Quit Wasting My Healthcare

Silver Bullet for Lower Healthcare Costs

November 18, 2008 – 8:46 am by DrEric
I write that title somewhat facetiously.  Of course there is no silver bullet to reduce health care costs and improve quality--or in other words, increase healthcare value.  But there is one thing that is as close to a silver bullet as I can think of: Bring value to the exam room decision making process between physician and patient. That's where the rubber hits the road.  Currently, that decision making process is largely low value.  What do I mean low value?  (1) It does not bring to bear current clinical best practices and (2) it does not attempt to be cost-effective without compromising care.  Here is an example of (1)--a June 2003 study from the New England Journal of Medicine (http://content.nejm.org/content/vol348/issue26/) found that physicians only followed their OWN best practices 50% of the time.  That means, roughly, 50% of the time patients are getting short changed.  Now sure, sometimes best practices should not be applied to ...

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A Risk with Health Risk Assessments

November 13, 2008 – 9:08 am by DrEric
When I have met recently with employers, wellness companies and companies that perform biometric testing, the first thing that comes to mind it--this information would be very helpful for their doctor AND if they don't have a doctor, then they need to get one and take this information to him or her.  Knowing that a person has elevated cholesterol, blood sugar or blood pressure is a trigger to have that person see a doctor.  They may have genetically high cholesterol, a condition called familial hypercholestrolemia that needs medication treatment.  They may have diabetes and need to be on medication.  They may have high blood pressure that has already started to cause kidney damage and need to be on medication. I have seen too many instances were people had information about one of these conditions and thought they could treat it adequately with diet and exercise--or worse, they go on the internet and read ...

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The Doctor is In: Two questions to ask the doctor to save you money.

October 22, 2008 – 5:42 am by DrEric
An article in the New York times today reports on how the current economic situation is causing people to stop taking their medications.  http://www.nytimes.com/2008/10/22/business/22drug.html?hp I posted the following comment on that article's site: There are many things that physicians can do to effectively lower the out-of-pocket costs for their patients without jeopardizing their health--prescribe a generic, do a more detailed physical exam to avoid a CT scan or MRI, enroll the patient in a medical assistance program (there are many sponsored by local governments, charities and yes, even drug companies). For those who are struggling financially with their healthcare, please speak up. Ask your doctor, "how much is this going to cost?" "Is there a lower cost alternative that would work for me?" The article mentions Lipitor. The maker of Lipitor--Pfizer--has a pharmacy assistance program and there are $4/month cholesterol medications available at Walmart, Target and grocery store pharmacies that are effective as ...

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A Company Who Got it Right

October 9, 2008 – 1:52 pm by ScottSchoenvogel
The Wall Street Journal (Matthews) recently reported in its article: The Open Enrollment Season: Beware of Out of Pocket Costs (http://online.wsj.com/article/SB122348910616316019.html): "Briggs & Stratton Corp., a Milwaukee-based maker of small engines and lawn mowers, has done away with most co-payments in its main plans -- a standard preferred-provider organization and a high-deductible option. In the standard PPO, workers pay 20% for all medical services with providers in the plan's network, including doctor visits. That comes with an in-network, out-of-pocket annual maximum of $5,500 for an individual and $11,000 for a family. "There's a much better case for shopping around" among medical providers if employees are paying a percentage of the cost of care, rather than a flat co-pay, says R. Craig Reynolds, the corporate director of employee benefits." Briggs & Stratton has consumer alignment figured out and so can you.  Call Compass for assistance designing the right type of benefits for you and ...

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Economy Forcing Value Based Healthcare Decisions

October 8, 2008 – 6:21 am by ScottSchoenvogel
"The Employee Benefit Research Institute released its 11th annual Health Confidence Survey that found "a majority of Americans, 51 percent, want a 'major change,'...while 20 percent say that a complete overhaul of the health care system is necessary. Thirty-one percent would rate the American health care system as poor, and 29 percent would rate it as fair." The survey found that insured patients who experienced an increase in health care costs over the last year "are looking to cut costs themselves, with 63 percent saying they discuss treatment options more thoroughly with their doctor and 62 percent saying they go to the doctor only for more serious problems." Reported by CQ (10/8, Stanchak).

