Category Archives: stakeholders

Neoliberals Can’t Fix Health Care

Don McCanne’s Quote of the Day blog returns us to a previous post I wrote about the ACA and neoliberalism, as well as others. The reader might also want to review posts about MEMEnomics.

In the following article from The Milbank Quarterly, not known as a radical publication, but rather as a financial one, John McDonough discusses some of the other reasons why neoliberals cannot fix health care.

As his title suggests, it has a lot to do with the non-medical facets of the health care system in the US — namely, the shareholders and stakeholders who profit from the status quo, and not just the insurance companies and pharmaceutical industry.

That a pro-business publication would publish this article attests to the reality that the problem with enacting Medicare for All/Single Payer is not just a political one, nor one made difficult by the power and influence of the industry itself, by insurers, drug manufacturers, device manufacturers, durable medical equipment companies, etc.; but also the investor class.

Here is McDonough’s article in full:

The Milbank Quarterly
November 2019
Shareholders, Stakeholders, and US Health Care
By John E. McDonough

August 19, 2019 was a big day for The Business Roundtable (TBR), the Washington, DC non-profit association of chief executive officers of major US companies. The organization released a new “Statement on the Purpose of the Corporation” signed by 183 CEOs declaring that the interests of workers, customers, communities, and “other stakeholders” should be as important as the interests of a company’s shareholders. This represented a significant change from its 1997 Statement that declared “the principal object of a business is to generate economic returns to its owners.”

While actions, not statements, will reveal real intent over time, this change was noteworthy—including for the US health care sector. The subject has deep roots in American society, especially in the advocacy of the late economist Milton Friedman, who derided corporate social responsibility as “fundamentally subversive” and asserted that “there is one and only one social responsibility of business—to use its resources and engage in activities designed to increase its profits.”

In the 1970s and 1980s, Friedman’s notion powered a movement in the United States, Great Britain, and around the globe called “neoliberalism” that promoted deregulation, defanged labor unions, shrunken government, and ever lower taxes. From business schools to high cathedrals of capitalism “greed is good” became more than a movie line from Wall Street and its iconic Gordon Gekko. Binyamin Applebaum’s new book, The Economists’ Hour, lays out the neoliberal narrative, warts and all, in compelling detail.

What about US health care and this neoliberal era in which we still breathe? The connections are multiple, deep, and noteworthy. For starters, of the 183 CEO signers of the TBR statement, only 11 come from companies primarily embedded in the health sector, such as Pfizer, CVS Health, and Siemens, far less than a proportionate share of health care’s 18% jumbo slice of the US economy. And it is not difficult to view TBR’s statement as whitewash, especially when signers include CEOs of Johnson & Johnson and Mallinckrodt Pharmaceuticals, companies that are neck deep in the nation’s opioid marketing scandal.

Influential US political and economic historians refer to the period from the late 1970s through today as the “Reagan era,” crowned during the presidency of Ronald Reagan who declared in his inaugural address that “(i)n this present crisis, government is not the solution to our problem, government is the problem.” His term in office ushered in the modern era of tax cuts, growing inequality, wage stagnation, diminished unionization, and repeated assaults on government legitimacy. The “Neoliberal Era” may be a better fit.

Coincidentally or not, in the early 1980s US national health spending as a percent of gross domestic product (GDP) split from rates in other advanced nations toward its current extreme outlier status. US spending on health increased from about 8% of GDP in the late 1970s to 17.8% in 2017, far ahead of the nation with the second highest rate of national spending on health, Switzerland, at 12.2%.

In return for this massive societal investment in medical care, we have the world’s most technologically advanced health care system along with the highest prices in the world for any category of medical services or products one can imagine. The rush of private investment capital into our medical sector has resulted in cutting-edge medical care, advanced drugs and medical devices, and the highest salaries of any professionals in American society.

In these 40 years, we also have seen three consecutive years of declining life expectancy, a deep anomaly among our international peers, humiliating rates of infant and maternal mortality, shocking levels of gun violence, and extreme incidence of overweight and obesity. As economist John Komlos has documented, during World War II, native born Americans were the tallest among advanced nations, both men and women—we are now among the shortest. For good measure, Americans are also among the most dissatisfied with our health care system. For what it is worth, money doesn’t buy us good health or happiness.

