AHIP Releases Health Reform Recommendations: Read the Condensed Version Here

Read the America’s Health Insurance Plans' (the association that represents the nation's health insurers) comprehensive reform proposal here – or, speed read this exclusive Disease Management Care Blog summary. Go ahead, call them self serving, call them obstructionist, call them names but unless these guys are at the table, meaningful health reform is going to be very very difficult. What's more, if you're going to expand insurance, it makes sense to listen to these guys. They know what they're talking about.

Here's the summary. Ready? Go....

Reduce projected costs though evidence-based medicine, reward quality, streamline administrative processes (1), wellness, prevention and chronic care coordination, uniform quality reporting standards, an advisory group (2), an ‘independent comparative effectiveness entity’ (3), strengthened public health infrastructure, combining a community rating with individual mandate (4), tax equity for individuals and small businesses, high risk pools, tax credits, essential benefits plan (5), transparency, first do no harm to the large employer market, avoid unintentional cost shifting, strengthen public programs and partner with the States.

There. You're all done. Now here are 5 details that the DMCB thinks are interesting:

1. Multi-payer portal: instead of dealing with differing billing formats, AHIP’s members are apparently agreeing to share a one-stop web site which would simultaneously handle multiple health insurers. This would reduce the administrative hassles for the physicians. Ironically, this probably represents an additional short term cost for the insurers, who would need to alter their billing work flows. It would need to be outsourced to a third party so that the insurers couldn’t “peek” at each other’s fee schedules. Care to guess if Medicare FFS is going to participate?

2. Public private advisory group: Rather than an all powerful ‘Health Fed,’ AHIP is respectfully disagreeing with and Senator Baucus and former Senator Daschle. They’d rather have an entity develop recommendations on slowing spending, rewarding quality and reducing administrative costs (like the ‘portal'). Recommendations are easier to ignore or modify than Federal regulations.

3. Independent comparative effectiveness entity: You can bet the health insurers would like this. Contentious and sometimes embarrassing coverage decisions/denials over ‘medical necessity’ and the possible ‘investigational and experimental’ dimensions of treatment would become much easier to manage. Count them as being on the NICE bus.

4. Community rating and mandates were covered here. As a regular reader, you’re already expert on this.

5. Essential Benefits Plan: a not so bare bones but minimalist high deductable-health savings account insurance thingy that meets one of the DMCB’s recommendations: the purpose of health insurance is to reduce the likelihood of a financial catastrophe due to unexpected illness, not meet countless mandates.

Medicare Fee Schedule Cuts, Private Fee For Service, the AMA and Hand Gestures

The Disease Management Care Blog thought Karen Ignagni had cornered the hand gesture market. Ms. Ignagni’s classic two-handed chops, sweeps and grabs in her speeches not only help emphasize her points, but remind the DMCB of a martial artist's kata. Observe Ms. Ignagni’s interview here (once the initial question is over) and this classic kung-fu exercise and see if you can tell the difference.

Well stand back, because Nancy Nielsen, MD, President of the AMA has her own repertoire of jabs, pokes and pushes that accentuate her organization's considerable annoyance at the U.S. Senate’s recent failure to cancel a scheduled 10.6% fee schedule cut by transferring the necessary funding from the private fee for service (PFFS) Medicare plans. Dr. Nielsen and Ms. Ignagni obviously stand on opposite sides on this issue, and the DMCB recommends someone get these two experts together not only for what would be a hugely educational discussion but for an equally entertaining hand gesture smack-down.

Want to learn more about this Republican-Democrat health care kerfuffle? In the opinion of the DMCB, the best summary can be found here at the Health Affairs blog site.

But the DMCB wanted to learn more about hand gestures. This is an excellent article from Scientific American that explains speech and hand gestures are hard wired together in humans. For example, babies who have not yet learned to speak use gestures, while persons with damage to the brain’s ‘speech centers’ lose their ability to interpret gestures. In addition, humans (and primates) are vicariously endowed with ‘mirror neurons’ that are not only activated when we perform a movement but when we observe another person performing the same movement. Numerous studies that have shown speech plus gestures results in far better communication than speech alone.

In fact, this hand-speech connection may be so hardwired, that having your mouth say one thing and your hands do another can be a telling clue to an audience that something is amiss. Unsurprisingly, the best medium for observing this mismatch can be found in politics. Not getting this right can make all the difference in a contender’s career, which is why considerable time and effort may be needed to tie a speech and the movements ‘naturally’ together.

In the meantime, the DMCB has trouble understanding what the Medicare physician fee schedule has to with Medicare PFFS. It has to admit, however, that tying them together and forcing the PFFS supporters to vote ‘against physicians’ was a stroke of partisan genius. Too bad it’s also another example of the manipulative gamesmanship that can get in the way of real health care reform. To the folks in Congress, here’s a gesture from the DMCB to all of you.

'Adopt' versus 'Release.' What AHIP Really Says About the Patient Centered Medical Home

Hat tip to Modern Health Care Online with their June 26 story that ‘AHIP adopts principles on patient centered medical home.’ Interestingly, the AHIP press release does not use the word ‘adopt,’ as in ‘accept,’ ‘support,’ ‘embrace,’ ‘desires,’ or ‘likes.’ Rather, the document itself is a carefully crafted and rather cautious outline of what the risk-bearing health insurers think about this topic at this time. Read it for yourself here and/or consider these quotes (bolding mine) and decide for yourself:

'The Patient centered Medical Home is a promising concept that would replace episodic care.'

'Even though many clinical setting can potentially constitute a patient centered medical home, we believe certain principles are crucial…'

'….ongoing market experimentation regarding designing and implementing the medical home, our community has made a commitment to work collaboratively with other stake holders…..'

'The medical home is not a concept designed to provide one standard of care process…..'

'Learning collaboratives, both physical and virtual, should be encouraged as a way to share early successes….'

'Clinicians…should commit to being accountable for improving clinical outcomes and patient experience, appropriate utilization… and ensuring transparency.'

'The benefits of a medical home only [sic] will be realized if both clinical practice and consumer behavior evolves….'

And what the DMCB thinks is a bottom line:

'Pilot testing…. should be completed before the patient centered medical home concept is broadly implemented to determine which approaches are most effective. Research is needed to determine a sustainable framework for improvement of clinical outcomes, ways to ensure long term affordability for patients and the best methods for implementation to ensure a stable infrastructure that prioritizes improved health outcomes.'

The verb used in the AHIP headline ‘releases.’ Sorry, PCMHitzens, you still have some work to do before the insurers will start cutting checks.