's #Medicaid compromise would not preserve anyone’s coverage in the long run: https://t.co/dqCBCehp21 #MedicaidWorks pic.twitter.com/Oj7n9PNe7L
— Center on Budget (@CenterOnBudget) June 8, 2017
When you call a Senate office, ask to speak to the relevant Health Legislative Assistant. Hey look, a list of staffer names! 18/ pic.twitter.com/UQ0yZNaSxc
— Ben Wikler (@benwikler) June 8, 2017
by David Anderson| 31 Comments
This post is in: Open Threads, Sports
Let’s enjoy tonight’s game and hope that the Penguins can actually generate some cohesive offensive zone time in the face of the Predator’s stifling defense.
No politics.
Open thread
by David Anderson| 14 Comments
This post is in: Anderson On Health Insurance
It’s hard to be an insurer. Integrated Delivery Networks (IDN) have waves of popularity where hospital systems usually try to become an insurer. Occasionally insurers try to become hospital systems. We hear about Kaiser, Geissenger and a few other case examples on a regular basis as they should be able to align payer-provider incentives in a more coherent fashion as well as building deep, rich data sets which should power useful but non-obvious insights. I worked at UPMC Health Plan, part of a profitable IDN, before I came to Duke.
The Robert Woods Johnson Foundation recently released a review of the IDN’s that were created in the first half of the decade.
provider systems established 37 new health insurance companies and acquired five existing health plans….
it is not unusual for a startup health plan to lose money in its first years, only four of the new plans were profitable in 2015. Some
reported significant losses, and five have gone out of business. It has generally been a difficult time for health plan startups, as demonstrated by the demise of most of the health insurance cooperatives formed under the ACA and the large losses posted by companies like Oscar and Harken Health…..
Being an insurer is hard. Being both an insurer and a provider is even harder. The National Academy of Social Insurance looked at IDN’s in 2015 and made the following point:
There is scant evidence in the literature of either societal benefits or advantage accruing to providers from IDN formation. From the societal perspective, there is little evidence that integrating hospital and physician care has helped to promote quality or reduce costs….
From the provider perspective, the available evidence suggests that the more providers invest in IDN development, the lower their operating margins and return on capital…..
Moreover, there are few or no scope economies within health plans, hospitals, or physician groups —let alone between these lines of business contained within IDNs. Provider-sponsored insurance plans face similar problems regardless of whether they were formed by hospitals or physician groups: poor capitalization, lack of actuarial and underwriting expertise, limited marketing capability both to
employers and consumers, adverse selection risk, and an inability to reach minimum sufficient scale of enrollment.
To be a successful insurer, there is a chicken and an egg problem for open to the public IDN systems.
It’s hard to be an insurerPost + Comments (14)
In order to gain good rates from providers, an insurer has to be able to promise a large and steady stream of patients. In order to build membership, the rates paid to the providers must be low enough to be reasonable for a competitive break even premium. A health plan needs members to get good rates, and it needs good rates to attract healthy members. Or it needs to be able to lose significant sums of money on bad contracts to buy significantly large membership for better contracts in the first renegotiation cycle. IDN’s can get around this to some degree if they price their own services at a significant discount to the rest of the market.
If they are selling commercial plans where they pay non-owned providers standard commercial rates but they only pay their owned providers Medicare like rates, this is a massive opportunity cost but not an explicit cash cost. This only works if the providers have both spare capacity and the ability to attract membership on their own. UPMC could do this as the hospital side of the system has a positive regional brand. A small community hospital chain in a quasi competitive region may not be able to do this.
Finally, the mindset needed to be a good insurer is very different than the management mindset of being a good hospital. The insurance side of the business will want to do as much as they can to keep people out of a hospital. Insurers want patients to avoid inpatient stays, they want patients to avoid hospital based testing, they want patients to avoid any service that comes within 1,000 feet of the hospital parking lot. Hospitals are expensive. Hospital executives, in most states, have strong financial incentives to find ways to get people to come to the hospital.
Managing this inherent tension between keeping people out of the hospital and putting heads in beds is a tough swing. Furthermore, the technical skills of being an insurer with good actuaries, good pricing, an aggressive knowledge of risk adjustment and pharmacy benefit management and a dozen other unique to insurance skill sets are not skills that many hospitals use. There is a significant learning by doing curve needed to build up a minimally capable skillset.
Being a new insurer, and especially being a new, small insurer that is attempting to bridge two worlds of being a provider and a payer, is tough. It’s a rough business model.
by David Anderson| 98 Comments
This post is in: Open Threads
Quinnipiac has a new poll out on Trump. I am confounded by a subset of people:
President Donald Trump did something illegal in his relationship with Russia, 31 percent of American voters say, while another 29 percent say he did something unethical, but not illegal, according to a Quinnipiac University national poll released today. The president did nothing wrong, 32 percent of voters say.
President Trump’s campaign advisors did something illegal in dealing with Russia, 40 percent of voters say, as 25 percent say they did something unethical but not illegal and 24 percent say they did nothing wrong.
The president’s job approval rating dips to a new low, a negative 34 – 57 percent, compared to a negative 37 – 55 percent in a May 24
So 60% of the public think he did something personally fishy with Russia. 65% of the public think his inner circle did something fishy with Russia. And yet only 57% of the country disapproves of his performance. So there are at least 3% of the country who think he is doing a good job and he is up to his eyeballs with Russia in at least an unethical manner. Who are those people?
Open thread…..
by David Anderson| 26 Comments
This post is in: Anderson On Health Insurance
Erik Westlund in Medium wrote a stunningly good piece on being a parent of a child with hemophilia in Iowa. He made five points that I want to highlight.
The key chunk is here:
Nowadays, the standard of care for hemophilia patients is to “prophylax”, or in common parlance, “do prophy,” from a young age. You get an IV shot two or three times a week to prevent bleeds before they start. Improved treatment products and regimens have made hemophilia a more livable disease. Life spans are now similar to those without the disease and daily life for a kid with hemophilia often differs little from those unaffected.
This comes with a cost, however: factor drugs are expensive. Very, very expensive. My guess it that my son’s treatment costs somewhere between $100,000 and $200,000 a year. My son, however, is lucky. So far he hasn’t had an inhibitor, which is when the body reacts to factor treatment with an antibody. About 20% of hemophiliacs have inhibitors. Patients with inhibitors need a lot more factor, more frequently. The costs can add up fast.
I found this post from a patient/caregiver point of view to be stunning, humanizing and well worth the three times I read it.
by David Anderson| 23 Comments
This post is in: Anderson On Health Insurance, Organizing & Resistance
Call the Senate.
Right now, it looks like the Senate’s plan is to make a few minor tweaks to the AHCA, and then dare half a dozen Repbulicans to vote no. It would be a rapid turn-around with votes in under a month from today.
If McConnell has his way, the public will only have two days to read the bill, with a day to debate & a vote 6/28. 2
— Andy Slavitt (@ASlavitt) June 7, 2017
Call the Senate. If you live in West Virginia, Alaska, and Nevada, call it twice.
Right now, my pessimism index has gone back to 80%. After the AHCA was introduced in March, I thought the chance of a bad healthcare bill passing and getting signed into law had dropped to about 65%. I was at 97% on November 9th.
So let’s call the Senate. And then start working on calling the House as they’ll have to revote on anything that the Senate passes or a conference report.
Call the Senate & pessimism index updatePost + Comments (23)