Archive for March, 2011

Health Care Networks Allowed To Form Under White House Rules

March 31st, 2011

Under the new Obama administration, hospitals and doctors will be able to form networks with the aim to reduce health care costs for consumers.  The US Department of Health and Human Services issued new rules today for the important accountable care organizations that will be formed during the ongoing health care reform overhaul.  The program may save the US government over $960 million over a three year period. 

The program wants doctors, hospitals and medical providers to collaborate on better care for patients and also reduce costs through efficiency.  The incentive for the government is that they will share in the cost savings along side with the medical care providers.  This will also inevitably lead to lower health insurance premiums for consumers.  The program wants independent hospitals and doctors to act more like integrated health systems.  This will make their practice more efficient, similar to groups like the Mayo Clinic or the Cleveland Clinic. 

The government will create new laws and regulations to allow doctors and hospitals to share confidential information.  A key requirement in the new program that the government wants to implement.  Read more about the changing medical environment here.

Smart Food For Heart Health

March 30th, 2011

A new study showed that walnuts provide strong cardiac health benefits by containing healthy antioxidants the body needs.  In fact, walnuts rank above peanuts, almonds, pecans and pistachios according to Dr. Joe Vinson.  A handful of walnuts has twice as much antioxidants than any other nut. In addition to antioxidants, walnuts have many other healthy nutritional benefits.  Walnuts contain a healthy dose of protein, vitamins, minerals, and dietary fiber.  All these essential elements add up to a very healthy snack.

Medical experts urge people to include walnuts in their everyday diet.  According to the Mayo Clinic, people who eat nuts on a daily basis can lower their LDL, or “bad” cholesterol levels.  High LDL levels is one of the leading causes of heart disease so anything to lower this is very important.  Additionally, Mayo Clinic experts stated that eating nuts on a regular basis may also decrease the likelihood of developing blood clots. 

As for calories and possible weight gain from eating nuts, doctors agree that eating nuts does not appear to cause weight gain.  In fact, people who eat nuts will feel more full and are less likely to overeat.  Vinson said about 7 walnuts a day is the right amount.  Small improvements in your diet, like eating walnuts, can help you live a healthier life.

The Real Cost Of Health Care

March 29th, 2011

Their is no debate that as the reform continues to be implemented throughout the US, their are still a fair amount of people that are opposed to the new legislation.  The big challenge and risk that the opponents of reform are still asking to see from the administration is the true total cost of the new law.  Figures have been tossed around but they continue to change as the health care landscape inevitably changes everyday.  To state the obvious, health care and health insurance takes up a big portion of the average consumers’ disposable income.  And, it’s not getting any cheaper.  Currently, consumers spend 19.9% of their discretionary income on health care expenses.  That is a staggering figure to say the least.  To put it into perspective, it surpassed housing and utilities which is at 18.8%.

These statistics are significant even beyond health care.  The overall economy suffers as a result when consumers have less to spend in the market.  The average household does not have much discretionary income left after they pay down medical bills and insurance premiums.  Moreover, unemployment is still at all time highs and people are forced to get insurance from the private market.  Historically, cheaper company sponsored health insurance plans made it easier to afford health insurance, but the job market is still not showing significant signs of improvement and consumers will continue to pay the price. 

Both the health care and financial industries are at major regulatory and structural turning points.  Their is a lot of uncertainty both out in the marketplace and in the household.  By 2014, everyone will be regulated to have health insurance.  Consumers are hoping that rising health care costs will turn for the better, soon.

Health Care Innovation Is Needed

March 28th, 2011

With the passage of the health care legislation last year, more than 32 million people are expected to enter the health care system.  This is obviously a big challenge for the health care system and the government to undertake.  Their are already rising costs that people are not sure if the new law will even help curtail.  The government has to find some innovative ways to help keep the system functioning well, keep costs low and still maintain high quality care. 

It is not just on the government hands alone.  Physicians, insurers, medical clinics, and hospitals also have to step up very big.  Deliver of health care will be even more important with all these new members expected to join.  Another big concern is the highly fragmented industry.  The health care industry has historically been resistant to change and also has been rewarded for quantity as opposed to quality.  This has to change.  With a complex health insurance exchange on the way that claims to streamline and promote costs savings, the government will have their hands full delivering on that promise. 