In this epoch, we have seen enormous growth in private investor funding into a sector formerly dominated by nonprofits or government, in hospitals, physician practices, home health, hospice, air ambulances, and much more. The pharmaceutical industry has always been for-profit, yet its extraordinary concentration has ballooned its pricing structure. The for-profit health sector keeps evolving, assuming new forms. As Gondi and Song document, between 2010 and 2017 the value of private equity deals involving acquisition of health-related companies, mostly hospitals and physician practices, increased 187% reaching $42.6 billion.

Could the investor dominance of much of US health care explain at least part of our outlier status on health spending and outcomes? It is hard to imagine that the investor-driven corporatization of American society could have left medical care untouched. Even today, the most common complaint from conservatives and Republicans about US health care is that government regulation thwarts the free market.

The notion that we could put this massive bulk of toothpaste back into the tube seems preposterous. The economic and political power of the incumbent system would easily stymie any serious challenge, including the apparent one, a nationalized “Medicare for All” structure. Assuming anything of this magnitude could get through Congress—or the Supreme Court—is a daunting stretch. And yet, the real frustrations of Americans with a system organized first and foremost to serve money and power before patients deserve attention.

If, as the Business Roundtable advocates, we are embarking on a new national conversation concerning the role of the for-profit corporation in American society, perhaps we should also instigate a parallel and sustained national examination and conversation about the history, experience, and results from for-profit corporatization of our health and medical care sector. It is clear that this revolution produces good and bad results for American society and for the world. Is it time for a reckoning?

John E. McDonough, DrPH, MPA, is a professor of public health practice at the Harvard University TH Chan School of Public Health in the Department of Health Policy and Management.

Shareholders, Stakeholders, and US Health Care

References

  1. The Business Roundtable. Statement on the Purpose of the Corporation. Washington, DC. August 19, 2019. https://opportunity.businessroundtable.org/wp-content/uploads/2019/09/BRT-Statement-on-the-Purpose-of-a-Corporation-with-Signatures.pdf. Accessed October 30, 2019.
  2. Friedman M. The social responsibility of business is to increase its profits. New York Times Magazine. September 13, 1970.
  3. Fink L. Larry Fink’s 2019 letter to CEOs: profit and purpose. BlackRock. January 2019. https://www.blackrock.com/corporate/investor-relations/larry-fink-ceo-letter. Accessed October 30, 2019.
  4. Komlos J, Buar M. From the tallest to (one of) the fattest: the enigmatic fate of the American population in the 20th century. Economics and Human Biology. 2004;2:57-74.
  5. Gondi S, Song Z. Potential implications of private equity investments in health care delivery. JAMA. 2019;321(11):1047-1058.

 

Published in 2019
DOI: 10.1111/1468-0009.12432

No Socialists Here

Dear Insurance company execs, pharmaceutical company execs, employee benefits consultants and executives, Wall Street investors, and all other stakeholders in the current dysfunctional, broken, complex, complicated, and bloated mess called the US health care system.

You have heard many politicians, and journalists, not to mention your own peers, or even you yourselves label the push for Medicare for All as “Socialism.”

We even have the Administrator of CMS, Seema Verma, calling it, and the public option plan,  “radical and dangerous for the country” recently when she spoke to the Better Medicare Alliance’s Medicare Advantage Summit in Washington, D.C.

Her solution, and probably yours as well, is to keep selling Medicare Advantage plans, which only makes the current system worse.

So, to help you get over your fear and loathing of Socialism, and to prove to you that the only reason why the US is the only Western, industrial nation to not provide its citizens with universal health care is because you are making money off of other people’s health, or lack thereof.

You are doing so, because you are greedy. There I said it. Now I hope you will pay attention to the following graphic:

Do you see any socialist countries? Do you see any radical and dangerous regimes that are hostile to the interests of the US? Well, maybe Slovenia. After all, they did send us Melania and her illegal family.

