Physician Patient

Archive for August, 2016

Health Care Competition In Minnesota – Missing In Action

Sunday, August 21st, 2016


Blue Cross/Blue Shield of MN is exiting all but its HMO product on a floundering MNsure public insurance exchange causing anxious concern for many rural-dwelling Minnesotans dependent on BCBSM. And, large insurance conglomerates such as UnitedHealthcare, Humana and Aetna are dropping offerings on the ACA (Obamacare) insurance exchanges nationally.

What impact do these developments have on care and insurance options for patients and potential patients (consumers) in Minnesota? For the cost of their health care insurance in 2017? On competition between clinics and doctors for their loyalty? And, competition for dollars among Minnesota insurance companies?

It depends on your point of view. Obviously the only way to find a low cost, best value health care procedure or select an insurance policy is to compare prices and benefits. But that is neither the rule or the goal in Minnesota. There are incentives and (designed) barriers to real cost transparency for the purchasers of medical care and health care insurance coverage in Minnesota. The messages and warnings from our health plans and government authorities are mixed, and we are warned about the consequences of working for true price disclosure to Minnesota citizens.

Hospital costs are so amazingly complex, bundled, and difficult to tease out that it’s impossible for a potential patient (consumer) to know in advance or even retrospectively the answer to the simple but essential question “What does this cost?”

For outpatient procedures, which theoretically are easier to price and evaluate, we should be able to shop for imaging, outpatient surgical procedures, and professional relationships. We need a market for HSA-insurance linkages which encourage consumers to shop for value as they determine this to be. See

Shopping based on knowing the price of a medical procedure or visit becomes irrelevant if there are very few competitors who are available in business offering real options for consumers. We have seen a dramatic decline of independent, entrepreneurial private medical practices in Minnesota. In 2016 most Minnesota physicians are employees of hospital-clinic organizations which are governed by (secret) provider network contracts with insurance companies which actually determine the financial terms of engagement for patients.

Some policymakers and analysts call for more health care data and more analysis. First it is apparent that we need a hard-nosed cost-effectiveness analysis of our massive and expensive Minnesota all claims data base (ACDB). What value is the ACDB to consumers (patients and potential patients)? How is it used now by private and government purchasers of health care and insurance products? Who pays for, collects, and analyzes all this big data now? And what do we need to analyze?

Minnesota’s health plans do not want public price disclosure for services or insurance claiming they will lose money if there is public knowledge of the finances in contracts they write with network providers (clinics) or the insurance products they offer. They are selling pre-paid medical care and the health plans claim that public knowledge of their business dealings with government and other purchasers will result in higher health care prices. This is adverse selection they claim. People will choose the richest health plan they can get paid for with someone else’s money rather than choosing the lowest cost health plan that meet their needs for specific benefits and protections.

Our current state of affairs confirms four facts: 1. Health care insurance in Minnesota does not operate in a competitive, consumer-directed marketplace. 2. Health plans which are selling pre-paid benefits must raise their prices and/or shift costs to patients and families. 3 There is little likelihood of competition for patients between health care providers or health plans until Minnesota citizens are given incentives to make prudent health care decisions (skin in the game). 4. Minnesota is spending a lot of time, money and analytic effort collecting a lot of expensive data to keep things as they are.

Consumer Power in Minnesota Health Care: It’s Simply a Question of Political Will Since Technology is Not Holding Us Back

Tuesday, August 2nd, 2016

The Wedge of Health Freedom allows consumers to find independent practice doctors. It’s like a medical market Angie’s List. Created by the CCHF, the Wedge is endorsed by the Association of American of Physicians and Surgeons (AAPS) and us at MPPA. See

Most Minnesotans want a true health care marketplace which invites competition for their patient loyalty among all of Minnesota’s medical practices, including the independent, private practices which are listed on the Wedge, and for a needed expansion of choices for health insurance from Minnesota insurance companies. MNsure has not been working, except as a pathway for patients to enroll in Medicaid (medical assistance) or MinnesotaCare The current federal health law, the ACA or Obamacare, discourages varied offerings of insurance products except in broad categories. Premiums and deductibles are on the rise, and alarmed Minnesotans agree that “one size fits all” does not work for providing medical services, insurance coverage, or medication benefits.

The political challenge in 2016: Change government laws and regulations in Minnesota and nationally to permit and encourage accurate, transparent, Web accessible cost and service(s) information for medical care, insurance products (costs and benefits), and pharmaceuticals. In this age of smart phones and personal computers, patients and families want and must have much more control control over to whom and for what money for their health care goes. Consumer Power is the missing link to 2016 health care reform in Minnesota and in America.

This can be more than a pipe dream. As a “non-techy,” I’m learning that existing technology called application-programming interfaces (API) makes possible all kinds of data connectedness. I’m told that an application-programming interface is a set of programming instructions and standards for accessing other Web-based software applications. Obviously, APIs can be a powerful tool for getting Americans to real time consumer-directed health care.

Here is a technical expert, Xerox information chief Tamara St. Claire, who says (below) that APIs can improve communication between physicians, cut through the maze of third party insurance, state and federal government, clinic pay-for-performance (P4P) “provider” rules and requirements, and encourage (business) opportunities for IT to enable consumer-directed health with APIs. So, an age of consumer-directed health care can be a realty.

But, and this is a big but, St. Clare’s utopian vision is unrealistic given the obvious financial conflicts of interest among Minnesota (and US) insurers, providers and health care consumers. The health care industry is comprised of state and federal government funders and providers, insurance corporations, and hospital-clinic systems. All stakeholders in our medical-industrial complex whether for-profit or non-profit benefit by keeping individual health care consumers (patients and families) in the dark about their actual or anticipated health care costs. In 2016, these growing oligopolies and oligopsonies of government, big insurance and consolidated providers hide in a smoke screen of useful consumer health care data.

Patients ask, “What does this care, imaging, test, or procedure cost?” And they are told not to worry because this is a question for their insurance company or government bureaucrat. Or, perhaps even more often, the doctor or other “provider” says, “I don’t know.” Yet, as health care premiums and uncovered bills increase, patients aren’t satisfied by asking: “What does my insurance cover?,” or “What is my co-payment or deductible?” This lack of cost transparency simply isn’t working out for them: their health care is truly Priceless, as John Goodman explains. See

Back to the API:

Consider When consumers are given marketplace power, then, a company such as Amazon will gladly release its API to the public for its own business reasons so that other software developers can design products that are powered by its service to customers. Everybody wins. gladly releases its API so that Web site developers can more easily access Amazon’s product information. Then, using the Amazon API, a third party Web site can post direct links to Amazon products with updated prices and an option to “buy now.” (I really like the convenience and efficiency of the Amazon site. Don’t you? BTW: Amazon is actually now profitable!). Imagine quantum leap advantages to patient choices and access to care when patients directly control where a good portion of their health care money goes — this is patient market power “skin in the game.”

However, for Ms. St. Clare’s ideas to become a reality, the Minnesota consumer must have the power to choose and pay directly for her health care services and insurance coverage. That means we should push for government actions which allow money in her pocket and/or credits on her health care spending account (based her employment, income or special needs). Except for paying direct pay (cash) practices such as those on the Wedge, today’s Minnesota health care consumers (patients and families) have little power in the health care marketplace.

Tell Minnesota senators and representatives that you want consumer-directed health care reform in Minnesota. Our politicians will be knocking on your door this election season, and they are listening!