WHAT Right to Privacy?

Back in the day, a controversial Supreme Court decision turned on the (presumed) Constitutional Right to Privacy. Apparently, someone forgot to inform the new administration of this Right (irony notwithstanding), because buried in the new Stimulus Package is this little gem:

"(E)very American [must] submit to a government program for electronic medical records without a choice to opt out."

Wow.

Privacy experts are a bit miffed at this (no surprise) because, in addition to the "normal" aches and pains, these records will include "documentation on abortions, mental health problems, impotence, being labeled as a non-compliant patient, lawsuits against doctors and sexual problems."

We've discussed the viability and advisability of electronic medical record keeping before, but always from the provider's standpoint, and always with an eye toward respecting and protecting the patient's privacy and integrity. This seems to be a giant leap beyond all that; given the gummint's less than stellar record regarding safe-keeping, I think this is -- at best -- worrisome.

Party on, Gramps!

Alzheimers and dementia are no laughing matter, but in addition to other non-intuitive treatments, this unusual advice may be just the ticket:

"Keeping a full social calendar may help protect you from dementia...Socially active people who were not easily stressed had a 50 percent lower risk of developing dementia compared with [those] who were isolated and prone to distress."

This is from a new report in the medical journal Neurology, which tracked some 500 senior Swedes, none of whom had been previously diagnosed with dementia. The study lasted six years; by the end, about a third had developed dementia. What was (perhaps) surprising was that folks with more active social lives were about 50% less likely to develop those symptoms.

It appears likely, based on this study, that there are some significant environmental and lifestyle factors that play roles in dementia; that's good news, since these are things we can (at least to an extent) control.

Health News Mini-Roundup

■ Looks like Galinda was right: it's good to be popular. But she may have been wrong, as well; some folks may just be born that way:

"Researchers at Harvard and the University of California, San Diego report that popularity seems to have an inherited component."

Here at IB, we've looked at the Alzheimer's gene, the breast cancer gene, even the Down Syndrome gene. But one that could predispose someone to be more popular? Who knew?

Researchers from Harvard and the University of California (San Diego) studied over a thousand teen-aged twins, and found that identical twins seemed to share the same social position than fraternal ones, which the researchers believe suggests a genetic component to social status (aka popularity).

■ Prince Charming may be wearing a wedding ring:

"(A) 34-year-old from the U.K. suffered a heart attack nearly two weeks after giving birth to her son and failed to regain consciousness.

Her husband, Andrew, spent two weeks by her bedside waiting for her to wake up from a coma – but her condition did not improve until he leaned over and asked her for a kiss..."

The comatose woman turned her head toward her husband, pursing her lips and kissing him.

This apparently happened two years ago; she's had a rough time, including some short term memory loss, additional brain surgery, and therapy. But she's coming along well, and seems to be on the road to recovery.

■ MVNHS©: Where's the Beef?

In yet another whimsical, and yet silly, move, Britain's health service has decided to limit its patients' carbon footprint (feetprint? footprints?). First up, taking a page from Domino's, the Service recommends that Brits call it in rather that dropping by:

"Patients should phone their GP rather than drive in for a visit...Ministers want family doctors to hold more 'phone-in' surgeries to help the environment by cutting carbon emissions from cars."

[ed: Don't be alarmed; "surgeries" in this case means doc visits, not procedures]

Actually, that may not be such a bad idea: there's certainly a justification for using the phone or email for simple, non-emergency consultations.

It's not exactly clear how this will help reduce so-called Global Warming:

"They also want hospitals to achieve their green targets by reducing the amount of meat they serve to patients in wards."

After all, it's well-established that bovine emissions increase greenhouse gases; wouldn't it make more sense to encourage eating beef?

This observation certainly rings true:

"(T)he NHS is responsible for a quarter of all the carbon dioxide emissions produced by the public sector."

That's a lot of gas.

Cavalcade of Risk #70 now online

Health Business Blog's David Williams hosts this week's collection of risk-themed posts. Take a chance and stop on by.

And consider hosting your own Cav - just drop us a line.

