Physician Patient

Archive for September, 2014

Consumers need to ask how much their health care costs and where the money is going

Sunday, September 28th, 2014

How much does my medical care cost? This question usually goes unanswered today in the Minnesota health care system. Unless a doctor is a Direct Pay physician and posts his or her fees, most doctors don’t know. Certainly the insurance company doesn’t know what your care will cost until after care is provided to you or your family and “adjustments” are made to the clinic or hospital bill regarding how much they will actually pay. The pharmacist runs the insurance card to see what of your doctor’s prescription is covered and what your co-pay will be. And, if you pay cash at the pharmacy (or clinic), the price actually goes up! What’s this about?

David Goldhill says that the consumer is the only player in our health care system who can ultimately change these realities (StarTribune, September 25, 2014 But, sadly Minnesota consumers are largely insulated from the prices of their health care.

As consumers evaluate their 2015 Minnesota health plan policy rates and shop for health insurance during Open Season this November (hopefully rates will be available very soon from MNsure), They will compare monthly health care insurance policy costs and what they will pay out of pocket before the “insurance” kicks in.
Here are pertinent questions consumers should consider before choosing a health care insurance policy or doctor or clinic:

Quality: Who are the doctors, clinics, and hospitals under contract in the health plan’s provider network? I want to have ready access to their credentials and the clinical experience of available doctors and other professionals who have treated cases similar to mine, especially if I am sick and/or have known diseases or problems.
Choice: Does my health insurance or clinic provide useful tools to help me find a doctor whose training and clinical care experience is best suited to my case or needs? What tools are there (online or by phone) for me to be personally evaluate and if necessary decide how and when to change doctors or clinics? If I have a health care savings account (HSA), do I need to go exclusively to care providers under contract with the insurance company in order to satisfy the insurance deductible (is the plan compatible with my HSA)?
Access: When I want to get a timely appointment with a well trained, credentialed physician or health care professional, does my policy offer a wide range of accessible care venues — such as store front clinics, Urgent Care, and ongoing specialty care? Can I find a trusting doctor-patient relationship?

Cost: How much will I pay to see the doctor, for lab tests, imaging and procedures? Are these prices available online through the clinic website? Can I find out online exactly what the insurance will pay a doctor or clinic for recommended procedures, lab tests or imaging? Can I shop for these? How much will I pay out-of pocket? Is the insurance policy compatible with using my HSA to pay for retail medical services while also satisfying the insurance deductible — what rules apply?

Provider bonuses and pay-for performance incentives: Do clinics or doctors in the insurance plan’s provider network receive increased pay for prescribing or not prescribing specified drugs or treatments or ordering or not ordering certain lab tests or imaging? If I want to know the financial incentives and arrangements for my “providers” who I am paying directly or indirectly, can I find out?

As David Goldhill advises, “Let’s reduce the role of the big intermediaries who have allowed our system to become so expensive and opaque, and increase [the power] of the one force that can drive good behavior — the consumer.”

When a mighty mouse consumer knows how much her medical care really costs — that is, who is getting paid, how much, and for what — she may well become the mouse that roars!

Election 2014 and The Future of Consumer-directed Health Care Financing

Monday, September 1st, 2014

In an excellent overview (see the 5/9/2014 YouTube video at ), Peter Nelson, JD, Public Policy Director of the Center of the American Experiment (CAE) and MPPA Board Member explains how Obamacare presents opportunities and challenges for consumer-directed health care — through expansions of high deductible insurance products and wider use of individual self-insured insurance policies.

Minnesota’s dominant health insurers are marketing directly to individual consumers (see Jackie Crosby’s StarTribune article below). But what is for sale here? Are information on cost and access to physicians and clinics avalilable from Blue Cross and other Minnesota insurers?