Their are initiatives though to see that change is accepted and innovation promoted.   For example, the government created the Center for Medicare and Medicaid Innovation to help streamline this change and also think of new ways to improve the system.  With baby boomers demanding more health care, this initiative will be more important than ever.

Drug Is Seen To Limit Progression To Diabetes

March 25th, 2011

A new study has shown that people at high risk of developing diabetes can slow down the progression by taking the drug pioglitazone.  Their is some debate whether the risks outweigh the benefits but it has drawn up enough attention to conduct further testing in the US.  Pioglitazone, belongs to the same class as rosiglitazone, which was pulled out of the market in Europe because it was found to increase the risk of heart attack. 

Pioglitazone appears to be safer than rosiglitazone though, but the FDA is still researching the other potential risks of the drug.  A study done by researchers at the University of Texas tracked higher risk patients over a two year period.  Those who took pioglitazone showed a significantly less chance of developing diabetes than those who were given the placebo.  In fact, those who took the placebo showed a 7.2% incidence rate while those who took the drug were much lower, at 2.1% incidence. 

Their were some drawbacks that were observed.  For instance, some of the patients that took the drug showed weight gain and increased fluid retention.  It was not clear whether this was a direct result of the drug or simply lowered elevated blood sugar.  Another challenge, the FDA has never approved a drug that claims to prevent diabetes.  It will be an interesting but challenging road ahead for researchers of this drug.

Most Obese Moms, Kids Underestimate Their Weight

March 24th, 2011

About two-thirds of all adults in the US are considered obese.  That is a very high number.  For kids it is not much better with the number being about one-third obesity in the US.  Their are a couple of factors here to consider that should be noted.  One, our definition of obesity has not always been consistent over the years as the environment and social pressures have evolved.  And two, everyday distractions such as video game consoles, TV, etc., make it increasingly difficult to get people outside to exercise.  None of these factors, however, should be used as an excuse by parents in their own households. 

As obesity has become more common, so has the perception of what is normal as far as weight gain.  People are less likely to feel the need to shed the extra pounds because everyone around them is the same.  A study done in Atlanta by Columbia University researchers reported that mothers and children tend to underestimate their own weight and each other’s weight.  According to Nicole E. Dumas, M.D., the leader of the research team, says their misperception of the weight has a lot to do with the fact that obesity unfortunately is becoming the norm.  This is also why health insurance premiums have continued to increase as well.  Unhealthy behaviors drives more demand for prescription drugs, hospital visits, etc., and that inevitably drives up health insurance costs for families.   

Their is no real overnight solution to this growing problem.  However, it all does start in the household.  Parents have to take ownership of what types of foods they bring home from the grocery store, the emphasis of physical activity, and the overall message of a consistent healthy lifestyle.

Future Of Health Care Reform Is Uncertain

March 23rd, 2011

More than half of the health care reform law has already been implemented within its one year of existence.  Although its roll out has been fast and streamlined so far, it hasn’t been without its fair share of opposition.  Many House Republicans have campaigned for months trying to get this law repealed.  The argument for many Republicans is that the law is unconstitutional and unsustainable in the long run.  In January, 2011,the House passed a bill repealing the health care law.  However, the Senate which is majority Democratic, will not pass this health care repeal. 

Their is also another debate and problem with the new health care reform law – the public acceptance and more importantly, their perception of its purpose.  Most people that are opposed to the law do not want government intervention.  Additionally, many people are still skeptical and confused by the many details of this legislation.  In March, Kaiser Family Foundation conducted a poll and only 30% of those surveyed supported an expansion of the new health care law. 

Chances of the law being fully repealed are very slim.  But that is not to say that House Republicans will not stop fighting to get their way.  The major challenge moving forward into 2014 is the mandatory health insurance exchanges.  Will they be successful and can the government really manage the complexities and demand of the “private” health insurance market?  We will have to wait and see.