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The Doctor is In: Driving Value in the Pharmaceutical Industry

October 7, 2008 – 5:58 am by DrEric
I have previously written in favor of the use of generic medications as a way for patients and employers to save money on healthcare.  Even when a generic does not exist for a specific medication, often there is a generic available that is a therapeutic equivalent.  In my practice, when I feel as though a generic will do my patient just as good as a name-brand medication, I prescribe the generic.  It’s that simple. The question then comes to mind:  How then can the pharmaceutical industry with it’s higher-priced medications justify their use on a long-term basis for chronic conditions?  How can they show that their medications actually provide value and are cost-effective for patients and employers?  How can they partner with the other players in the healthcare system to be part of the solution to escalating healthcare costs and not be seen as draining patient’s and employer’s budgets?  The answers ...

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The Nature of Health Insurance

September 30, 2008 – 11:43 am by ScottSchoenvogel
Drew Altman from the Kaiser Foundation (http://www.kff.org/pullingittogether/093008_altman.cfm) does a nice job of tactfully raising the question whether it is better for the nation if employers and individuals shift to more catastrophic forms of health insurance (think high deductible) or whether the view that comprehensive coverage is the key to access and societal good health (think expensive).  While Compass is on the side of the fence that believes the true nature of health insurance should be more related to catastrophic events, I would offer the point that catastrophic health insurance is much more feasible from an access and society standpoint when you have health professionals helping individuals and employees gain access, find lower cost services, and provide understanding.  It is the underlying philosophy behind the Compass consumer support and cost control solutions.

Posted in Costs of Care, Health Insurance Premiums, Universal Healthcare | 1 Comment »

Cost Trends Moderate but Shift to Consumer Plans on the Rise

September 25, 2008 – 7:30 am by ScottSchoenvogel
See this recent article posted by the Associated Press: http://hosted.ap.org/dynamic/stories/H/HEALTH_INSURANCE?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2008-09-24-13-36-36 Consumer directed health plans jumped by 50% to 18% of total plans in the AP survey.  Employers are finding consumer directed plans or some sort of risk sharing to be their only option for controlling costs.  In either case, Compass provides the plan design and support solutions to make these alternative benefit strategies successful for both the employers and their employees.

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The Doctor is In: Free Samples Driving Up Costs

September 13, 2008 – 9:21 am by DrEric
One month's supply of Cozaar--$59.  One month's supply of generic Lisinopril--$4.  Ninety-five percent of patients on Cozaar could be on Lisinopril instead.   However, the majority of the patients I see in the hospital who have high blood pressure have been put on a class of medications called ARBs (Cozaar is an ARB) by their primary care physician.  Why are so many patients on the more expensive medication? I posed this question to one of the outpatient primary care physicians whose office is next to the hospital.  His answer was two words:  Free Samples.  Drug reps fill doctor's offices with free samples of expensive brand name medications.  If a patient needs a new blood pressure medication, the doctor just reaches for a month's supply of free samples, writes the patient a prescription for the medication for when the samples run out and then "abracadabra" the patient is on an expensive, brand name medication for a condition ...

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Politics of Healthcare Taxation

August 25, 2008 – 6:44 am by ScottSchoenvogel
At my last employer, an uninsured patient paid the hospital somewhere between 3 and 8 cents on every dollar of revenue.  It cost the hospital 40 cents on a dollar of revenue to treat that patient.  Although small, the hospital still turned a profit last year.  How?  The managed care rates paid by employers essentially include a "hidden tax" to cover these costs and pay hospitals significantly more than the cost of care.  This dynamic has effectively acheived a universal care model in the US. Since the healthcare system in the US is currently paying for emergent care for everyone, no matter what the ability to pay, and employers are already being "taxed" to cover this cost, why would anyone want to take away the healthcare tax deduction status for employers.  If anything, this status should be extended to individuals to level the playing field and encourage more investment by individuals ...

Posted in Costs of Care, Health Insurance Premiums, Universal Healthcare | 1 Comment »