HealthWell Foundation

The HealthWell Foundation® is a 501(c)(3) non-profit organization established in 2003 that is committed to addressing the needs of individuals with insurance who cannot afford their copayments, coinsurance, and premiums for important medical treatments. Their vision is to ensure that no patient goes without health care because they cannot afford it.

As patients are required to pay a larger share of health care costs each year, even many individuals with insurance find health care unaffordable. These patients face challenges affording the treatments they need to fight chronic and life-altering medical conditions. The HealthWell Foundation was established to address and help alleviate this problem.

The Cost of Being Underinsured in America

• 6 out of 10 have skipped or delayed seeking healthcare due to cost
• 3 in 10 did not fill a prescription due to cost
• 2 in 10 cut pills in half or skipped doses due to cost

Learn more about the HealthWell Foundation by visiting: http://healthwellfoundation.org

Financial incentives to create patient-centered medical homes (PCMH)

There are a growing number of examples where primary care providers are receiving financial incentives to develop patient-centered medical homes (PCMH) for their patients. Here's an interesting press release that describes an example where $1.5 million was given to 236 primary care physicians in 11 practices:

Six health plans pay $1.5M in incentives to create medical homes for nearly half a million Hudson Valley residents

Taconic Health Information Network and Community convenes payers, providers and community to manage groundbreaking medical home transformation project

Fishkill, N.Y. March 9, 2011 -- Nearly half a million patients in New York's Hudson Valley can now call their primary care physician offices patient-centered medical homes, thanks to a Taconic Health Information Network and Community (THINC) project that garnered participation from six health plans to improve the quality of care in the region.

The health plans--Aetna, CDPHP, Hudson Health Plan, MVP Health Care, UnitedHealthcare and Empire BlueCross Blue Shield--represent some 65 percent of the commercial insurance market in the Hudson Valley and 43 percent of Medicaid managed care. Setting aside competition in favor of cooperation with THINC, the health plans paid $1.5 million to 236 primary care physicians in 11 practices that achieved patient-centered medical home (PCMH) recognition from the National Committee for Quality Assurance (NCQA), which served as an objective measure of medical home-ness. The incentives were paid to providers for transformation to a PCMH and for the enhanced, more robust services patients receive in a medical home.

Online health insurance finder tool

HeathCare.gov now offers an insurance finder tool that can help you get coverage. You can explore your coverage options and search your state for the best health plan that will suit your needs.

Find out which private insurance plans, public programs and community services are available to you. To access this insurance finder tool, visit: http://finder.healthcare.gov/

This tool will help you find the health insurance best suited to your needs, whether it's private insurance for individuals, families, and small businesses, or public programs that may work for you. It was created to help consumers under the health insurance reform law, the Affordable Care Act.

Under the new law, people who have been denied coverage due to a pre-existing condition and who have been uninsured for at least six months may qualify to buy insurance. Learn more about the plan.

Implications of Consumer-Driven Healthcare

Navicure is sponsoring a complimentary webinar about consumer-driven healthcare. I'll post a link of the archived webinar when it becomes available. In the meanwhile, I'd like us to consider how consumer-driven healthcare will change the way providers do business.


The upcoming webinar will address these points:

    * The importance of quality, pricing and patient satisfaction as it relates to consumer-driven healthcare.
    * How consumer-driven healthcare impacts your bottom line.
    * Strategies for providers to increase patient collections at the point of service.

As healthcare undergoes reform on this country, will consumers become more empowered so they can make informed medical decisions? Will health insurance plans converge and look very similar, or will we still live in a world filled with HMOs, PPOs, and other types of managed care plans. What will happen to CDHPs or consumer-directed health plans and health savings accounts or HSAs? Will we see greater momentum with health insurance exchanges? The health insurance marketplace is definitely changing and I'm curious to see how this industry evolves as reform takes place in this country. The public option will create competition, so how will private insurers react?

Are you waiting for the public option?

If you currently lack health insurance, are you waiting for the public option? What recently happened in Massachusetts has stirred a huge discussion about health care reform in this country.  As CNN is putting it: "Democrats scramble on health care after GOP win"

What's to happen to the public option?

All these recent discussions surrounding the health care reform bill(s) have been very emotionally charged. As President Obama states, "People are angry and frustrated." I'm sure many politicians are angry and frustrated as well. Perhaps our country needs more time to develop a better health care reform strategy. Perhaps we were rushing through all these changes.

If you're currently uninsured, I hope you will find a way to obtain the medical care you need. Let's hope that this country will find a solution that solves our current health care crisis.