But back to the case at hand. I defy any of you hotshots in the health care space to prove to me that all of these Capitalist, free-market countries are flaming Reds, or even a bit Pinko.

You can’t, because it is not true. You and those who call Medicare for All, Single Payer, or even the so-called “public option” radical, just don’t want the government to interfere with your looting the pockets of the American people for your financial gain.

And that is why we are the only country with an “X”, instead of a check mark below our name.

UnitedHealth CEO’s ‘Medicare for All’ bashing sends payer, provider shares tumbling | Healthcare Dive

On the heels of Monday’s post, Whistleblower Reveals Effort of Employer to Crush Medicare for All, comes the following from Healthcare Dive.

It seems that bashing Medicare for All has an economic impact after all; just not on the company doing the bashing.

Aren’t we sick (get it) and tired of Wall Street and their corporate CEO allies determining our health care system, which is just a mechanism for them to profit from other’s misfortunes or luck at not getting sick?

When will we stop letting these vultures pick away at the carcass of the American health care system for the benefit of their stakeholders, investors, and the medical-industrial complex?

The other day, on Fox News, Bernie Sanders attended a town hall in which the host asked the audience if they were willing to switch from an employer-based health care system to one provided by the government, as Senator Sanders and others have advocated. The host was shocked to learn that the answer was yes from the audience.

So let me get this straight. A Fox News audience wants Medicare for All, but a corporate CEO in the medical-industrial complex can veto their wishes. Is this a democracy or a plutocracy?

You decide, after all, that is Fox’s tagline. Here’s the Healthcare Dive article:

The biggest private payer beat Wall Street expectations on Tuesday, but a rebuke of plans to expand Medicare weighed on health companies.

Source: UnitedHealth CEO’s ‘Medicare for All’ bashing sends payer, provider shares tumbling | Healthcare Dive

Words and Phrases: Global Healthcare or Whatever You Want to Call It

This past Saturday, while waiting for power to be restored in my area due to a pesky lizard’s venture where lizards don’t belong, I was able to use my cell phone to read some posts on LinkedIn.

I came across a discussion by three of the top medical travel personnel answering the question, “Is the term “Medical Tourism” obsolete?”

This discussion thread was begun by Stella Tsartsara, and followed by Ilan Geva and Elizabeth Ziemba, including yours truly, who put his two cents into the conversation.

Since Stella has given me her approval to use her comments, and I suspect that Ilan and Elizabeth would not mind, I am going to quote them verbatim here for the reader to digest. There will be some names that I will leave out, because one, I have not contacted them, and two, they were mentioned in passing by the individual who I am quoting.

Stella I. Tsartsara:

“I see Elizabeth Ziemba talking about carrying capacity of HC systems. XXXXXXXXXXXXXXXXXX told me half of the international projects I do have nothing to do with Medical Tourism, XXXXXXXXXXXXXX told me we are dealing with “International Healthcare” anymore, we are passed the term “Medical Tourism ” probably instigated by people traveling to another destination for (cheaper) surgery not covered by their insurance where the “patient” had time to do some sightseeing. But once the demand came to more serious interventions like heart surgery then the only organization needed was a reliable MTF and good research from the patient to guarantee results. Here the “tourism” is at the 4-5th place after doctor, hospital reputation, waiting list time, safety, post- surgery follow up, price and cost reimbursement from insurance.

Now with the Cross Border Healthcare and the Trade in Services Agreement (TiSA) Wikileaks revelation on the globalization of healthcare officially by the states, things take a completely new turn and the fact that we are talking about Medical Tourism is raising some eyebrows. Or at least it should be split from Healthcare delivery.”

https://data.awp.is/international/2015/02/04/22.html

Stella I. Tsartsara:

“I have no possibility for edit, I rephrase here that XXXXXXXXXXXXXXXXXX told me some time ago that her projects deal with international healthcare mostly which is a healthy sign of evolution in the industry although XXXXXXXXXXX says this word does not exist either, to which of course I agree.

Terms are the beginning of taking the trend seriously by the demand. It’s about shaping policy in the end.”