UHC vs Diabetes: The Interview

Last week, we noted that United HealthCare has introduced a new program to help insured diabetics (and "pre-diabetics") cope with and finance their expensive health care. In a followup, I asked to speak with someone from the program's development team in order to help our readers understand how it came about, and how it's intended to work.

Alex Nelson, their PR contact, graciously arranged for me to interview Tom Beauregard, the CEO of UHC's R&D arm, United Essentials [ed: oddly, and after much searching, I could find no link to that entity]. Mr Beauregard and I spoke for some time, and we're delighted to present the fruits of that discussion:

So, who is Tom Beauregard?

Mr Beauregard runs the Research and Product Development arm of UHC. He's been with them for about 3 years; the previous 20 were spent consulting in this area.

What prompted this new effort?

Demand from employers, primarily. They want to move away from cost-shifting toward more "Value Based Insurance." The goal is to target communications to modify behaviors.

Some employers have begun encouraging voluntary efforts in this regard, and UHC decided to set up its own program to augment these, starting with diabetes and weight management.

How is this program different from previous endeavors?

The goal is to offer incentives based on compliance with ADA (American Diabetes Association) standards. It's both a carrot and stick approach: folks who continue to comply with the stated objectives receive extra benefits, at no cost, while those that "fall off the wagon" are directed back to the basic insurance plan.

[ed: Some might view this as somewhat "Big Brotherish;" I think it's good business sense - up to a point. More on that later]

I can see how this could help those currently suffering from diabetes, but what, exactly, is a "pre-diabetic?"

According to UHC and the ADA, these are folks with elevated levels of HBIC and cholesterol, who haven't - yet - developed full-blown diabetes, but are at increased risk of doing so. The standards, set forth by the ADA, aren't arbitrary; they estimate that up to 26% of adult Americans are "pre-diabetic."

[ed: And here's where I have to draw a line. I take issue with UHC's apparently uncritical acceptance of this whole "pre-diabetes" phenom. The ADA claims that "(p)re-diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 57 million Americans who have pre-diabetes, in addition to the 23.6 million with diabetes."

And just where does that 57 million come from? The ADA doesn't say, and, at something like 20% of the population, it doesn't pass the smell test. I think that this whole idea of alarming the public over obviously inflated numbers does more to harm a cause than to help it. The other "23.6 million" is similarly suspect. If you're wondering why the ADA would be okay with these inflated, perhaps spurious numbers, remember that many organizations rely on public perception for fundraising purposes]

One very simple way to decrease this risk is through weight loss, so the program includes numerous tools to help facilitate this.

Sounds like a plan. But why only self-insured groups? Is there a plan to expand it to fully insured plans?

UHC decided to focus on SI groups first, to get a feel for how many people would both sign up, and subsequently stay with it. It's easy for folks to say "sure, I'd be interested in such a plan," but the real test comes when it's actually offered to them, and they have to make the conscious decision to participate. And once they're on the plan, how many will stick with it? That can only be determined by trying it out in a controlled setting.

If the metrics bear out, then the company will consider expanding the program (in one form or another) to their fully insured groups.

We truly appreciate Mr Beauregard's time and candor, and will keep an eye on the plan's progress. He also indicated that he'd be happy to answer any other questions we might have, so readers are invited to suggest them in the comments.

Not Just for the Ladies: Grand Rounds at Chronic Babe

Jenni Prokopy, the hostess with the mostest, presents this week's roundup of the best medblog posts.

We're tickled pink to be included.

Humana Network Fallout

Fresh on the heels of Humana's recent faux pas, FoIB Rick Byrne alerts us to this important change to the way Ohio DOI handles network changes. Effective (apprently) immediately, health insurers must now report "significant changes to their medical provider networks to the Ohio Department of Insurance." They'll also have to tell the Department just how they intend to communicate these changes to their insureds.

What's more, they have to notify the state at least 15 days before they contact their insureds. One supposes this is to enable the Department to oversee the transition, and (perhaps) protect policyholders from the potential for significant reductions in how their claims are covered.

I'm pretty sure that this is a "good thing."

[Hat Tip: Rick Byrne]

Cavalcade of Risk #70: Submissions Due

Health Business Blog's David Williams hosts next week's Cavalcade of Risk. David asks you to include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).

You can submit your post via Blog Carnival or email.

