Friday, October 09, 2015

Early Fall Health Wonk Review is up

As usual, Joe Paduda has an outstanding selection of wonky posts, including a fascinating inside look at the role of IT and automation in health care.

Good stuff.

Thursday, October 08, 2015

La Plus ca Change

Hey Mr Peabody!

Wayback (SWIDT?) in 2006, we blogged about Minnesota Blue Cross/Shield's new, bleeding edge health care transparency program:

"So, pick up a box of cereal, a package of pasta, or a can of peas, and you’ll find a handy little chart on the side. This is the Nutrition Facts label ... HealthcareFacts goes one (or three) better, by disclosing not just prices, but quality of care, outcomes, and more."

The idea was to distill critical, relevant health care cost information into as simple (and helpful) a form as possible. And it was indeed genius: who among us haven't at least glanced at the label on, say, that can of beans, or carton of milk? How great would it be to have that kind of detailed, but easily understood, information at one's fingertips when considering various health care options?

Fast forward 9 years, and, as Allison Bell reports, the federal SBC (Summary of Benefits) info required of all health care insurance plans have become bloated and useless:

"Federal regulators eventually decided that "four pages" could mean both sides of four sheets of paper."

Eight pages of fine print? Who reads that?

But it's "the law," so carriers are forced to toe the line.

Now, there's a movement afoot to reform that:

"When text boxes are long and full of complex terms, consumers will avoid reading the information in its entirety," officials say"

No kidding.

The reality is that people, as a rule, don't read their insurance policies any more than they read the EULA they agree to when they download a new app for their phone. Which is a shame: the whole point of the exercise is to produce a more well-informed health care and health insurance consumer, no?

Wednesday, October 07, 2015

Promise: Broken

Not to sound like a broken record, but remember when President Obama swore that "if you like your insurance, you can keep your insurance?"

Just got email from Humana that the following letter is going out to at least one of my clients:
Re:    Policy Number:
   
Your current Humana plan will no longer be available in your area for 2016
You will need to select a new health plan between November 1 – December 15,2015

Dear :

Unfortunately, your current Humana plan will no longer be available in your area beginning January, 2016; however, it will remain the same as it is today until December 31, 2015, as long as you continue to make your monthly payment. We know how important it is to select the health plan that best fits your needs, so we would like to help you understand your options and what to do next.
The entire letter is available here.

Color me shocked.

Urgent for our NJ readers

New Jersey health officials say nurse reused syringes while giving flu shots; testing urged.

Unintended Consequences #2,584

Back in 2013, we posted on the travails of an Old Line State same-sex couple trying to untangle their health insurance:

"I got a call today from a woman who needed to find new coverage. She had been covered by her same sex partner as a domestic partner, but since Maryland passed gay marriage, she's now been told that she can no longer stay on the policy unless they get married."

Fast forward two years, and the post-Obergefell era is claiming another scalp:

"The Obama administration reversed a policy Monday that had allowed unmarried federal employees and retirees in same-sex domestic partnerships to obtain insurance coverage for children of their partners"

That is, until now, same-sex couples could cover their children on their gummint-issue health insurance even if they weren't married. Back in Aught 14, "the Office of Personnel Management broadened eligibility ... It made children of an employee or retiree’s same-sex domestic partner — although not the partner himself or herself — eligible." That is, they could add their "step-children" (but not their Significant Other) to their health insurance plan.

As a result of the SCOTUS Obergefell ruling, that's no longer the case, and these folks will now have to join us great unwashed in searching for affordable health insurance.

Be careful what you wish for.

[Hat Tip: HotAir]

Tuesday, October 06, 2015

An embarrassment of linkage:

In no particular order:

■ Up to 3 million ObamaTax victims enrollees stand to forfeit their subsidies next year because they're behind on filing their taxes:

"Fully 40% of taxpayers who received ObamaCare subsidies last year haven't filed their taxes yet and are at risk of losing their subsidies for next year"

This, in addition to looming rate increases - Yikes!

■ Fear of going to the dentist is a major issue for a lot of folks; in fact, it affects 75% of us to some extent. But that may become a thing of the past with new Scottish tech (no, not that Scottish tech):

"Remineralization is a natural process ... Reminova's prototype device can speed up this process to the same amount of time it would take to have a filling -- but painlessly, without injections and drilling.'"