WellPoint Anthem To Cut, Delay California Rate Increase

March 22nd, 2011

WellPoint’s Anthem Blue Cross of California has agreed to delay and reduce its 2011 rate increases for individual and family plans.  This decision will save customers an estimated $40 million according to the state commissioner.  Anthem Blue Cross is the largest carrier in California, and they are projected to lose money this year.  Last year in 2010, they lost more than $110 million.  Anthem said the delay will be go from the originally planned April 1st increase to now being on June 1st.   

The delay in the rate increase will benefit about 600,000 policy holders.  That is a lot of people.  California Insurance Commissioner Dave Jones has asked many top insurers to delay increases.  Carriers such as Aetna and UnitedHealth are expected to follow the path of Blue Shield and Anthem Blue Cross.  Additionally, the commissioner has asked lawmakers to give his office the authority to control excessive heath insurance premium increases.

Anthem Blue Cross also announced that an estimated 80,000 Californians are exprected to get a rate decrease this year.  This, atleast, is some good news for consumers because unemployment still remains very high and people are forced to buy insurance from the private market; as opposed to the more affordable company sponsored plans.

Enrollment In Medicaid To Outpace Primary Care Doctors

March 21st, 2011

The health care reform will bring many changes both now and in the future.  According to a new study conducted by the Center for Studying Health System Change, Medicaid enrollment might outpace the primary care doctors available to treat them.  Starting in 2014, Medicaid eligibility will be expanded.  Under the new law, Medicaid will include all US residents whose annual incomes are less than 133% of the federal poverty limit, which is $29,327 for a family of four.

Additionally, health care providers’ Medicaid payment rates will be increased to 100% of Medicare rates by 2013.  This will inevitably raise the amount of enrollments in Medicaid.  The new law will try to encourage providers to accepts Medicaid patients and by 2014 the US government hopes that most providers will on board with their new initiatives.   

The study was conducted by analyzing survey responses of more than 4,700 physicians.

Health Reform Overhaul Necessary

March 18th, 2011

Our health care system is in desperate need of a meaningful overhaul.  Costs for the insured continue to rise year-over-year making it increasingly difficult to maintain health insurance plans within households.  The health care industry is one of the largest when it comes to GDP, comprising of 17% of the US economy.  That is a big percentage.  As these costs for getting health care continue to rise, providing care to the uninsured is becoming even more costly. 

The new health care law that passed over a year ago is going to increase the government’s role in providing health care to US citizens.  We all hope that this will add fresh competition to the marketplace and drive down premiums for consumers.  However, some experts say that the exact opposite will happen and their is already evidence of it now as premiums continue to rise out of control. 

The new health care reform law is estimated to have an overall cost of $2 trillion when it is all said and done.  Wow, who is going to pay for all that?  Many generations of people, unfortunately, is the answer.  This large amount of money will only add to the large deficit we are already in as a nation. 

Surprisingly, the employer mandate which should be rolling out in a few years, will have a negative effect on employees.  According to the National Federation of Independent Businesses (NFIB), the employer mandate could lead to the elimination of over 1.6 million jobs – mostly coming from small businesses.

Concierge Medicine Growing In L.A., Orange Counties

March 17th, 2011

Concierge medicine is a system or program in which patients pay an annual fee to keep the physician on a retainer.  This sometimes benefits both the patient and the doctor.  Why, it’s because patients are more likely to pay when they are contracted to a payment system and doctors benefit from the steady cash flow.  Additionally, it might be a cheaper alternative for the consumer than having health insurance.  That being said, only a small portion of Californians can afford concierge medicine or boutique medicine, or even health insurance for that matter.  However, this type of practice is growing rapidly in the United States, especially in California.  One doctor wrote:

“When I converted my practice in 2005, there might have been 500 of us across the country, and now there are maybe 10,000,” said Thomas LaGrelius, a Torrance-based specialist in family and geriatric medicine. 

One particular insurance provider, AARP, has many different options for patients to manage their health care expenses.  Some for example, concierge, direct, and fee-for-service all help them maintain a strong relationship with their members.  The direct financial relationship helps streamline paperwork and also reduces payroll overhead for the carrier.

