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healthcare price transparency

How Health Insurance Design Affects Access to Care and Costs

By healthcare industry, healthcare price transparency

This is a guest post by Wendy Dessler from The Real Awards. Weighing The Pros And Cons Health insurance comes in many forms, some more popular than others. Essentially, it’s not always the rate you pay; sometimes the sort of coverage you get, the network where your coverage applies, and other collateral benefits may be more valuable than primary ones. You’ve got to weigh the pros and cons of different options in reference to your needs. The primary options right now are HMO and PPO plans. HMO stands for Health Maintenance Organization, and PPO stands for Preferred Provider Organization. Medicaid options are also available, there’s ACA coverage, and even a few non-traditional solutions like Medi-Share. Many of these provide similar coverage options through different avenues, but costs and health providers are of varying quality. HMO and PPO solutions tend to be popular in part owing to the larger networks members are able to utilize. However, this design means certain individuals may have greater difficulty accessing approved medical practitioners within a given network. Such individuals have to go outside an HMO’s network to get healthcare and lose the associated cost cushion.PPOs tend to have more extensive networks, so this isn’t so much of an issue, but they’re also more expensive than HMOs in general. You can follow the hyperlink for a deeper look into what differentiates HMO and PPO plans. Essentially, HMOs are more cost-effective but have greater network limitations, PPO plans are a bit pricier, but have better networks. Convenience Of Care Is A Big Factor In Choosing Your Provider There are situations where one of these alternatives will be more convenient for you. Medical institutions aren’t evenly distributed across the United States, and sometimes conditions can develop which may require specialized practitioners that are far beyond your network. The…

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Surprise medical bills = stress on blast

By cancer, e-patients, healthcare industry, healthcare price transparency

In case you missed it, getting a Really Big Diagnosis like, say, cancer, is a big whack to the wallet. Even if you have titanium-plated insurance (spoiler: there is no such animal in the US healthcare payment system), there will be bills for many, many things. If you have a deductible, be prepared to build a spreadsheet matrix with complex algebra to calculate how much of what care will be on you. If you have co-insurance – your spouse’s employer coverage, for instance – that’ll add complexity to your algebra. It’s a lot. In a piece on the Discover credit card and financial services blog, recent Cancer Club inductee Kris Blackmon lays out how unexpected medical expenses impact people dealing with a Really Big Diagnosis, or any ongoing health issue that requires lots of clinical care – and therefore medical bills – offering a solid strategy for dealing with those bills. Do your research Talk to your clinical team’s billing office in advance about what your options are under your coverage plan. You’ll have to do this with each provider and facility you’ll receive care in – Blackmon says she chose to be treated at a major academic medical center because of the one-stop care coordination available in a comprehensive care setting. Ask all the questions If you’ve been hanging around these parts for any length of time, you know I’m all about being your own best advocate when getting medical treatment. Kris Blackmon puts mustard on that ball by recommending that, even if you wind up in the emergency department (which can totally happen during cancer treatment), you ask to speak to the billing department rep in the ED before any treatment is ordered, or delivered, so you know what your options are, and what the bill might be for them. Read the…

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“How much is that?” is a critical question in healthcare

By healthcare industry, healthcare price transparency

This story from PBS Newshour clearly shows how important it is to ask questions, and shop around, when it comes to prescription drug prices. Think a generic drug guarantees a lower price? Not so much. Watch this story, and learn how the same generic drug can cost anywhere from $11 to $455. The best way to get the lowest price? The same way you shop for shoes, or appliances: research online, ask local retailers, and make an informed decision.

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“How much is that?” is a critical question in healthcare

By cancer, e-patients, healthcare industry, healthcare price transparency

This story from PBS Newshour clearly shows how important it is to ask questions, and shop around, when it comes to prescription drug prices. Think a generic drug guarantees a lower price? Not so much. Watch this story, and learn how the same generic drug can cost anywhere from $11 to $455. The best way to get the lowest price? The same way you shop for shoes, or appliances: research online, ask local retailers, and make an informed decision.

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Firehose of healthcare cost resources for #billesq

By e-patients, healthcare industry, healthcare price transparency, participatory medicine

I attended the 2nd edition of the bill conference in Richmond VA today (for the record, that’s Saturday, April 6, 2013), and wound up kicking off the talks with what’s become my core topic: #howmuchisthat, healthcare edition. That link goes to the hashtag’s home on Symplur, the healthcare hashtag registry that’s also a veritable time-sink of terrific healthcare thought leadership. Including healthcare data visualization. You’re welcome. Why is this a topic I care so much, and know so much, about? I believe that in all the hot air that’s been expended in the discussion about healthcare and healthcare reform in the US – and boy, howdy, is that some hot air! – very little shrift is given to how consumers (commonly called “patients”) can effect grassroots change themselves. The firehose below takes a wander through the history of US healthcare, particularly from the cost angle, and resources that the average human can use to start figuring out, ahead of time, how to assess the value (medical and fiscal) of their healthcare options. Here’s the firehose. Steve Brill’s epic TIME piece, Bitter Pill  pack a lunch, it’s the longest article TIME has ever published My take on where Brill missed the mark on his “fix this mess” recommendations A Feb. 12 post that raises Brill’s issue in what I think of as a great-minds-thinking-alike synergy My health econ guru Uwe Reinhardt’s Chaos Behind a Veil of Secrecy article in January 2006 edition of Health Affairs A post that includes intel on the RUC and the LA Times piece – both of which I mentioned in my verbal firehose A NY Times story on the unintentionally hilarious 2013 report in JAMA (Journal of the American Medical Assn.) on the wide disparity in pricing for hip replacements in the US – the RUC is an AMA committee! Society…