Sign me up!

■ LifeHealthPro's Allison Bell alerts us to something that's generally been under the radar:

"[I]nsurers that participated in Gen Re's latest critical illness issuer survey reported a total of $380 million in 2014 critical illness premium revenue, up 15 percent from the 2013 total."

It seems that the Critical Illness (CI) market is exploding, and it's not difficult to understand why: these plans pay actual cash dollars to their insureds who suffer a listed condition (such cancer or stroke).

Something to consider if you have one of the new high out-of-pocket ObamaPlans.

Monday, October 05, 2015

Training Day Update 1

First, the good news: I received email this morning from the training "Help" Desk in reply to my pleas for assistance.

The bad news is what it said:

"After you have completed all registration requirements for the Individual and/or SHOP Marketplace, you may print your completion certificate specific to the Marketplace(s) for which you completed registration.

Note: your certificate will be marked Incomplete if you have completed training but you have not completed identity proofing. After you have completed training and identity proofing, your registration completion certificate will be marked Complete
."

Here's the problem:

[click to embiggen]

I've obviously completed step 1 and, as noted previously, completed all the training (as confirmed by the site itself).

So I replied that I had, in fact, completed both the identity proofing (?) and the training, but am still unable to print the certificates.

Wait and see, I suppose.

Sunday, October 04, 2015

ICD-10 Arrives

Co-blogger (and Medical Office Manager) Kelley B is working on an interesting ICD-10 post, but I couldn't resist blogging on some of the more ... esoteric ... examples:
■ Other Contact With Pig (W55.49X)

■ Problems in Relationship With In-Laws (Z63.1)
[Methinks this one will become a Top 10]

■ Sucked Into Jet Engine (V97.33X)
[That's gonna leave a mark!]

■ Prolonged Stay in Weightless Environment (X52.XXX)
[Really? How prevalent is this?]

■ Struck By Turkey (W61.42XA)
[Paging Les Nesman!]
Welcome to the brave new world of health care.

[Hat Tip: Ace of Spades]

Friday, October 02, 2015

Runnin' on empty

As we've long noted (here, for instance) the ObamaTax 'risk corridor' (essentially a slush fund to cover excess claims) was always unsustainable. But hope springs eternal (at least in DC).

Until, of course, Mrs Thatcher's observation kicks in.

Frustrating Government Tricks

So, it's that time of year again: Federal Marketplace training for Open Enrollment v3.0.

So, as I've done for the past few years, I set aside a day to get it all done, logged in and started learning. This year, there are 10 "modules," including 2 exams that must be passed (minimum of 70% correct answers). About halfway through, get this delightful message:


Sigh.

So, pick it back up an hour or so later, and complete the training (acing both exams, by the way). So far, so good.

Click over to print my certificates of completion, and am told that, despite the fact that I've completed all the modules (and the site confirms this) my training is "Incomplete," so no certs for me.

Are you kidding me?

So I futzed around on the site for another half hour or so, then decided enough for one day, will come back and pick it up - fresh - in the morning.

Which I do, to no avail. However, I find an online form to use to report a problem and an email address to accomplish same. Being a belt-and-suspenders kinda guy, I did both (keeping copies, of course). That's Wednesday (two days ago).

Wednesday comes and goes, no response from either inquiry, so repeat.

Thursday comes and goes, still no joy.

So this morning, I repeated (again), and then poked around a bit more until I find an actual phone number to call to report and/or discuss training issues. So I call the number, and a very nice young man named Jeremy explained that there is nothing he or anyone else at the "Help" Center can do, I'll just have to wait to hear from the folks at the online "Help" Desk. And no, he can't tell me how long that might be.

So here I sit in training limbo: yes, Open Enrollment doesn't start for a month, but I'd really like to put this behind me, and I can't do that. And I am completely powerless here: no one to threaten with bad ink (well, pixels), or to take my business elsewhere (only game in town).

Just call me Indy.


Private Fitbit Reporting for Duty

As we noted this past summer, the privacy challenges posed by folks using their FitBits (or similar exercise tracking devices) remain murky. One problem is that one doesn't necessarily know where the data will actually land, and whether or not that end-vendor (for lack of a better term) is a "HIPAA covered entity." The sticking point is defining just who (or what) is a "HIPAA covered entity."