Important to note, concierge medicine does not replace health insurance but is only another option for the consumer to manage the rising cost of health care.  Read more about concierge medicine here.

Blue Shield of California Withdraws Individual Market Rate Increase

March 16th, 2011

According to Bruce Bodaken, BSC chairman and CEO, Blue Shield of California (BSC) has withdrawn its rate filing with the California Department of Insurance and the company will not increase rates to any individual or family plan member for the remainder of the year.  Blue Shield of California has over 340,000 individual and family plan members in California.

“Our not-for-profit mission is to provide Californians with access to quality health care at an affordable price,” said Bodaken. “As long-time advocates for universal health care coverage, we are also deeply committed to the success of health reform.  The best way to fulfill our mission and make reform work is to keep costs down. By agreeing not to raise rates this year, we are helping to make coverage more affordable for our members during tough economic times. It’s a financial risk for us, but a risk that’s worth taking.”

This is a powerful statement by one of the leading health insurance carriers in California.  Given these tough economic times, we need more carriers to step up and take the lead in health insurance cost control measures.  This decision will save members a lot of money.  It is estimated that the savings will be between $35-40 million this year.  This will help tremendously as consumers are struggling to pay and manage everyday expenses in their household.  With unemployment still at all time highs, we can only hope more carriers will take this same action as Blue Shield of California. 

Read more about Blue Shield of California’s commitment to the health care reform. 

Obama Cost-Cut Plan To Aid The Sickest

March 15th, 2011

State Medicaid budgets are experiencing large shortfalls and this is primarily due to the sickest within the Medicaid pool.  Over half of all Medicaid costs come from only 5% of the enrollees.  Why is this?  Well, many of the enrollees that cover that 5% are dual-covered; by both Medicaid and Medicare.  These are people that are elderly and/or disabled usually.  According to Kaiser Family Foundation, 66% of the dual eligibles have three or more chronic conditions.  Moreover, 61% are mentally or cognitively impaired and 22% require assistance with two or more daily tasks, such as getting dressed or bathing. 

The issue for the dual eligibles is that the two programs (Medicare and Medicaid) do not work well together.  Medicare is a federally funded program primarily targeted for seniors and young disabled, and Medicaid, is targeted more towards low-income families. 

The Golden State Reaches 21% Uninsured

March 14th, 2011

Looking back over the last three years, California has the sixth highest uninsured rate (as a percentage of the population) in the US.  When looking at the amount of individuals uninsured, California has the most uninsured in the United States.  The three year national average for the uninsured has climbed to 17.8%, or 46 million people.  In California, this number is now 21%, or 6.8 million people.  Their are many reasons for this dramatic increase – one, unemployment remains very high and people lose their employer provided group health insurance plan, and two, the price of health insurance for many families is still too much.

Not surprisingly, the segment with the highest uninsured rates are the lower income families.  For households that are making less than $25,000 a year, the percentage of uninsured is 37%.  For those families making above $75,000 per year, for instance, the number drops to 10%. 

The biggest change is who is paying for the health insurance premiums.  As employers tighten their payroll and continue to layoff employees, consumers are forced to go out into the private market and find an affordable insurance plan.

Drug Prices Outstrip Other Medical Costs

March 11th, 2011

Over the last four years, prices for prescriptions drugs have rose at a faster rate than costs for other medical goods and services.  Drugs (55% brand name and 45% generic) rose at an annual average of 6.6%, compared with 3.8% for medical goods and services.  Moreover, prices for brand name drugs rose the fastest, at 8.3% annually. 

This points out how drug dependent our society has become.  Stress in the workplace, unhealthy behaviors, and everyday lifestyle choices lead consumers to let the prescription drugs do the work for them.  Where will this all stop and what does the future hold as far as healthcare cost control and insurance?  No one really knows.    

“This report reminds us that this is an area where we should be looking for savings for taxpayers and beneficiaries,” Democratic Rep. Pete Stark, a ranking member of the House Ways and Means Subcommittee on Health.