Historic health care reform in the USA

We all know that the Senate passed a historic health care reform bill. It's hard for me to imagine $871 billion. According to CNN:

The bill passed in a 60-39 party line vote after months of heated partisan debate. Every member of the Democratic caucus backed the measure; every Republican opposed it.

Will it become law? Probably. Will it raise taxes? Yes. Will it reduce health care costs? No one really knows the answer, but there are many people who don't seem to think so. What do I personally think? I think that it depends on too many unpredictable factors at this point. We know that everyone needs health care, but we don't know how doctors are going to respond to this type of reform. If doctors choose not to accept certain types of health insurance policies, then we'll be stuck in a worse situation than ever before.

It's hard to believe that Medicare and Medicaid was enacted over 40 years ago. Now, we're about to see Medicaid get a massive expansion, but what good will that do if more physicians choose to drop Medicaid coverage? There are so many unanswered questions for practicing physicians in the United States. My personal prediction is that many more physicians will choose to drop Medicare/Medicaid and they will rely more on cash-based practice models. A large number will simply leave clinical practice to pursue other careers. 

Increasing confusion about mammograms

Everyone is getting confused about mammogram guidelines. The U.S. Preventive Services Task Force (USPSTF) recently came out with new guidelines and these cancer screening recommendations are quite different from those published by the American Cancer Society (ACS). Now, the Senate is dealing with amendments of amendments. What do I mean by that? There was an amendment by Mikulski. Then, there was one by Vitter. Then the Murkowski amendment got rejected (I'm not sure if all this chronology is correct, but I think you get the picture). Soon, we won't remember what the original amendment said.

So what's with all these amendments? One key question is: how will insurance plans (including a possible public option) pay for screening mammograms? Who will need to pay a copay? What is the appropriate age to start breast cancer screening? 40? 50? How often should women get a mammogram?

I've heard some people argue that the USPSTF came up with these revised guidelines to reduce the number of mammograms the government would need to cover under the proposed public option. Does this make sense? Well, if the government can find a way to reduce health care costs, it would be to eliminate expensive tests. A mammogram isn't super expensive, but if you could stop all those women who are ages 40-49 from getting a mammogram, you would save a huge amount of money.

Are screening guidelines published to save costs or save lives? Where do you draw the line to declare that a screening test is indeed "cost effective?" How is that term even defined? At this point, I think that most of us have more questions than answers.

How will health care reform impact your job satisfaction?

If you're a health care professional involved in direct patient care, how will the proposed health care reform impact your level of job satisfaction? My wife is a primary care physician and we often talk about how a reformed health care system would impact her practice. Would you be more inclined to leave clinical medicine to pursue a non-clinical career?

I have met so many disgruntled physicians who feel "trapped" by their career. They can't imaging doing anything else. They don't know how they can make a career transition and they can't afford to take huge risks.

How closely are you following the discussion on health care reform? Even if you hate politics, it's very important to understand what's being proposed. It's not just about Medicare or the Public Option. It's not just about managed care companies and denied coverage. Perhaps all the recent discussions have renewed your writing passions as you draft letters to your senators. Perhaps you've recognized that you have a passion for health policy and politics. Maybe you're seeing the forest instead of the trees and you're planning to pursue a career in public health.

I've noticed that I can't see the trees anymore. For me, it's mostly about the forest. Blame that on my MPH. When we compare population health against individual health, we can't deny that our nation needs a new health care system. I just don't know that we've identified the right way to approach this problem yet.

H1N1 and the uninsured in America

Let's face it: many uninsured patients don't have primary care providers. They are reluctant to seek medical care because they can't afford it, and more importantly - they're afraid of the potential medical bills that may result from a sick visit.

So, what's going to happen to the uninsured as H1N1 spreads across the country? We know it's going to spread because we can't stop it. Global public health agencies have admitted that H1N1 simply can't be stopped.

• We're not going to see any type of public option emerge this fall/winter. There will be no universal health coverage to help patients this winter.
  
• Unemployment is still a significant problem in this country. With unemployment comes uninsured patients and families.
• H1N1 may lead to increased hospitalization. How will individuals handle these hospital bills?

Here's a novel thought: if you're uninsured in the United States, perhaps you may wish to spend this winter in a westernized country that offers free universal health care coverage. That way, if you get sick, you'll have access to free health care. Do you have any relatives living in other countries?

This winter will be a trying period for many individuals and families living in the United States. My hope and prayer is that H1N1 infections will be mild and that they won't cause too many hospitalizations or deaths. If we all do our part to wash our hands and practice good sanitation and hygiene, then I think we'll help prevent the spread of this contagious virus.