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Medicine has a major image problem

By cancer, healthcare industry, healthcare price transparency

When you hear the word “monopoly,” does it fill you with a warm and fuzzy feeling? (Unless you’re Hasbro, you really should say no, unless you’re a cyborg.) Healthcare is a monopoly. We can’t DIY cancer treatment, or surgically repair a broken hip for ourselves, so we have to go to the medical-industrial complex to regain our health if we wander into the weeds, health-wise. We also have deep difficulty accessing pricing information. I’ve talked about that hereand in even more depth on the Cancer for Christmas blog over the last few years. This “chaos behind a veil of secrecy” (all credit for that phrase belongs to healthcare economist Uwe Reinhart) has created the impression in healthcare customers that there’s no way to tell what something will cost before you buy it. You checks the box and takes yer chances. That’s a rotten way to run a railroad (one of the original monopoly industries in modern history), and an even worse way to run a hospital. Dan Munro wrote about this, and the star-chamber cabal that actually sets the prices in healthcare, the RUC, on Forbes.com yesterday. I’ve talked about the RUC myself. And the search for price transparency, which seemed such an outlier activity just a couple of years ago, is now popping up in the Well blog on the New York Times site, as well as on Reuters. The Reuters piece has the addition bonus of quotes from my buddy Jeanne Pinder, founder of ClearHealthCosts.com. (Yesterday was a big day in medical price transparency.) This is the central reason I registered the hashtag #howmuchisthat with Symplur, the healthcare hashtag registry. We all have to start demanding that prices be visible, and that the RUC stop cabal-ing around with our lives and our wallets. As more and more people are finding themselves with high-deductible health insurance, asking how much things cost before you…

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HOW MUCH DOES IT COST TO GET IRRETRIEVABLY PISSED OFF?

By healthcare industry, healthcare price transparency, participatory medicine

Nothing. It’s free. Just costs a little of your time. First, a piece from the New York Times magazine on the science of making addictive foods.           Second, a post on the TIME Healthland blog about the insanity that is medical billing.                   Go ahead. Read, get angry, get engaged, DO SOMETHING. Lather, rinse, repeat.

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More medical Monopoly: How Steve Brill got it wrong

By healthcare industry, healthcare price transparency

I talked about Steve Brill’s epic TIMEpiece Bitter Pill: Why Medical Bills Are Killing Us last week. I’m still absorbing the cost data he uncovered in that piece, and the graphics and images alone are worth the $5.99 cover price to get a physical copy of the magazine. The stories he shares about the healthcare industry’s Great & Powerful Oz – the hospital chargemaster price list – do reveal a big reason for the out-of-control price spikes in US healthcare. As brilliant, informative, and galvanizing as Brill’s piece is, I believe he dropped the ball just short of the goal line when, in his wrap-up recommendations, he talks up solutions that nibble around the edges of the cost problem, but don’t address its core cause: our crazy 3rd-party payer system. Take a walk with me through the hallways of US healthcare history. Here’s the timeline: 1880s: Chloroform in use as surgical anesthesia (thank GAWD). 1900s: The American Medical Association (AMA) becomes a big player. 1900s: Doctors no longer work fee-free in US hospitals (see bullet #2). 1910s: America lagging behind European nations on health insurance (already?). 1920s: Political complacency (must have been all the bathtub gin) leads to a “what, me worry?” attitude toward rising medical costs. 1930s: Oops, we broke the stock market. Blue Cross, against insurance industry advice, starts offering hospital insurance coverage. 1940s: Stiff wage controls in WWII defense plants lead to employers offering health insurance to their factory workers. President Truman draws up national health insurance plan, gets beat up on the White House lawn by Congress. 1950s: Pharma industry becomes big player via antibiotic and vaccine development, along with meds for a variety of illnesses. Lots of proposals for national health plan, all get beaten up in public and sent home. Employer-based group insurance plans, offering coverage for “major…

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2013: The Year of Healthcare Emancipation?

By e-patients, healthcare industry, healthcare price transparency, participatory medicine

Hang on to your hats – this one might wade into controversy. As I write this (3:30pm EST on January 1, 2013), I’m listening to a conversation on NPR about the Emancipation Proclamation, which was signed into law by Abraham Lincoln 150 years ago today. I’m also reflecting on a couple of movies I’ve seen in the last 45 days: Lincoln (over Thanksgiving weekend) and Django Unchained (on Christmas Day). Is it time for an emancipation proclamation for patients? Or should we just saddle up and have a shootout at the plantation … um, hospital instead? Too many healthcare transactions are still conducted over the patient’s supine form. Doctors, hospitals, and other entities in the “provider” column horse-trade with health insurers, including Medicare, in the “payer” column. That means that the patient winds up shackled. No say in how much something costs, no real voice (yet) in what happens next, little interest on the part of the two trading entities in clueing us in to what’s happening. Some of my connections in the participatory medicine/e-patients movement use a driver-rider metaphor for transforming healthcare, with the patient moving from passenger to driver in healthcare. It’s a less controversial/confrontational metaphor than referring to patients as chattel on the medical plantation. However, I’m sticking with that plantation metaphor for the moment, because too many in the provider and payer camps are still viewing patients as meat puppets, not as full participants. Does healthcare need an emancipation proclamation? Yes. Here’s where the metaphor shifts: let’s not wait for someone to proclaim us (patients) emancipated. Let’s break our own chains, and be our own liberators. Let’s demand that the providers and the payers give us an equal seat at the table, and then let’s … LEARN EVERYTHING WE CAN TO BE PRODUCTIVE CONTRIBUTORS TO THE HEALTHCARE SYSTEM. That last statement is…

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