Ilan Geva:

“Stella, I think that the term Medical Tourism was pushed upon us by an association. The fact is no one, except our circle of Professionals, is using it or cares about it. In the effort to differentiate and stand out, many started to use Medical Travel, Global Healthcare…whatever. Patients don’t really care what you call it, they have a need or a want that requires a solution. Many of them are not looking for the “Tourism “aspect of a medical issue. Have you noticed that even the MTA is not using their name as much as they used to? They are now pushing the GHA brand.

Is that an indicator that medical tourism is dead? Who knows, and frankly, who cares? Globally, there are enough tremors in the healthcare sector, enough to guarantee continued movement of patients from one region to another. Maybe we should start calling it “Medical Voyages”?”

Elizabeth Ziemba:

“Thanks for starting a very interesting conversation, Stella. The term “medical tourism” isn’t dead yet because it is still the top search term in the sector and is heavily used by the media. But the sector itself has outgrown the term. I will be giving a presentation at the IMTJ/World Health Care Congress about this very topic. The sector is changing but it is hard to get away from “medical tourism” when SEO rules. I must admit that the name of my company, Medical Tourism Training, was selected because of its SEO and familiarity to people. Even now, people react to it favorably even though I hate it. Time to look past the label to the substance.”

Stella I. Tsartsara:

“Ilan Geva “medical tourism” is not dead and maybe never dead as there are interventions where tourism plays an important part and here individual consultants have a bigger profit margin. But definitely movement of patients for elective treatment is not and cannot be called this way.

In EU we call it “Cross Border Healthcare” because we established the Institutional parameters for its organization and delivery.

This is what is lacking from an international perspective for the term to have a meaning. By the way trained eyes in institutional development like XXXXXXXXXXX will see immediately that the TiSA is exactly the same (with 2 additions on insurance and compulsory post-surgery monitoring & liability) with the EU Directive 24/11/EC on the Cross Border Healthcare in EU.”

Me:

“I have used “Medical Travel” in my posts, but for the purpose of selecting a category to place them in, or to tag them when I write, I use both “Medical Tourism” and “Medical Travel”.”

Stella I. Tsartsara:

“Elizabeth Ziemba & Richard Krasner, MA, MHA I tend to agree more with Ilan Geva on the matter. However as I said there will always be room for the “tourism” side for hundreds of treatments where tourism plays a very significant part like Medical SPA, cosmetic surgery, diagnostics, dental etc, although still I do believe that it’s not a priority. What Ilan said it’s a revelation for the “association”. Who else would give international care such a limited meaning maybe pushed by its operators back then.

But what is coming ahead e.g. Institutional and Regulative development of international healthcare (among public hospitals as well) has absolutely nothing to do with “tourism”. We have to set things straight if we want to be taken seriously by those who will be in our path in the consultation activities for its future development. Those who were (are still) building the TiSA are not going to look or refer to “medical tourism”.”

Stella I. Tsartsara:

“I also have the impression that something is moving in layers that are not yet visible to us, on the management of this new trend. I believe that actors are organizing themselves differently and as there is not yet a market (it’s still a taboo internationally exactly because it involves also public HC, we in EU have solved this but it’s not the case at global level) and the demand is still hybrid, there is no business development and marketing yet of this new consulting set of skills and delivery. But very soon we are going to see a new type of developers in this perspective catering for the state development of international HC. I have proposed years ago through this group the organization of such Groups combining inevitably many specializations and some do exist already run by big Hospital Groups.”

It would seem there is not clear consensus on what term is appropriate for the activity of leaving one’s home country and travelling to a second country for medical care, no matter what the reason for travel may be.

If, as Stella said, it was for heart surgery, doubtless the patient would not be doing much sightseeing post-operation. Yet, on the other hand, if it was for less invasive, and less stressful surgeries and procedures, and if the patient was cleared by the physician and physically able, then the tourism part would apply.

The revelations by Wikileaks of the negotiations on the TisA is no doubt a concern to the entire industry, whether one calls it medical tourism, medical travel, health tourism, health travel, etc. The result is the same. Knowledge of the existence of such an agreement may forestall that agreement being finalized, if not totally scrapped altogether if the right individuals lead a campaign against it in member countries.