Donate a kidney and get stuck with a "pre-existing condition"

I received an e-mail today from Mitch Stewart (Director, Organizing for America). Here's the part that caught my attention:

Jenny U. from Missouri did what any parent would: When her son needed a kidney, she donated one of hers. But she didn't realize insurance companies would use her kindness as an excuse to never cover her again, calling her donation a "pre-existing condition."

Now, insurance companies are spending millions on a campaign of lies to kill health reform that would help folks like Jenny. So, today, with crucial negotiations taking place in Congress, we're raising our voices and making it clear: It's time to deliver on reform.

Would you donate a kidney if you knew that you would have a very difficult time obtaining health insurance in the future? I know many people who have donated kidneys, but I've never thought about the consequences associated with having a "pre-existing condition."

To get more information, visit: http://my.barackobama.com/TTDCalls

Is COBRA the best option for the unemployed?

Earlier this year, the government provided assistance to people who lost jobs in 2009 by paying for a portion of the Consolidated Omnibus Budget Reconciliation Act (COBRA) health insurance premium. Having the government pay 65% doesn't last forever, so those who lose their jobs in 2010 will have to pay 100% of the COBRA premium.

Will COBRA be the best option for people in 2010? Or, will alternative health plans be more cost-effective? Since health insurance is regulated at the state level, your options will really depend on where you currently live. Perhaps you may want to consider moving back home with your parents if they live in a state that offers better healthcare options. If you lose your job, you get 60 days to decide if you wish to enroll in COBRA.

To learn more about COBRA, visit the U.S. Department of Labor website here.

Shifting health care costs

According to a recent story on BusinessWeek, the heavy costs of health care are shifting more towards employees. Employers will need to pay more to provide health insurance, but the burden will increase significantly more for employees. I suppose it will also really depend on how much your employer currently pays. Will your company start paying a smaller percentage of your health insurance premiums?

According to the story titled, "Health Costs: Steeper Still," we have seen employers' health care costs rise 149% since 2000. 175 million people are covered by private employers.

Perhaps the role of wellness and disease management programs will need to be re-evaluated. If a public option becomes available, I wonder if that will also include some type of wellness program. What percentage of health plans will offer formal wellness and disease management programs in 3 years? What about in 5 years?

Technology is making it more easy for patients to learn ways to improve their health and wellness. There are many personal health record (PHR) services that are freely available. Consumers can get educated about certain diseases by reading articles on reputable websites. There are web-based health programs that can guide patients to live a healthier lifestyle. Advances in mobile technology are also contributing to health and wellness initiatives.

More thoughts about health insurance and health care reform

The other night, my wife and I were discussing some of the issues surrounding health care reform. She's a family physician and she works in private practice. The topic of discussion was: what do we do about all the uninsured?

So many people don't have health insurance. Among the young adult population who lack health insurance, some of them may choose to spend a few hundred dollars per month so they can afford cable TV and a nice large plasma TV. Others may have large cell phone bills. To many, they don't see health insurance as a high priority. After all, they tend to be relatively healthy and they don't want to spend money on expensive health insurance plans.

It's a sad reality, but many commercial health insurance plans are simply too expensive for many people. At the same time, many uninsured don't qualify for Medicaid. But then again, what good is Medicaid if you can't find a healthcare provider who accepts Medicaid? Will the public option suffer a similar fate as Medicaid? Will physicians refuse to accept the public option? (that may also mean that they have to give up Medicaid and Medicare, but some won't mind) What about all those docs out there who aren't accepting any new patients? How many people will have a difficult time scheduling an appointment with a healthcare provider?

What's the fate of the public option?

The public option was rejected by the Senate Finance Committee. According to CNN:

Republicans unanimously oppose the government-run insurance option, saying it would drive private insurers from the market and eventually bring a government takeover of the health care system.

Democratic leaders reject that claim, saying the public option would provide needed competition for private insurers while making health coverage accessible to millions of people currently lacking health insurance.

Who's right? Is the public option simply a battle between the Republicans and the Democrats? I don't think it's that simple when we're talking about healthcare reform. Should they define a trigger? If they define such a "trigger," they will have proof that expanded coverage and lower costs are not possible unless major changes are made to our existing system.

At the end of the day, I think we will eventually see some type of public option emerge in the United States. In my opinion, it's inevitable. Our healthcare system is so broken that we need to go through a major overhaul. It's difficult to overhaul a system in small stages. On the flip side, a complete overhaul isn't practical. So, we're stuck between a rock and a hard place. This is a true dilemma.

Do you bargain with your doctor?

