Challenges in Serving the Newly Insured

April 27, 2010
1:06 pm

An interesting, and troubling, piece ran recently in the Wall Street Journal.  The article highlighted one of the major shortcomings of the newly enacted health reform law.  This article, “Medical Schools Can’t Keep Up,” said covering 32 million more people who haven’t had health insurance outpaces the capacity of the number of doctors we have to attend the new total number of patients.  As well, the medical education system won’t be able to produce enough new doctors to meet the demand.

Estimates predict a deficit of doctors potentially reaching a 150,000 gap by 2025.  The United States currently has 954,000 physicians.  The area in which doctors are needed is in primary care.  Yet, that’s the practice fewer medical students have been selecting.  Medical training programs have begun to push primary care, but the supply pipeline is definitely behind the curve.  The new health law only adds to that problem.

Plus, everyone must train in a medical residency program in order to lawfully practice medicine.  But residency slots are limited, and the law’s cuts to Medicare, which pays for medical training programs, don’t help.

Unfortunately, all Americans will feel the effects of this physician shortfall.  The Journal reported:  “A shortage of primary-care and other physicians could mean more-limited access to health care and longer wait times for patients.”

The Wall Street Journal article reminds us that healthcare coverage doesn’t necessarily equal healthcare access and that more work remains to be done to fulfill the vision of healthcare reform.

HHS’s Full Plate

April 24, 2010
8:13 am

For anyone interested in the responsibilities bestowed upon the Department of Health and Human Services in the recently-passed health reform legislation, here they are in one handy 35 page, 7,600-plus word document.

A Sobering Report From The CMS Actuary

April 23, 2010
11:36 am

Rick Foster, the chief actuary for the Centers for Medicare and Medicaid Services, has issued his findings regarding the health reform legislation passed by Congress last month.  The main headline will be that, contrary to the Congressional Budget Office report that this bill will reduce the federal deficit, Foster says the new reform law will result in $828 billion in new spending over the next decade but only $577 billion in savings.

But that’s not the part that caught my immediate attention.

Foster raises two points that should be of critical concern as Congress contemplates its next steps on health policy.

First, he projects that it will be difficult for the healthcare system to meet the increased demand for services and that this, according to today’s The Hill newspaper, “could lead to price increases, cost shifting, and/or changes in providers’ willingness to treat patients with low-reimbursement health coverage.”  The latter eventuality is particularly important with the new health reform law sending 15 million Americans into low-reimbursement Medicaid coverage.

Then Foster states that many employers may be motivated, under the new law, to stop providing health insurance coverage for their employees.  The Hill article states, “For example, some smaller employers would be inclined to terminate their existing coverage, and companies with low average salaries might find it to their – and their employees’ – advantage to end their plans.”  Should those employers cease providing coverage, employees would then either go into the expanded Medicaid program or find insurance through the new health exchanges.

I would find it hard to believe that it was the intent of many of the lawmakers who voted for this bill to undermine the current employer-based coverage system.  Yet, according to the CMS actuary, that could be the end result.

We know the next Congress will be looking at changes to the health reform legislation passed by this one.  Mr. Foster has provided at least a couple of issues that should be high on the agenda for review.

Demonstrating Outreach in Delaware

April 20, 2010
9:00 am

I’m in Wilmington, Delaware today for a ceremony honoring three organizations that have made a tremendous difference helping uninsured Delawareans find affordable, accessible health insurance.

Before I tell you more about this event, though, let me flash back a couple of years.  The Healthcare Leadership Council had been conducting an experiment in 10 cities across the country.  It was called Health Access America and it was designed to test the validity of a premise, that it’s possible to reduce the number of uninsured Americans by investing resources in outreach.  Could linking people with reliable information about health coverage actually result in them acquiring a private insurance plan or enrolling in a public program?

Data says it could.  Studies we commissioned showed that half of the uninsured people in this country don’t know where to turn for information on available plans and prices, and we know from talking to small businesses that they have neither human resource departments nor the time to effectively comparison shop for health insurance.

Having experienced success with our outreach approach in 10 cities, we had a conversation with one of our HLC members, AstraZeneca, about the uninsured problem in Delaware.  AstraZeneca was committed to addressing the problem in the state where their headquarters is located and we agreed that it was an ideal launching pad for another outreach project.

The Delaware version of Health Access America has taken place over a two-year period and involved the hard work of over 100 organizations who served as partners in this effort.  In that time, these groups organized 176 events to provide people with information about health insurance and over 1100 people, a solid number given the economic downturns during this period, touched by these events now have some form of public or private coverage.

So, today, I was joined by AstraZeneca officials and Delaware lieutenant governor Matt Denn, a strong supporter of the project, to honor three organizations that showed tremendous leadership in helping their fellow citizens gain health coverage.  To the United Way of Delaware, the Central Delaware Chamber of Commerce and the Delaware Healthy Children Program, it was a privilege to recognize your success today.

Pictured below (left to right):  Rita Landgraf, Secretary, Delaware Department of Health and Social Services; Lt. Gov. Matt Denn; Michelle Taylor, Delaware United Way; Mary R. Grealy, Healthcare Leadership Council; and Bob Perkins, AstraZeneca.


A New Initiative in the War Against Diabetes

April 16, 2010
5:14 am

One of our nation’s greatest health threats is diabetes.  Over 25 million Americans have it, and another 57 million of us, or one of every four American adults, have pre-diabetic conditions.  If not diagnosed early and treated properly, diabetes can lead to kidney failure, heart disease and a host of other potentially lethal conditions.

And, besides the societal costs, we already know that 70 cents of every healthcare dollar Is spent on the treatment of chronic disease, diabetes being one of the leading cost drivers.

That’s why I’m so encouraged by the initiative being undertaken by the Walgreens’ pharmacies.  Walgreens is working with the insurer United Health and the YMCA.  The Diabetes Control Program will involve trained pharmacists working face-to-face with patients in their local pharmacies, providing personalized coaching and counseling to people with Type 2 diabetes.  These pharmacists will offer advice on how to manage the condition and help ensure that patients are following their physicians’ treatment plans. 

More information about the program can be found here.

I’ve often said that all the public policy in the world can’t do as much to improve public health as intervening person-to-person in the doctor’s office, the clinic or the local drugstore.  Kudos to Wallgreen’s for making a difference on one of the nation’s most pressing health challenges.