Consumer-directed financing is key to competition and cost-effectiveness. MPPA knows there are a growing number of Minnesota Direct Pay medical practices which bypass health insurance rulers and restrictions (although many provide procedural codes for medical care so that patients can be paid directly for provided medical services by there insurance). Since Direct Pay practices market directly to consumers, they post their fees (payment transparency) and offer (better) patient-centered access to physicians and care teams. Patients therefore have choices and control with Direct Pay. See, for example,

So how will citizens and policymakers in Minnesota guage evidence of competition during the 2014 election season? And do they think this is important? Mppa thinks Minnesota needs a working medical markelplace. Patients and their families need power to hire (and fire) doctors and/or choose (or cancel) health care insurance based on cost and value to them. Unless there is real price and benefits transparency, this is not possible. MPPA thinks Medicaid enrollees as well should have choices and control over where (taxpayer) money goes for their care. Patients and their families are best able to select physicians and clinics which respect their culture and preferences. Since Minnesota Medicaid enrollees are arbitrarily assigned to an HMO now, they do not have choice of doctor, treatments, or their insurance coverage.

What is the future of MNsure? MPPA wants potential customers of our MN government insurance exchange to know the costs of 2015 Obamacare insurance policies soon.
Also, we encourage viable private sector alternatives to ACA run or ACA compliant (Mnsure) government insurance exchanges.

We are with Obamacare creating a two-tiered health care payment system in Minnesota.

Polish your crystal balls, send me your comments, and I’ll circulate them with your permission.

Blue Cross and Blue Shield of Minnesota to open a retail store in Edina
Article by: JACKIE CROSBY , Star Tribune Updated: August 29, 2014 – 12:21 AM
The state’s largest insurance company will deal directly with consumers in an Edina store.

1 comments resize text print buy reprintsShare12 Cross and Blue Shield of Minnesota will open a retail store in Edina, the first insurer in the state to make a direct play to consumers as health care becomes ever more competitive.

The store is scheduled to open this fall at Yorkdale Shoppes, a busy retail node near Southdale Center and Cub Foods, in space once occupied by specialty retailer Christopher & Banks. It will serve consumers shopping for individual plans and seniors eligible for Medicare.

Eagan-based Blue Cross is the state’s largest, nonprofit organization and the largest insurance company. The $9.3 billion organization is a dominant player outside of the Twin Cities area, and traditionally has relied on an active network of brokers to reach individual consumers.

But changes in health care are putting more choice in the hands of the consumers, and insurers are marketing directly to them to try to win their business.

“Everybody in health care wants to reach the masses, and retail is one way to do that,” said Tom Charland, CEO of Merchant Medicine, which tracks retailing trends in health care, particularly walk-in medical clinics.

No date has been set to open the doors, but Blue Cross officials said the store will be ready for the upcoming open enrollment period, which begins Nov. 15. More stores could follow in the coming years.

The 3,500 square-foot space will be also used for informational sessions and wellness activities, such as yoga, light fitness and healthy cooking classes.

Retail storefronts aren’t new to insurers. Nationwide, Blue Cross and Blue Shield operates about 50 retail stores in nine states. Michael Guyette, CEO of Blue Cross and Blue Shield of Minnesota since January 2013, was instrumental in opening the first of those stores, for Florida Blue, in 2006.

Minnetonka-based UnitedHealthcare, the nation’s largest insurance company, has long had a storefront presence and in recent years has opened temporary stores and kiosks in shopping malls around the country during the busy holiday season to sign up seniors for its Medicare plans.

HealthPartners also has tested a pop-up store concept at Ridgedale Center in Minnetonka.

The timing of the new venture is strategic, with the store opening just as tens of thousands of Minnesotans will be renewing policies bought under the first year of the fully implemented federal health law.

Blue Cross saw modest enrollment growth through MNsure, the state’s online insurance exchange established by the Affordable Care Act. About 23 percent of those who purchased coverage through MNsure bought a Blue Cross plan, compared with the market-leading 59 percent who went with PreferredOne.

Monica Engel, a vice president of sales at Blue Cross, said the insurer will take a “somewhat aggressive … but thoughtful” approach to opening additional retail outlets in the coming years. The stores are meant to complement, not replace, insurance agents, she said.

“Brokers are a key member of our distribution,” Engel said. “We see the store as being an extension of the services that the brokers provide to consumers today.”

But Charland said that brokers’ traditional business model is under siege, and the move is one more sign of massive changes underway in the health insurance industry.

“We see health care providers entering the insurance business, we see insurance companies entering the health care business,” he said. “And everybody’s starting to talk about ‘customers.’ The whole vocabulary is changing.”

Jackie Crosby • 612-673-7335