Back in the old days, patients used to pay their physicians with crops, knitted blankets, and animal meat. Of course, we now have supermarkets and Walmart, so physicians are expecting cash for their services. Some patients still bring gifts (like fruit and vegetables from their gardens) to their physicians, but I don't think that most patients are bargaining for their healthcare services (unless they lack health insurance and they're paying with cash).

What if that evolved? As we prepare for healthcare reform, maybe bargaining skills will be one of the main components of reforming healthcare costs. What if more patients start bargaining with their physicians? Some are doing that right now because people would rather get paid something (even if it's less) over nothing. What if physicians start offering sales and specials for certain services? (get two physical exams for the price of one!)

Physicians can only control so much when it comes to price. The prices for labs and other diagnostic tests are generally not controlled by physicians. Maybe we'll start seeing some special deals (20% off your CT scan this month!) in the hospitals.

Obama's health plan defined and outlined

What do you think about President Obama's health plan? He states that although he isn't the first president to address health care reform, he is determined to be the last. You've probably read the story on CNN. What do you think about all of this?

Here's my favorite line: "No one should go broke because they got sick."

Medical bills continue to be a leading cause of bankruptcy for the aging community. I'm curious to see how this public option will impact existing plans such as Medicare and Medicaid. Insurance companies are probably starting to create some plans to downsize if they face some steep competition from the government. However, maybe the government option will flop if providers refuse to accept it. Then where does that leave us?

Shopping for health insurance

Over the long weekend, I had a chance to catch up on some reading. I pulled out the August 3rd edition of Forbes and started reading the "Fact and Comment" section by Steve Forbes, Editor-in-Chief of Forbes magazine. The heading for this column was "Washington: Still Abusing the Economy... and Undermining Health Care." These days, it seems like you can publish just about anything when it comes to politics and health insurance reform.

Forbes suggests some "helpful and constructive measures" that may move our country to a more genuinely "free-enterprise" health care system. One of the points he mentions is this:

• Allow consumers to shop for health insurance across state lines.

I don't know how often people think about health insurance plans in other states. If you move around quite a bit, then perhaps you're aware of the differences that may be present. However, unless you're a student and you have your health insurance through your parents who live in a different state, you won't find many people who have coverage through a different state. You simply can't purchase health insurance from a different state.

When looking to buy insurance, you can save time and money by getting auto insurance quotes or health insurance quotes from reliable insurers. I recently did some insurance shopping for my family and I got quotes from everyone. It helps to use a broker if you're too busy to fill out forms, but you may be surprised to know that much of this can be done online these days. I also used comparison sites like J.D. Powers and Associates to compare different insurance plans.

When we see a public health insurance plan emerge, will this new plan actually cause enough competition that private insurers lower their prices? If it's properly designed, then I'm sure we will. Otherwise, it will flop. I'd like to be optimistic and hope that the government sponsored health insurance plan will be a success. If so, I'd like to see some public insurance options for auto, homeowners, and malpractice insurance.

Making house calls to the uninsured

It's great to see that some doctors out there still care about patients. Watch this brief CNN video of Dr. Jeffrey Katz who makes house calls to see people who don't have health insurance. It's a very inspiring story.

Cancer patients struggling to pay for their healthcare

New cancer drugs are extremely expensive. Many cancer patients are having significant difficulty keeping up with all their healthcare costs. Watch this CNN video describe how a "cancer survivor drowns in debt." Breast cancer survivor Catherine Howard talks about how she got into $100,000 worth of debt buying health insurance.

It's an unfortunate reality, but healthcare costs are too high for many people. If you enroll in a clinical study and meet all the eligibility requirements, then you may end up receiving free medical care. However, many patients don't live near major cancer centers that perform medical research. Others don't like the idea about being enrolled in a clinical trial. Some simply don't meet any eligibility requirements, so they're unable to enroll.

Is a co-op the right model for health insurance?

Are you familiar with the co-op or cooperative model for health insurance? A co-op is a non-profit, member-run system for providing insurance plans. HealthPartners is one of the largest co-ops in the U.S. According to CNN, HealthPartners currently has a network of 70 facilities in Minnesota and Wisconsin and serves more than a million members. I wonder what physician reimbursement looks like in the HealthPartners co-op model. Perhaps it's not very different from billing a commercial health plan. Could it be better?

At the end of the day, we're all looking for affordable healthcare. If you're unemployed and uninsured, you may be looking for a free option as well. So many ideas are being thrown around in the current healthcare debate. As things change, I wonder what this will do to the healthcare co-ops that are out there. You can read more about health insurance co-ops here: CNN Health article titled, " Dissecting a health care co-op"