The good news is that the situation recently became a bit less murky, at least for some folks:

"Fitbit announced it will enter into HIPAA business associate agreements with covered entity health plans and self-insured employers that will offer Fitbit’s wellness platform to employees and insured individuals."

So what does this mean in practice?

Basically, that FitBit will need to "implement the security controls required by the HIPAA Security Rule, but only with respect to data it is receiving from or collecting on behalf of covered entity health plans or healthcare providers."

So if your health plan includes FitBit-style tracking, then your info is likely  a bit more private than it has been. Of course, this applies only to FitBit users: if you're using some other similar device, you may want to do a little research on how your ostensibly private info is being treated.

Thursday, October 01, 2015

Medicaid HIX Credits SNAFU

Co-blogger Bob alerts us to this little glitch:

"The CMS has sent letters to Medicaid consumers who received tax credits to purchase insurance through the Affordable Care Act marketplace."

The first problem is that subsidies are supposed to be available only to folks in a narrow swath of income; those that fall below the minimum and are thus Medicaid-eligible aren't eligible for tax credits (subsidies). But in some states using the Federal Exchange system, "a small number" of Medicaid-eligible folks received these credits by mistake.

Never fear, though:

"The agency says these people will have to ... pay back the amount of the credit they've received."

Which gets to the second problem: um, good luck squeezing blood from that particular turnip:

"Many people will not understand what they need to do. Low income families tend to move often, so many addresses may be inaccurate.”

Not to mention that they're Medicaid-eligible for a reason.

Top. Men.

From the Mailbag: Wellness & Privacy revisited


Wednesday, September 30, 2015

NCQA-BBQ: It is to laugh

So, got this in email the other day:

"A new ratings system created by the National Committee for Quality Assurance (NCQA) provides consumers with a more accurate picture of how health insurance plans perform in key quality areas."

That's (mildly) interesting, but what were those "key" areas?

Oh:

"[C]linical quality, member satisfaction and NCQA Accreditation Survey" [emphasis added]

Are you kidding? One third of the metric is itself?

How does that work?

More importantly, though, is the self-delusion that consumers actually care about these kinds of things:

"Oh sure, Anthem has a terrific rate, $100 a month cheaper than Humana, but Humana ranks 3 spots higher on NCQA, so I'll go with them."

Said no one, ever.

It's similar to the experts who claim that folks inadvertently "leave money on the table" by not choosing a health insurance plan that offers cost-sharing in addition to premium subsidies. There's a reason, and it's not ignorance of the program.

It's human nature.

Tuesday, September 29, 2015

Wellness vs Privacy

Are you kidding me?

"Houston required employees to tell an online wellness company about their disease history, drug and seat belt use, blood pressure and other delicate information."

And the best part (for certain values of "best")?

"The company ... could pass the data to "third party vendors"

Oh goody!

Of course, employees could opt out, no problem.

Wait, what?

"[B]ut only if they paid an extra $300 a year for medical coverage."

So the vendor sells employee info, and employees that take a pass get dinged for $300?

Exit question: how much cash does each employee get for the re-selling of their private health info? Oh, they "save" $300 on insurance?

Seems legit.

Monday, September 28, 2015

ICYMI: Kaiser Foundation Lies

The lying liars at the Kaiser Family Foundation want us to believe that:

"Since 2008, average family premiums have climbed a total of $4,865."

And this, while they "calculate that deductibles have risen more than six times faster than workers’ earnings since 2010."

Now, how do we know that they're telling fibs?

Well, who ya gonna believe, KFF or:

Kudos to us!

So, just received word that we've been selected as one of the best Men's Health blogs by Healthline (a comprehensive health information portal). Healthline's editors chose us "based on quality, frequency of updates and contribution to the community." The full list is available here.

We're honored to be #2 (out of 10 selected). Thanks, Healthline!

Sunday, September 27, 2015

Yes, The New York Obamacare Co-op Pissed Away $340 Million

I posed a question for this answer to IB readers back a year ago. In fact, Mike and I both wrote posts about New Republic dating back to January of 2013. So what's happening now?