Thanks!

It's fun and easy to host - just drop us a line to find out how.

Lights out for CFL?

Insurance, which is the primary theme of this blog, is about identifying and managing risk. But it's not the only risk-related subject; sometimes risk is simply about assessing whether or not it's safe to change a lightbulb.

Hunh?

Anyone who's had to change a light bulb recently [ed: quick - how many insurance agents does it take to change a lightbulb? Answer: no one knows, we don't mind being kept in the dark] has seen those nifty new "twisty-bulbs," aka Compact Fluorescent Lights (CFL). Touted as a substantial energy savers, they're now actively creeping into widespread use.

Of course, our nanny-state gummint-class has mandated that these little marvels must soon replace the familiar "regular" bulb (notwithstanding their potential danger). But are they good for our health?

In addition to toxic mercury, our Neighbors to the North are becoming increasingly concerned that they may also be giving off "potentially harmful ultraviolet radiation." Health Canada (the "department responsible for helping Canadians maintain and improve their health") recently studied CFL's to determine whether they pose a radiation risk. Oddly, I couldn't find any mention of this study on the HC website; perhaps it's too new.

But it's not just Canadian authorities in a dither:

"The United Kingdom's Health Protection Agency said in October that open, or "single envelope," bulbs — which have a corkscrew-like or tube-like design — can emit ultraviolet radiation at levels that can result in exposures to UV radiation similar to exposing bare skin to direct sunlight."

It's so bad, in fact, that the Brits are recommending that folks spend no more than an hour a day in their immediate vicinity (the bulb's vicinity, not the Brit's). There's also concern that these little wonders may negatively impact those with lupus.

Stranger still, our own Consumer Product Safety Commission is completely silent on the subject.

Why is that?

Post-Inaugural Health Wonk Review

Jaan Siderow hosts this week's roundup of interesting and provocative health care policy posts. It's a true rock concert of a 'Review.

Admirable Carrier Tricks: Good News for Diabetics

United HealthCare's Stacy Cohen just alerted us to that carrier's new health care plan "designed to help the rapidly growing numbers of diabetics and pre-diabetics manage their conditions more effectively while controlling employers' escalating costs of insuring them."

Currently, the program is available only to self-insured groups, and is available for both diabetics and what UHC calls "pre-diabetics." One supposes that these are folks who, because of genetics and/or lifestyle choices, are more at-risk of developing the disease.

Folks participating in the Diabetes Health Plan receive on-line monitoring and special disease-related educational tools and training. They also receive some diabetes-related meds, including not just insulin but even anti-depressants.

I've asked Stacy about interviewing someone from the plan's development team, and hope to have that set up and posted in the near future. I'd also like to know if there's any chance of porting this program to fully-insured groups down the road; given UHC's stated concern about the "rapidly growing numbers of diabetics and pre-diabetics," one would think that this is on someone's drawing board.

In the meantime, here's a quick video with some background, and an explanation of how the program works:

Healthcare Stakeholders: A Perspective

We're delighted to welcome guest-blogger Deron Schriver, blogmeister of Healthcare Rx. Deron recently proposed a post about physician/insurer relations, and we're happy to oblige. He's worked in the health care field for for ten years, with the last three spent as a medical group administrator for a large OB/GYN practice. Deron tells me that his "daily interactions with the various healthcare system stakeholders have enlightened me and sparked my interest in system reform, which has lead to my other life as a rookie healthcare blogger."

Deron believes that there is a tremendous amount of room for improvement in that area. Given today's political climate, this seems like a capital idea, and we are pleased to present his take on where we "go from here:"

The high per capita spending of the U.S. healthcare system has been widely published. As a result, we have seen a renewed interest in system reform. Despite the large number of people and organizations developing and proposing reform strategies, no single strategy has emerged as the best solution.

Considering the magnitude of the problem, we would be best served if we could identify synergistic reform opportunities. I would like to suggest one very important opportunity that could produce significant benefits: a focused effort to improve and enhance the relationship between physicians/hospitals and health insurers/managed care organizations (MCOs), with a goal of improving quality and reducing cost.

