Ilovebenefits’s Blog

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Moving from Fee for Services

Editor’s note: It is critically important that we move the reimbursement system from fee for services to fee for care. A movement in that direction is bundled services, but it has to be more than that. Payment has to involve information about efficient process, quality, and outcomes. Otherwise in the words of Demming, “If you only focus on the ends, you may get it in ways you never intended.”


Expert: U.S. is on path toward health care payment reform
More than a dozen health care payment reform efforts are under way around the U.S., according to Karen Davis, president of the Commonwealth Fund. She told a conference that the country is on a path away from fee-for-service and heading toward bundled payments that go beyond pay-for-performance models. Healthcare Finance News (3/12)


March 15, 2010 Posted by | healthcare, insurance, Plan design | , , , , | Leave a comment

Helping with Your Benefits Challenges

Please check out the web site

Healthcare Benefits Network – Experienced healthcare consultants transforming the medical benefits industry.

March 14, 2010 Posted by | Benefits, Cost, Electronic health records, health information technology, healthcare, hospitals, insurance, Pension, Plan design, Prevention and Wellness, retirement, Technology | , , , , | Leave a comment

The Solution To Lowering Healthcare Costs? Keep Your Employees Healthy.

Daniel Touizer

January 27, 2010

Daniel Touizer is Founder and CEO of Cinergy Health

Healthy Americans may account for only 8 percent of the population, but these 24 million people are the answer to saving America billions of dollars on unnecessary health care expenditures each year. More than 40% of premature deaths in the U.S. are a result of unhealthy behaviors like obesity and smoking. These habits are costing Americans $100 billion to $150 billion a year!

As a result, healthcare costs are higher than ever and the increased prices have forced many business owners into bankruptcy. So what is the solution to lowering healthcare costs? Take the steps to encourage your employees to make better lifestyle choices. Companies must acknowledge the health problems affecting their employees and implement programs to solve them.

February 10, 2010 Posted by | Cost, healthcare, Plan design, Prevention and Wellness | , , , | Leave a comment

Projected Health Care Cost Increases for 2010

Editor’s note: Here are the projected cost increases for HMO type coverage for 2010. Note that these numbers are before plan design changes. Design changes generally shift cost to the insured either in the form higher copays, deductibles or a reduction in the coverage itself. So, generally speaking the actual cost increases in premiums will be less when actually implemented for 2010.


HMO Rate Increases Expected to Remain at 11.8 Percent in 2010

According to data released by Hewitt Associates, HMO rate increases by region have stabilized for 2010, with less variation by region relative to the national average HMO increase level. Preliminary* HMO rate increases by region for 2010 are as follows:

  • West: 11.1%
  • Southwest: 14.0%
  • Southeast: 13.2%
  • Northeast: 11.3%
  • Midwest: 12.5%
  • National: 11.8%

*Preliminary HMO Increases are before plan changes, negotiations and terminations; data as of July of each renewal cycle.

Source: Hewitt Associates, July 15, 2009.

July 20, 2009 Posted by | Cost, healthcare, Plan design | , , | Leave a comment

What Kind of Health Care Do Congress and Obama Get?

Read this article if you would like to see the kind of health care that Congress and the President get.

July 20, 2009 Posted by | Federal Government, healthcare, Plan design | , , | Leave a comment

Health Care — What Washington is Selling

Buyer Beware: When you strip away all the talk, all the bills, is what Washington really selling HMOs of the 21st century? Capitation, patient-centered (around a primary care doctor) care…

July 20, 2009 Posted by | Federal Government, healthcare, Plan design | , , , | Leave a comment

What Will Happen to Provider Reimbursements

Editor’s note: It appears that if President Obama has his way provider reimbursements will come under Executive Branch control. They report that they want to do this to control the cost of services rendered.

So, two things then follow:

1) They intend to reduce or reduce the rate of growth of government reimbursements. This will shift more cost to the commercial (private sector)

2) If the is a public plan, it will have lower reimbursement rates (i.e., overall costs to consumers) and therefore in none too short of a period eliminate private plans.

But, he promised you can keep your plan if you like it. You won’t like the price so you will move into the public plan with its plan provisions. Will you fully understand the implications of those provisions? Do you understand the provisions of your current plan? I suspect not.


Obama Eyes The Purse Strings for Medicare

Washington Post
Shailagh Murray

July 16, 2009

At the same time President Obama is asking members of Congress to take one of the most politically difficult votes of their careers, he is also pressing lawmakers to give up one of their most valued perks of office: boosting Medicare payments to benefit hometown providers.