New Republic is the health insurance cooperative in New York. They boast having the largest enrollment of any of the government funded co-ops with over 150,000 members. However, it is being shut down by the State of New York and CMS. This should not come as a surprise. Especially knowing that in 2014 they had the lowest rates (by far) in several areas across the state and weren't allowed the premium increases they requested by the New York insurance regulators for 2015. They hemorrhaged $77.5 million dollars in 2014 and another $57.2 million was lost over the first six months of 2015. Ouch.

A little history is important. Before New Republic we had the Freelancers Union. They had their own insurance company - Freelancers Insurance Company (FIC) that was notorious for consumer complaints. Freelancers ended up terminating the entity when Obamacare became a reality. As FIC was winding down, the union was in the process of creating a new venture which they received $340 million in Obamacare grants to start up a health insurance co-op. Instead of associating it with Freelancers, union leadership created a new non-profit which became known as New Republic.

We've already seen other co-ops bite the dust so why should we care more about this one? One word:  relationships. The relationship concern here is between the Freelancers Union, New Republic, and the Obama administration. Freelancers was established in 2003 by Sara Horowitz. Ms. Horowitz is a longtime close friend of President Obama. Back when President Obama was in the Illinois state senate, he and Ms. Horowitz worked together to launch the George Soros-funded liberal think tank Demos. It should also be known that Ms. Horowitz is a Deputy Chair of the Federal Reserve of New York and has been reported to have close ties with U.S. Senator Kirsten Gillibrand.

Having friends in high places has netted Horowitz and the Freelancers Union a nice chunk of change. Some may suggest that these co-ops were funded in the same scope as Solyndra. In this case it is not even close. This goes well beyond the scope of Solyndra. This didn't hedge on success of a new technology or product. This allowed our federal government to give huge amounts of money that went directly to lining the pockets of those who aligned and aided a political interest.

As we untangle the web we can see one thing - it's good to be one of Obama's political cronies. And for 150,000 people in New York, sorry but, if you like your plan you definitely aren't keeping it.

Friday, September 25, 2015

#LIAM2015: What's it's *Really* All About

So, two decades ago, George bought a 20 year level term policy. Two months ago, the initial rate guarantee period ran out, and his premium shot up dramatically (as they are wont to do). A month or so ago, we met to discuss options, at which time he decided to "let it ride," at least for a while.

Three weeks ago, he died on the operating table from a stroke.

Yesterday, I met with his widow to finalize the death claim paperwork (it took several weeks for the official death certificates to be processed).

And in another week or so, I will deliver a check for $250,000 (plus interest) to her.

There is really nothing remarkable about this process; after all, everything went as it should (save for the delay on the death certificates, which was out of our control).

And yet...

And yet, there is everything remarkable about it: over the years, George paid in several thousand dollars in premiums, a mere fraction of what his widow will receive. When we met last month, he was considering applying for a new policy with lower premiums and, of course, a lower face amount.

But he let it ride.

And in a week or so, I will be the only person in his widow's life who will be giving her money.

It just doesn't get any better than that.

Thursday, September 24, 2015

Thursday Linkage

■ FoIB Jeff M alerts us that Medicaid Reform has at long last arrived in the Tar Heel State:

"After several major revisions, Medicaid reform that had delayed budget approvals during recent years passed the General Assembly ... This new system will focus on keeping people healthy and delivering care where it makes the most sense for patients"

Time will tell, of course, whether these new metrics ultimately make a difference.

■ And from FoIB Holly R, we learn that health insurance deductibles are outpacing wage increases:

"Kaiser ... calculates that deductibles have risen more than six times faster than workers’ earnings since 2010."

This is, of course, typical right-wing propaganda, since we know that "if you like your plan, you can keep your plan" including your preferred deductible.

Shame on the Kaiser Family Foundation.

■ From the "Your Tax Dollars @ Work" Department:

"Nearly half a million ObamaCare enrollees were able to claim more than $235 million in excess subsidies that they will never have to pay back" [emphasis added]

The article includes a real contender for "Best Line of 2015," as well:

"[T]hanks to a quirk in the law that leaves the program vulnerable to potentially billions in excess subsidy payments."

Gee, maybe they should have read it before they passed it.

Naah, that's just crazy talk.