In a well-functioning healthcare system, providers and payers would partner in the name of improving the health status of their mutual customers: the patients/covered members. However, patient-centeredness has taken a back seat in the current environment. Factors such as market share and leverage have played a big role in fee schedule negotiations and provider network development and maintenance. Instead of identifying common goals and opportunities to work together, the two sides have been guided by short-term financially-motivated thinking.

So where do we start with an initiative like this? My suggestion is that we get the two factions to sit down and discuss 1) the measures they can take to improve the health status of their mutual customers and 2) the steps they can take to reduce waste and complexity in their relationship.

The two must identify key indicators to help guide their efforts. Clinical measures such as average spending per condition, hospital infection rates, and screening rates (mammograms, cholesterol checks, bone density tests, etc.) should be routinely analyzed and acted upon when necessary. Administrative measures such as claim denial rates, phone hold time, and consistency of policies with national standards (ex. CCI) should also be considered.

As someone who sees this relationship play out on a daily basis, I can tell you that there is tremendous room for improvement. Turf protecting is a big problem within the U.S. healthcare system, and all stakeholders, particularly the two mentioned, engage in it routinely. If it’s done right, reform does not have to mean that insurance companies, physicians, or any other stakeholder needs to take a big financial hit. Reductions in revenue will be offset, to at least some extent, by corresponding reductions in cost. When the focus is where it needs to be, waste will be eliminated and everyone will come out stronger. This is a best-case scenario, but I can’t imagine striving for anything but the best.

Many, many Thanks, Deron! It's obvious that there's a lot more to the challenge of health care delivery and financing than meets the eye, and that a good place to start is by opening up these lines of communication between providers and insurers.

Moronic Carrier Tricks: The Aetna Story

I tend to write a fair amount of individual medical. For one thing, a lot of agents in my area have given up on this market; for another, I actually enjoy the one-on-one nature of this type of business (as opposed to group).

There are a number of carriers available, but of course the market is dominated by one or two. As a firm believer in competition, I'm always on the lookout for alternatives. Recently, I've started using Humana and Aetna in an effort to broaden the marketplace. Unfortunately, I've had to (at least temporarily) curtail placing business with Humana, so I had high hopes for Aetna.

Which have been dashed to little, teensy weensy pieces:

First, despite their insistence on how well they do online applications, I can rarely get their link to work. I have clients sitting in front of their monitors, waiting patiently for the page to load, only to see the page time out. And time out. And time out.

So back to paper apps, which are cumbersome and add even more processing time. Not to mention additional, stupid procedures. Recently, two brothers and a sister applied for major medical this way. We tried, in vain, to get the online app to work. When that proved futile, we switched to paper. I had their father (who's initially paying the premium) write one check for all three, hoping to at least save some effort.

This is what I received:

"We will need once [sic] check for each applicant because technically each application is it's [sic] own separate policy, and will have it's [sic] own ID #"

To which I reply:

So. Freakin'. What?!

What possible difference does it make that there's one check for each application, when the only thing that matters is that they got the money?

In another case, we were finally (and after much technical support) able to get the online application to work. The underwriter then decided that he (she? it?) needed additional info, and tried to call my client. Unfortunately, they were calling his home number during business hours; when I called to suggest that they use his business number (which was on the application), they countered that he should call them back at their special, super duper toll free hotline. Here's how that worked out:

"Boy have I been having a hard time with Aetna. They do not answer or return calls. But finally, I got through. They want stuff faxed from [my] doctor--last three ... and last ... reading. The doctor is faxing it to them."

Why would a carrier offer a "streamlined" service which was itself so difficult?

Oh, I know: because they're...well, see the title of this post.

Needless to say, I won't be writing any more Aetna individual plans.

Inauguration Day Grand Rounds

FoIB Val Jones presents an inspiring and thoughtful Grand Rounds, including eye-catching pics and thought-provoking posts.

Do check it out.

Back in the Pool

Last fall, we took a look at the North Carolina high-risk insurance pool. And tomorrow, of course, heralds a new day in Washington, where health care delivery and financing will take on new urgency.

So it seems rather timely that the National Association of State High Risk Insurance Pools (NASCHIP) has released their comprehensive report on state high risk insurance pools, and how these mechanisms may play a vital role in both state and federal reform efforts.

