Physician Patient

Archive for June, 2018

Minnesotans to lose Medicare Choices in 2019

Sunday, June 24th, 2018

Re: http://www.startribune.com/big-medicare-shift-coming-to-minnesota/486297431/

The advice to “Stay calm, and check your mail” from Minnesota Council of Health plans CEO Jim Showalter is not at all reassuring. Be skeptical when government or Big Business says not to worry about Minnesota Medicare costs or choices.

For about 400,000 Minnesota patients (consumers), the Medicare Cost Plan option is going away next year. 
Compared to other states, Minnesota has a lot of patients now enrolled in Medicare Cost plans. But it’s also true that Minnesota has a growing majority of seniors who are enrolled in Medicare Advantage plans (at least 53% https://www.medicareresources.org/minnesota/ ) compared to thoise on traditional fee-for-service Medicare.

The difference between a Medicare Cost Plus and Medicare Advantage plan is that a Cost Plus patient is able to go to a “health care provider” of her choice outside of a restricted provider network. https://health.usnews.com/health-care/health-insurance/articles/medicare-advantage-vs-medicare-cost-plans-whats-the-difference
 
Minnesota seniors will receive a huge increase in solicitations for Medicare Advantage plans. But will this result in true competition for access to quality care? I’m very skeptical. The business frenzy is due to the now dominating managed care business model in Minnesota. Whether sponsored by government, businesses or insurance companies, the managed care companies make money (profit) by ensuring the difference between the aggregate payments they take in for a population of patents and what they pay out to the care “providers” who actually treat the patients. To succeed financially, organizations (whether profit or nonprofit) must tightly control their payouts to their “provider” network (hospitals, physicians, and other health care professionals). Today, payers pass on the financial “risk” of the 10% or so most expensive patients to their “providers” through Accountable Care Organizations (ACO). Then the contracted “providers” internally restrict access to expensive and “unnecessary” health care. https://innovation.cms.gov/initiatives/Next-Generation-ACO-Model/
 
The Minnesota Medicare crunch is here.

Minnesota legislature approves steps to improving health care price transparency

Saturday, June 2nd, 2018

Health care price transparency in Minnesota for clinical care, medications, and medical products  as well as patient-specific allowable insurance payments is a  good thing. The 2018 Minnesota legislature took a helpful step forward by passing SF 3480: https://www.revisor.mn.gov/bills/text.php?number=SF3480&version=2&session_year=2018&session_number=0&format=pdf When patients and families know the costs of their care, doctor-patient relationships are strengthened and effective clinical decision-making is enhanced. Most Minnesota patients already have a lot of financial skin in the game.

However, passing this legislation is only a first step. More timely health care price disclosure is needed for Minnesota patients and families to manage their high insurance deductibles and to effectively partner with their doctors when selecting health care options which have predictable costs. Today the Minnesota health care consumer is too often in the dark. Although the new legislation will help, health care expenses are usually knowable to the patient only after a bill collector from the clinic or insurance company calls to collect.

Re: http://www.medicaleconomics.com/patient-relations/patient-engagement-through-price-transparency?cfcache=true&elq_cid=486445&elq_mid=1676&rememberme=1
Patient engagement through price transparency
By: Jonathan Kaplan, MD, MPH
May 30, 2018
Patient Relations, Business, Med Ec Blog, Money

The race towards better patient engagement is ultimately about better communication and better health. But underlying those goals is cost containment.
Here’s a novel idea: cost shouldn’t only serve as the goal. It can also be the “carrot.” In other words, cost (price transparency on healthcare services) can engage the patient, allowing for better education and thus leading to a healthier, more compliant lifestyle which eventually reduces healthcare costs.

Nothing captures the consumer’s attention more than cost. Especially a healthcare consumer’s out-of-pocket costs. As more consumers shoulder their healthcare costs through high-deductible health plans (HDHPs), they’re hedging their bets by paying a relatively lower monthly premium while knowing they risk greater out of pocket expense if they actually get sick or hurt.

HDHPs aren’t going anywhere. Aside from the potential cash flow benefit to consumers, it reduces the insurance companies’ risk of paying out a benefit before the deductible is met.

So let’s use that thirst for pricing information to society’s advantage. If every doctor or healthcare facility used a lead-generating price estimator to provide price transparency to consumers, those same facilities would receive the consumer’s contact info in return. With those “leads” that include name, email address, phone number, and ZIP code, the healthcare “provider” now has a means to engage the patient.

That engagement can consist of further discussion about costs. It can simply be education on the procedure or service-of-interest. Either way, it’s a legitimate tactic to engage the consumer and navigate them through the healthcare process.

Pricing can be presented in several ways:
•A bundled out-of-pocket fee for a medically necessary service at a surgery center for example; or
• An estimate of the negotiated rate for an insurance-covered procedure.

Opponents of price transparency are quick to point out that patients don’t always know what they want. Or they may choose the wrong procedure or not understand it’s an estimate.

This is an Amazon world we live in, and in that world, consumers are expecting to know costs ahead of time. By clarifying that these are estimates, they understand it’s not a guarantee. Regardless of the cynics out there, don’t forget the underlying benefit here. By receiving the consumer’s contact information, the doctor now has the opportunity to fill in that education gap before the patient steps in the office. 

Cost isn’t the only pain point. Of course, board certification and experience matter. However, cost is the ultimate pain point. And if the patient can’t afford the out-of-pocket costs for a procedure, it doesn’t matter how board certified you are, they won’t be able to move forward. 

So let’s use pricing to capture the patient’s contact info. Once engaged, we can drive them to make better choices and a healthier lifestyle.

Jonathan Kaplan, MD, MPH, is a board-certified plastic surgeon based in San Francisco, CA and founder/CEO of BuildMyBod Health, an online marketplace for healthcare services that allows consumers to determine cost on out-of-pocket procedures, purchase non-surgical services, and in exchange, the healthcare providers receive consumer contact info – a lead – for follow up.