2018 October

Doubling Down

Why are Americans doubling down on a broken healthcare system?

The current healthcare system is commonly referred to as broken, it’s rife with fraud and abuse, it has little transparency – yet we expect people to act as consumers.

Here’s just a few clips from Axios that has to make you wonder.

1/ Both Democrats and Republicans support Medicare Advantage, so the enrollment wave likely won’t subside in the near term. But there are still deep concerns about insurers gaming the program.

2/ The entire Medicare Advantage industry — estimated to cost the federal government $250 billion in 2019 — remains under the microscope for gaming the payment system. Dialysis chain DaVita agrees to pay $270 million to settle allegations of fudging claims billed to Medicare Advantage plans.

3/ Getting an unexpected bill for thousands of dollars is a gut-level problem. Yet that problem is a product of the health care system’s complexity, and every potential solution runs into roadblocks: from an industry that wants to protect its profits; or skepticism from policy experts; or political opposition.

4/ Balance billing is especially common for emergency-room care, where patients are often in no position to inquire about their insurance networks.

5/ Putting a stop to balance billing requires shifting the cost to someone else, or reducing the size of the bill, or both.



The definition of insanity is doing the same thing over and over again, but expecting different results. ~Albert Instein





Millennials may be rejecting the ACO model.

As prices for comprehensive health insurance increase, millennials seem to prefer on demand service purchased at time of service [aka: fee for service].

Primary care physicians work as the coordinator and gatekeeper in the ACO model. They care for, triage and refer patients to specialists as needed.

However, new reports indicate that most millennials don’t have a primary care physician. Instead they seek care on demand from walk-in clinics and urgent care centers as needed. Both are fee for service business models.

Millennials seem to be cost conscious healthcare consumers that will likely engage in care decisions and explore self-care solutions over traditional healthcare.

What we expect from millennials in 2019:

1/ Many millennial purchasing health insurance on the exchanges will purchase the Copper Plans over comprehensive coverage.

2/ They will continue to use the healthcare system as needed and pay on a fee for service basis.

3/ They will leverage technology to the fullest extent possible to manage their health, direct their care and store their health records.

What’s the impact to the exchanges?

The cost of comprehensive coverage is going up. Reportedly, the population covered is again using more healthcare expenses than expected.

The concern about the viability of the ACA comprehensive insurance plans seems to be playing out as many expected.

Post: Cost of Healthcare

Lower healthcare costs or jobs?

There is enough evidence now that the cost of healthcare in the US is driven by the fragmentation and the adverse demographics.

1/ Medical supplies cost healthcare providers 30-40% of their revenue and the cost of supplies are substantially higher than other developed countries. For example:

– Pharmaceuticals in the US cost 3x more than Britain and and 4x more than Canada.

Medical Devices cost 2 – 6x more than other first world countries.

2/ Billing and collections for services provided to patients cost healthcare providers between 6-12% of their revenue due to the number and complexity of contracts with insurers.

3/ The fragmentation in the payer market results in the coverage and  pricing variability in healthcare services that many American find confusing and alarming.

The increase in the cost of healthcare has returned to pre-recession levels of 4% which is largely driven by demographics:

1/ American’s population is aging slower than other developed countries but the 65-and-over population is projected to balloon from 48 million to 88 million by 2050.

2/ According to the CDC, the prevalence of obesity was 39.8% and affected about 93.3 million of US adults in 2015~2016. Obesity is now the #1 cause of cancer in women.

The flip side of is American jobs.

Learn More >

Post: Workplace Wellness

Fundamentals of wellness in the workplace.

Wellness is for companies of all sizes. It doesn’t take a lot of money to provide employees with a workplace that promotes wellbeing and empowers them to do their best work.

1/ Environment: The workplace itself matters. Fresh paint that enhances the light and a well organized space will promote a feeling of calm.

2/ Tools: Get creative. White boards and colorful markers are great tools to engage people in problem solving.

3/ Location: Reduce travel time. Incorporate collaboration tools to enable remote work and work from home programs.

4/ Travel: Reimburse and reward healthy choices. Allow for expenses the promote walking, healthy meal choices and exercise.

5/ Education: Provide a path for growth. Online education is an affordable way for companies to promote continuous learning.

6/ Coaching: Provide diversity and equality training. Appropriate behavior and conduct for the workplace needs to be defined so that people are clear about what movements like metoo means to them.

7/ Compensation: Provide equal pay for equal work. Compensation is the foundation of health.

Everyone wins with the fundamentals.