Such was the case with Brexit, and such was the case with the 2016 U.S. elections that Wikileaks had a hand in derailing.

The solution, therefore is a stronger effort on the part of all stakeholders to develop strategies, plans, and standards to regulate the industry and to promote it effectively. Relying on an association we know is unreliable is not going to work. Before TiSA is tossed aside like the TPP, or the Paris Climate Treaty by nationalistic dunderheads, the industry must do more.

P.S. The rest of the thread can be seen here: https://www.linkedin.com/groups/4304089/4304089-6368077962927050755

Illogical!

Picking up where I left off last week with my post, Regulation Strangulation, regarding too much regulation, a series of articles from earlier this week, published in various health care journals and magazines, discussed a new scheme the good folks at CMS have cooked up to make our health care “system” better. (Or worse, depending on whether you have drunk the kool-aid yet)

You may recall my post from late last year, Models, Models, Have We Got Models!, that reported that CMS was launching three new policies to continue the push toward value-based care, rewarding hospitals that work with physicians and other providers to avoid complications, prevent readmissions and speed recovery.

In that article, I mentioned the various models CMS was implementing. My view then, as it remains today, is that these models have not worked, and have only made matters worse, not better.

So when CMS unveiled their latest scheme recently when Administrator Seema Verma spoke at the Health Care Payment Learning and Action Network (LAN) Fall Summit, this is what she said:

The LAN offers a unique and important opportunity for payors, providers, and other stakeholders to work with CMS , in partnership, to develop innovative approaches to improving our health care system. Since 2015, the LAN has focused on working to shift away from a fee-for-service system that rewards volume instead of quality…We all agree that quality measures are a critical component of paying for value. But we also understand that there is a financial cost as well as an opportunity cost to reporting measures…That’s why we’re revising current quality measures across all programs to ensure that measure sets are streamlined, outcomes-based, and meaningful to doctors and patients…And, we’re announcing today our new comprehensive initiative, “Meaningful Measures.”

Let’s dissect her comments so we can understand just how complicated this so-called system has become.

  1. Develop innovative approaches? How’s that working for you?
  2. Improving our health care system? Really? What planet are you living on?
  3. Financial cost? Yeah, for those who can afford it.
  4. Revising current quality measures? Haven’t you done that already after all these years?
  5. “Meaningful Measures”. Now there’s a catchy phrase if I ever heard one. You mean they weren’t meaningful before?

You have to wonder what they are doing in Washington if this is the level of insanity and inanity coming out of the bureaucracy on top of our health care system.

In an article in Health Data Management, Jeff Smith, vice president of public policy for the American Medical Informatics Association stated the following regarding the new CMS initiative.

According to Smith, “the goals are laudable, but the talking points have been with us for several years’ now…measurement depends on agreed-upon definitions of quality, and in an electronic environment, it requires access to and use of computable data. If CMS is going to turn these talking points into reality, it will need to put forth far more resources and commit additional experts to a complete overhaul of electronic quality measures for value-based payments.”

Mr. Smith’s comments are at least an indication that not everyone goes along with CMS every time they unveil some new initiative, model, or program, but again we see the words associated with the consuming of health care being used in discussing the current state of affairs. Terms like “value-based payments”, and “quality measures”, and “financial/opportunity cost”, etc., only obscure the real problem with our health care system. It is a profit-driven system and not a patient-driven system.

Let’s push on.

A report mentioned Monday in Markets Insider showed that 29% of total US health care payments were tied to alternative payment models (APMs) in 2016, compared to 23% in 2015, an increase of six percentage points. These APMs were discussed previously in Models, Models, Have We Got Models!,

The report was issued by the LAN, and is the second year of the LAN APM Measurement Effort (try saying that three times fast). They captured actual health care spending in 2016 from four data sources, the LAN, America’s Health Insurance Plans (AHIP), the Blue Cross Blue Shield Association (BCBSA), and CMS across all segments, and categorized them to four categories of the original LAN APM Framework. (Boy, you must be tired trying to remember all these acronyms and titles!)