Setting reimbursement rates for local hospitals, doctors, home health-care centers and other providers is a legislative ritual that amounts to one of the most effective and lucrative forms of constituent service. Delivering federal money through Medicare, the country’s largest insurance program, can be a powerful tool on the campaign trail, allowing lawmakers to argue that they are creating jobs and improving the quality of health care for voters.

Longtime members of Congress have become masters at dominating the tug of war between keeping providers flush and trying to rein in the entitlement program’s dramatic growth. House Ways and Means Chairman Charles B. Rangel (D-N.Y.) champions New York City’s teaching hospitals. Charles E. Grassley (Iowa), the Senate Finance Committee’s ranking Republican, makes sure rural health-care services are amply funded. Months before Sen. Ted Stevens (R-Alaska) left office, he secured a permanent 35 percent increase in Medicare payments for Alaska physicians.

Obama administration officials say they are determined to stem soaring Medicare spending, arguing that it is a root cause of the broader health-care crisis that they are trying to address with Congress. Behind the scenes, Obama is pushing for a mechanism that would take Medicare payment authority out of the hands of politicians and invest it in a separate entity, possibly under the executive branch.

July 16, 2009 Posted by | Cost, Federal Government, healthcare, Plan design | , , , , | Leave a comment

Patient Satisfaction with their Health Plan

Editor’s note: Apparently people are having a better experience with Medicare type plans than private plans. This does not, however, lead to any other conclusion. It doesn’t follow that people are getting better care. It doesn’t follow that Government reimbursement controls have no effect on the supply of physicians and health services. This information is only what it is.

 According to a 2007 survey of elderly Medicare beneficiaries: 

  • Only 8% rated their insurance as “fair or poor,” compared with 18% of those with employer insurance. 
  • Only 32% reported at least one negative insurance experience, compared with 44% of those with employer coverage. 
  • Only 10% said that their physician didn’t take their insurance, compared with 17% of those with employer coverage.

Source: “Meeting Enrollees’ Needs: How Do Medicare And Employer Coverage Stack Up?”, Health Affairs 28 Number 4, May 12, 2009, 

May 28, 2009 Posted by | Economics of Health care, Federal Government, Health care delivery, Plan design | , , , , , | Leave a comment

Paying for Telehealth

Editor’s note: As payment for care evolves there needs to be focus on altering it in ways that will spur creative disruption. It is creative disruption that will spur improved efficiency, effectiveness and hopefully improved health status.   

House bill would expand Medicare telehealth coverage
The U.S. House is considering a bill to expand Medicare reimbursement for telehealth services to urban and suburban areas. It also would expand the types of facilities eligible for payment.Health Data Management 

May 16, 2009 Posted by | Cost, Creative disruption, Health care delivery, Plan design | , , , | Leave a comment

Catastrophic coverage may be financially catastrophic

Editor’s note: Beware of catastrophic plans. Will people be able to afford the costs up to the catastrophic point? Instead these legislators are worried about a $1 levy.

Bill Would Provide Insurance Pool For Catastrophic Health Care

The Hartford Courant
Diane Levick

May 14, 2009

Smiles and chuckles are about the only things that come easily to 21/2-year-old Evan Kreighbaum of Stratford, who was born with a floppy body from a muscle condition that makes him so weak that he’s needed tubes to help him breathe and eat.

His medical needs are so great — physical therapy twice a week, 16 hours a day of nursing care at home, numerous medicines — that they’re costing the family up to $600 a month now, even though they have insurance. They’ll face much heavier expenses once the insurance benefits are exhausted.

Others like Evan — whose coverage falls far short — are a crucial part of the epic debate over comprehensive health care reform at the state Capitol and in Washington, D.C.

Among the many ideas in the patchwork of reforms is a “catastrophic medical expenses pool” advancing through the Connecticut legislature to help some insured families meet their kids’ vast health needs.

The pool wouldn’t be state-financed but would raise about $2.5 million a year through a $1-a-year levy on each state resident who’s covered by private health insurance.

“There are pockets of need that are narrow but deep,” said Kevin Lembo, state health care advocate whose office would administer the unusual pool.

But $2.5 million won’t go very far, and the legislation isn’t a slam dunk in a time when many people are watching every penny and are wary of new programs under state auspices.

Although Deputy Republican House leader Themis Klarides says she’ll probably vote in favor the bill, she predicts some colleagues may object to the $1 levy, which could be viewed as a tax.

May 14, 2009 Posted by | Cost, Economics of Health care, Plan design | , | Leave a comment