The report itself is available here.

According to Noah Rouen, Vice President for Accounts, "(t)he paper is particularly timely as Congress and the Obama administration seek to add coverage for millions of Americans. You may recall that Sen. McCain had proposed expansion of state high risk insurance pools as a cornerstone of his reform proposal."

Of course, we had our own take on Senator McCain's dubious proposal.

Nevertheless, the NASHIP report makes compelling reading, and underscores how important it is to address the problems facing our health care system on a state-by-state basis before overhauling it on a national level.

A Classic Carnival of Personal Finance

Penelope Pince, blogging at Pecuniarities, hosts this week's Jane Austen-themed Carnival of Personal Finance. If you're a fan of the classics - literature or finances - this one's for you.

Food Pyramid Update: Good News, Java-style

Turns out that El Grande double-mocha-frappa-latte espresso may help decrease your chances of developing Alzheimer's:

"Middle-aged people who consume modest amounts of coffee can significantly lower their risk of developing Alzheimer's disease, according to a new study by Finnish and Swedish researchers released on Thursday."

Of course, we've discussed the "nuances" of Swedish scientists before, but teaming with the Finn's may have been a good idea. Those of us in that nebulous demographic called "middle aged" may benefit from a few Cups o' Joe every day, to the tune of as much as a 60% reduction in the risk of Alzheimer's.

There's no word on why coffee has such magic properties; oddly, I couldn't find a report on the study which indicated whether or not decaf obtained similar results. Miia Kivipelto, a professor at the University of Kuopio in Finland and lead researcher on the project, noted that "coffee contains strong antioxidants, which are known to counter Alzheimer's."

MVNHS© Dirty Little Secret

Proponents of nationalized health care systems often tout the benefits of gummint control, with no need for nasty, profit-driven "private insurance." After all, the thinking goes, health care is "free," and "available to all."

As we've repeatedly demonstrated here at IB, this is simply wishful thinking.

But don't just take our word for it:

"Simple and affordable health cover with added peace of mind...Access healthcare when you need it not when you can afford it."

Well, that looks like pretty much every health insurance ad we've seen around here.

Except for one thing:

"New Enquiries: 0800 072 6712"

That, dear readers, is a British phone number. That's right, the "dirty little secret" is that, despite the hoopla, Brits still need that evil insurance. In fact, there are a number of different plan options available, all reasonably priced.

Well, they're in Euros, so who knows, really?

According to Jennie Burraway, Digital Strategy Consultant for HSA Healthplans, the company is looking to expand its marketing efforts, presumably to all those Brits currently enjoying their free health care.

The company even touts its own long history of "helping individuals, families and organisations access affordable healthcare since 1922, a history that pre-dates the NHS."

Hmm.

The truth is, even the Much Vaunted NHS has numerous holes which need to be addressed, and it appears that Brits actually pay for their health insurance twice: through expensive taxes and additional premiums.

Blimey!

Cavalcade of Risk #69 is online

Debbie Dragon hosts an outstanding Cavalcade, the first of the new year. Head on over and check it out!

And please consider hosting your own Cav, just drop us a line.

CDHP Wins Another Round

Consumer Driven Health Plans (e.g. HSA's, etc) continue to help solve one of the underlying, persistent problems facing health care delivery: cost.

As we continue to demonstrate here at IB, health care costs drive health insurance costs. That is, increases in the cost of care directly affect the cost of financing (insuring) that care.

One proven method for reining in that trend is through health plans that empower and involve the consumer. Recently, UnitedHealthcare underwrote another major study of Consumer Driven Plans, and how they have affected costs. They studied their own claims experience for the past 5 years, and found that these plans "consistently delivered lower cost than PPO plans in four of the five years, even after adjusting for differences in health status, demographics and other influencing factors. Importantly, the bulk of the savings are attributable to changes in health utilization, not cost shifting to the employee."

That last part is key: one of the major arguments against consumer-centric plans has been a (false) perception that they come at the expense of the insured. Turns out, not surprisingly, that that's not the case.

The study comprised over 400,000 insureds, which seems like a pretty decent sample size. Folks (and fellow wonks) who'd like more details can access the results by clicking here.