Here are their results:

  • 43% of health care dollars in Category 1 (traditional FFS or other legacy payments)
  • 28 % of health care dollars in Category 2 (pay-for-performance or care coordination fees)
  • 29% of health care dollars in a composite of Categories 3 and 4 (shared savings, shared risk, bundled payments, or population-based)

Speaking of shared savings, an article in Modern Healthcare reported that CMS’ Medicare shared savings program paid out more in bonuses to ACO’s than the savings those participants generated.

As per the report, about 56% of the 432 Medicare ACOs generated a total of $652 million in savings in 2016. CMS paid $691 million in bonuses to ACOs, resulting in a loss of $39 million from the program.

Chief Research Officer at Leavitt Partners, David Muhlestein said, “Medicare isn’t saving money.”

This is attributed to the fact that 95% of the Medicare ACOs (410) participated in Track 1 of the Medicare Shared Savings Program. Only 22% participated in tracks 2 and 3.

Two more articles go on to discuss a Medicare bundled-pay initiative and the Medicare Merit-based Payment System (MIPS) .

What does this all mean?

It has been long apparent to this observer that the American health care system is a failure through and through. Sure, there are great strides being made daily in new technology and therapies. A member of my family just benefited from one such innovation in cardiac care. But luckily, they have insurance from Medicare and a secondary payor.

But many do not, and not many can afford the second level of insurance. From my studies and my writing, I have seen a system that is totally out of whack due to the commercialization and commodification of health care services.

And knowing a little of other Western nations’ health care systems, I find it hard to believe that they are like this as well. We must change this and change this now.

If Medicare is losing money now, with the limited pool of beneficiaries, perhaps a larger pool, with little or no over-regulation and so many initiatives, models, and programs, can do a better job. Because what has been tried before isn’t working, and is getting worse.

The logical thing to do is to make a clean break with the past. Medicare for All, or something like it.

 

 

Another Scheme to Delay the Inevitable

After my last post on my personal health issue and the debate over the health care bills that now have been shelved, I thought I’d share with you the following article in its entirety that is just another scheme to delay the inevitable fact that we will need and have a single-payer, Medicare for All health care system.

The article came to me courtesy of Don McCanne, former President of Physicians for a National Health Program (PNHP).

Here is the article:

Healthcare Dive
August 2, 2017
Health reform driving payer-provider partnerships
By Les Masterson
Payers and providers have for decades stayed in their silos, leading to a more fractured and adversarial healthcare system. That relationship, however, is starting to soften for many in the industry. Payer-provider partnerships put the two groups on the same team in hopes of reducing costs and improving care and outcomes through sharing data and better communication.
A major driver of these partnerships is the move away from fee-for-service payments and toward valued-based payments and population health management.
The payer-provider partnerships popping up across healthcare vary in type, size, location and model. There are 50/50 joint ventures with co-branding, and less intensive partnerships like accountable care organizations (ACO), patient-centered medical homes (PCMH), pay for performance and bundled payments.
The first step in these partnerships is building trust between payers and providers.
Another key is communication. (Chuck Lehn, president of Banner Health Network) acknowledged that communicating across systems and platforms between two organizations and healthcare providers requires time, attention and resources.
Caring for the whole patient works best when payers and providers share data, so there is improved care management, better interventions and better analytics around population health.
The two sides can go much deeper into care for patients by going beyond claims. In partnerships, payers shouldn’t have to wait for claims to see how their members are doing and doctors shouldn’t have to hope that their patients tell them when they have received care elsewhere.
In addition to regular back and forth, payers and providers need regular meetings, whether monthly or quarterly, that focus on strategic issues about the partnership, said (James Leatherwood, marketing communications manager at Availity).
One barrier that still needs resolution in partnerships is moving providers away from phone communication.
Leatherwood said a more efficient way is a queue system. In this system, a provider could check the status of all claims and get alerts when they need to provide more information. The system would allow providers to look in one queue, update the claims information and then move on with their day. Payers would have their own queue and would get alerts when providers have questions. This would reduce phone calls and create immediacy.
Leatherwood said the healthcare system is stuck in a “chart chase” between providers and payers, and moving to an automated queue system would be a gamechanger.
“I think in the near-term what we’re going to see is larger healthcare providers are going to be more strategic, working directly with payers. The health plans are going to be more interested not just in working with the staff level, but executive levels,” said Leatherwood.
The third part of a successful partnership is aligning incentives that focus on keeping people healthy and creating a positive healthcare experience, said (Thomas Robinson, partner at Oliver Wyman).
Partnerships must provide patients the right incentives, integration, investment, insight and innovation to work with the plan to deliver improvements across cost, quality, outcomes and experience, said Robinson.
“The point of these partnerships is to create something new, rather than just building the same old offerings with a narrow network. Successful partnerships will take the opportunity to innovate around the product and experience now that the incentives, insight, investment and integration are all for it,” said Robinson.
Aetna and Banner Health agreed on the partnership in October 2016 and have been laying out the groundwork before its launch this month in Maricopa and Pinal counties in Arizona. The two companies hope to expand the program statewide ultimately.
To prepare for the partnership, Tom Grote, who became CEO of Banner/Aetna joint venture in May, told Healthcare Dive that Banner Health and Aetna have developed joint operating committees, including marketing/sales and population health, that include members from both organizations.
The partnership looks to improve consumer experience by fully integrating providers, Aetna and administrative services, while eliminating redundancies in care and administrative problems. Aetna and Banner Health expect streamlining care and services will lead to savings for patients and employers.
(Brigitte Nettesheim, president of transformative markets for Aetna) said the partnerships are about “each side playing to its strengths, aligning incentives and driving scale.”
(Tom Leyden, director II of the Value Partnerships Program at BCBSM) said providers want to be active participants in system transformation.
“This requires ongoing support from the payer and demonstrated evidence of practice transformation and clinic results from the provider community,” said Leyden. “Administration of these programs is an integral aspect of measuring performance.”
Leyden said the payer strives to make the programs as manageable as possible because physicians need to perform many administrative tasks on an ongoing basis. BCBSM regularly solicits feedback from providers during quarterly meetings and phone calls, emails, webinars and in-person meetings on what’s working, what’s not and what needs to be changed.
“If we keep the customer — the end user — in mind and build partnerships with that as our North Star, we believe we will have a more successful, efficient and collaborative health system,” said Grote.
McCanne says they are the ones who control the medical industrial complex, and are part of the problem with our health care system. I agree.
And finally, here is a video from MSNBC with Ali Velshi debating a GOP’er on single-payer and Canada. The GOP’er says Canadians flock to the US for medical care, namely surgery, but Velshi disputes that rather forcefully.
Until we get these defenders of the status quo removed from Congress, we will never have the kind of health care all other developed nations have.
Health care is not a business, health care is a human right.

Deaf, Dumb and Blind, part Deux

Back in June, I wrote a post with the above mentioned title. Then, I was on a rant, now I am just reporting what my fellow blogger, Joe Paduda has written about today regarding a report from the U.S. Department of Labor (DOL) on the various state workers’ compensation systems.

This report harks back to one conducted in 1972 on the state of workers’ compensation then, but as Joe points out today, seeking a return to that Commission report and to that decades-old recommendations is absurd.

Rather than give you my take on this meeting from yesterday, here is Joe’s article. I always give credit where it is due, and he is due a lot of credit for his reporting.

It would seem that not only is the workers’ comp industry deaf, dumb and blind, but so is the federal government, if we are to take Joe at his word.

And in the meantime, who gets hurt while these eggheads, bureaucrats, nincompoops and sticks-in-the-muds do more study, research, look back forty years and pine for an economy and workforce that no longer exists? The injured workers.

And who, in the meantime, while the insurers, employers, and various stakeholders gouge and game the system, gets hurt, disabled or even dies? The injured workers.

It seems to me that the only thing that matters to the eggheads, bureaucrats, nincompoops, sticks-in-the-muds, insurers, employers, and various stakeholders is, how to screw the worker, save money by not paying adequate wages and benefits, make more profits off of someone’s disability, and not the care and treatment of the one who is disabled and forced into poverty.

Here is the perfect example of the state of affairs in workers’ comp, both inside and outside the industry:

hear-no-evil-see-no-evil-speak-no-evil