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Washington’s Inaccurate Way with Words

December 11, 2014
4:19 pm

In assembling the so-called “CRomnibus” legislation that will set federal government spending levels until September 2015, U.S. House of Representatives appropriators have included language in the measure that would significantly affect a provision in the Affordable Care Act intended to maintain health insurance stability and affordability.

Some lawmakers want to curb funding for the aspect of the ACA known as risk corridors, saying it represents a taxpayer “bailout” for health insurers.

One would have to do some historical digging to see if the word “bailout” has ever been used quite so incorrectly. In no way whatsoever are the risk corridor provisions being attacked in the “CRomnibus” a handout to health insurance companies. Rather, they are valuable protections for coverage-purchasing consumers.

Here’s why risk corridors are so necessary. For the health insurance industry, the implementation of the Affordable Care Act was essentially a leap into the great unknown. With the new law barring medical underwriting – basing insurance premiums, in part, on a consumer’s health status – health insurers simply did not know whether the population enrolling in plans through the ACA coverage exchanges would be less healthy and prone to using more, and more expensive, healthcare services.

Risk corridors are simply temporary (they run through 2016) protections against significant unforeseen financial losses until the ACA marketplace can be better defined and understood. Without these protections, consumers face the danger of rapidly escalating costs. Risk corridors bring stability to a new, uncharted health insurance environment.

Oh, by the way, this tool has been used quite effectively in the Medicare Part D prescription drug program – without a whisper of political controversy.

Conservative analyst Yevgeniy Feyman described the importance of risk corridors well in a Forbes column, noting that “Risk adjustment mechanisms get you the buy-in of insurers, but they also help keep premiums at manageable levels while insurers develop enough experience to properly price plans on their own. This helps encourage people to enroll in these plans, which in turn helps insurers develop the necessary pricing experience – resulting in a virtuous cycle.”

It should also be noted that the lawmakers and political advocates who want to take an ax to the risk corridors are doing so after health insurers have already set premium rates for 2015. They want to, in essence, change the rules in the middle of the game.

The losers, though, wouldn’t be the health insurance companies or the Obama administration. Rather, consumers would be taking a direct hit to their checking accounts.

And if this ill-conceived action takes effect and millions of American households suffer financially for it, who exactly is going to bail them out?

Policymaking That Releases the Brake on Innovation

December 05, 2014
1:27 pm

I want to bring to your attention an op-ed piece that appeared on the Government Health IT website this week because it goes right to the heart of the issues affecting the technological innovation that will shape healthcare’s future.

The commentary by McKesson Chairman and CEO John Hammergren (McKesson is a Healthcare Leadership Council member) and Tejal Gandhi, president and CEO of the National Patient Safety Foundation makes two important points.  First, interoperability – the ability of information systems to “talk” to each other – is commonplace in consumer electrics, but woefully lagging in the healthcare world.  Enabling interoperability is critical in unleashing the power of data to improve healthcare quality, cost-effectiveness and research.

Hammergren and Gandhi make another important, and often overlooked, point about policymaking.  For all we read and hear about partisan strife in Washington, D.C., there has actually been an admirable level of bipartisanship on issues affecting healthcare innovation and technological advancement.  In the coming months, it’s critical that we build upon that bipartisanship to, as the authors put it, “achieve, rather than impede, the potential that health IT has to improve patient care and enhance clinical safety.”

I encourage you to take the time to read the Hammergren-Gandhi perspectives on issues so critical to the next generation of healthcare delivery:

Commentary: The key to patient safety? Innovation

There are few areas of modern life that technology hasn’t altered. From our smartphones to our DVRs to the GPS in our cars, technology has changed the way that we shop, read, watch movies and television, drive … the lineup goes on. What’s missing from this list? Healthcare.

While there have been pockets of innovation, the healthcare consumer has not benefitted from the rapid advancement of technology that has touched nearly every part of American life.

The promise of what technology innovation can bring to patient care and outcomes is high — but two major challenges stand in our way. First, we have dated government rules in place that are slowing innovation. Second, even if the pace of healthcare innovation matched that of, say, consumer electronics, it wouldn’t matter because we don’t have interoperability — that is, a system in place to safely and seamlessly share patient information between providers, payers and other healthcare stakeholders. Just imagine the public’s response if the smartest smartphone couldn’t place calls to a similar smartphone on a different wireless carrier.

What is it going to take to bring about the changes that are needed? The answer is cooperation across party and competitive lines in both the public and private sector, as well as cooperative work between industry stakeholders to develop standards and best practices for patient safety and health information technology (IT).

We need to start by updating the current health IT regulations. Health IT operates under a regulatory framework that was crafted nearly 40 years ago. Think about it: We’re working with regulations written when people had 8-track tape players in their cars. It’s time we update the rules to create predictability for everyone involved and to support the innovation in healthcare that patients deserve.

The good news is that there is bipartisan support and momentum to update health IT regulations. While the conventional wisdom these days suggests that our nation’s capital has become dysfunctional and unable to work across party lines for the greater good, we have seen real bi-partisanship at work on the issue of health IT, with key members of both parties working together to bring health IT regulation into the 21st century. These elected leaders, along with hundreds of organizations across the industry, are working to create a framework that will achieve, rather than impede, the potential that health IT has to improve patient care and enhance clinical safety.

Just as members of Congress are reaching across the aisle on the issue of health IT regulation, competitors in the private sector need to join together to achieve interoperability. Creating such a system will improve the patient experience, care delivery system efficiencies and, most importantly, the quality and safety of care.

There is also real momentum in the private sector to advance the interoperability of our healthcare system. Through the not-for-profit CommonWell Health Alliance, competitive businesses are deploying a universal system nationally to allow for the seamless access of patient-centered data across all settings of care. Through both government efforts and this Alliance and its member companies, healthcare interoperability is becoming a reality and, when realized, will significantly transform the future of the industry.

Leading industry stakeholders are working with well-respected organizations like the National Patient Safety Foundation and the ECRI Institute’s Partnership for Health IT Patient Safety to develop tools to achieve patient safety through health IT, but more must be done. Developers, implementers and end-users need to work cooperatively to ensure that patient safety is always a priority when creating and deploying any healthcare technology solution, as well as assuring usability for clinicians. By working together, we can optimize the safety benefits and mitigate any new risks that technology may bring.

We cannot deny that there is a need for increased innovation in health technology. The benefits of technological advancements are numerous, from improving patient safety to providing consumers with more tools to manage their own healthcare. At this moment in time, public and private leaders have a unique opportunity to demonstrate their ability to work cooperatively to modernize health IT regulation and achieve real interoperability — with the goal of improving patient safety and outcomes.

When that happens, we’ll begin to see exciting innovation that will fundamentally change and improve patient care.