Sunday, December 30, 2007
This posting, and the resulting comments, are interesting - but not surprising. Cigna has been in the news lately due to the news reports about the tragic death of a young girl who was denied payment for a transplant until it was too late. Cigna was the bad guy this time, but it could have been any "Payor," including medicare or medicaid.
The comments highlight the fact that people are frustrated by the US healthcare system - and should be. Our system is badly broken, and every part of the system needs to be involved in fixing it. To put it simply, our incentives are all wrong.
1. Insurance companies have every incentive NOT to pay for treatments that either are not covered under their plans (determined by Employers, in most cases) or are not deemed helpful or necessary (which I believe was the case in the recent Cigna example). A lot of people don't understand that their employers purchase specific services from insurance companies for a cost; often when a claim is denied, it's because their employer decided not to cover it when it bought the plan.
2. Doctors and Hospitals are incented to see lots and lots of patients, and to do lots and lots of tests and treatments. There are statistics* that indicate that millions of patients each year receive treatments that are medically unnecessary or unhelpful (or even dangerous). NOTE: As the son of a physician and a clinical psychologist, I know that 99% of doctors prescribe treatments that they believe are best for their patients. However, the system works against them just as it does for their patients. They're fighting an uphill battle.
3. Consumers have inadequte incentive to become educated about their health and treatment options, and typically have no idea what treatments are effective, which doctors and hospitals provide the best quality care for their needs, or what various treatment options cost. NOTE: Payors and providers have not done consumers any favors here; shielding them from cost and quality data and making it very difficult to access the right information at the right time.
I do not believe that simply socializing medicine is the best option; the only way to make things work is for all 3 groups to get together and align their needs in a new health care system. That's the reason that my company has started ChangeNow4Health [http://www.changenow4health.com/]. This is an open forum designed to give all the stakeholders in the system a voice in how to fix things.
Please understand that this is not an advertisement for insurance companies; my industry is as guilty as any of the stakeholders in the system (and perhaps more than most) in creating the system we have today. But no one stakeholder, including (and perhaps especially) the government, is positioned to come up with "the answer."
*The following is excerpted from the Agency for Healthcare Research and Quality's 2002 fact sheet, Improving Health Care Quality [http://www.ahrq.gov/news/qualfact.htm#Recent]
Overuse of services. Each year, millions of Americans receive health care services that are unnecessary, increase costs, and may even endanger their health. Research has shown that this occurs across all populations.
For example, an analysis of hysterectomies performed on women in seven health plans found that one in six operations was inappropriate. A study examining the use of antibiotics for treating ear infections in children on Medicaid found that expensive antibiotics were used far more often than indicated.
According to the findings, if only half the prescriptions written in 1992 for more expensive antibiotics had been written for amoxicillin, a less expensive but equally effective antibiotic, Colorado's Medicaid program would have saved nearly $400,000 that year
My company, Humana, is featured in the Courier Journal article. Our new lunch spot is terrific; it is ironic however that I learned 2 things in this article that I didn't know:
- There is an online menu available. Cool, but I had no idea (and don't know how to access the menu).
- That there is wireless access in the area. Humana has been diligent (to say the least) in not allowing wireless access to anything, anywhere on its premises. I am really curious to see whether this is really true, or is the result of some overzealous reporting.
read more digg story
Thursday, December 27, 2007
Since moving to Louisville in 2004, our family has been blessed by special visits from Santa Claus at some point during the week before Christmas. I am compiling a video log of all four visits, but here is the 2007 version for your edification . . . you can see why Christmas is so much fun in our house.
But it gets better! After Santa left, Ellie wanted to check the front yard for Reindeer tracks. We got out the flashlights and looked . . . and found something even better! Ellie found a leather strap covered with jingle bells, and an initial "B" branded into the side. Clearly, this was part of Blitzen's harness! This was a very exciting discovery. Fearing that Santa might need this important piece of equipment, Ellie left it out for Santa with cookies and milk on Christmas eve. But apparently Santa's elves had repaired the harness; she got to keep the piece that she found.
Wednesday, December 26, 2007
This nice article provides some closure around the tragic death of one of the great baseball figures of our generation. Hyperbole? If we just look at his performance on the field (stellar as it was), yes. But when you look at what Rod Beck represented to fans, and the man he was; no.
This is the guy who, when rehabbing in AAA (at Iowa) didn't live in a hotel. He lived in a motor home behind the centerfield fence. A motor home that was open to whoever cared to drop by and have a beer with him.
I was lucky enough to meet Rod Beck through a common friend on a few occasions. If you didn't know he was a world-class athlete, you could easily believe that he was a part-time hot-rod mechanic (which he was). I miss him a lot, and my prayers go out to his wife and kids . . . this must have been a really hard Christmas for the Beck family. God bless you, Shooter.
Sunday, December 23, 2007
I loved this article. This retired Louisville-area farmer has rehabbed thousands of used bikes to be donated to underprivileged kids.
My company, Humana, is building a bike-based program called Freewheelin, and I would love to see if we might be able to incorporate a program like this nationwide. If we could train some of our 22,000 associates around the company to rehab bikes, or engage them in distributing them through inner city schools, it would be fantastic. What a great way to get kids off of the couch and out exercising!
I am really eager to get this business of the phone calls behind us. I continue to be really disappointed in the fact that Sampson didn't get this right. How is this not a top priority? And how long will it be before we can trust KS again?
I'd like to believe that this is an honest guy. He seems to be disciplining his players appropriately, and I hope that they are learning that IU plays the right way - on and off the court. But how long 'til we're sure? Now, it's going to be at least one more recruiting season before we know. It doesn't help that Sampson, IU and the NCAA are keeping mum on the subject.
Avery shows off her best vocal skills. She attempts here the tremendously challenging "More than a Dream" from Disney's acclaimed direct-to-video release of "Cinderella III." She also does a few bars of "The 2nd Star to the Right" as a vocal exercise.
In this blog, I'll be sharing thoughts and info about my family, my friends, my work . . . in fact, whatever interests me. That means that you'll probably see lots of stuff about kids, baseball, Indiana University basketball, and the consumer movement in Health. You'll probably also see some stuff on the relationship between church and state, religion and politics, spiritual and secular, etc.
Anyway, I hope that you enjoy . . . and I always welcome your comments and questions.
See you soon,