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In the past two weeks I have visited two college campuses---one in Brooklyn and one in Wisconsin.' Large numbers of students turned out to hear about the new reform law and wanted to know what it meant for them.'
Do you have your prescriptions filled through a mail-order pharmacy? You are not alone.
Throughout the long debate over health reform, the president told us if we liked the insurance we had, we could keep it.' No government would come between us and our health coverage!'
The new health reform law is what I like to call an 'over-the-line proposition' because undoubtedly, someone is going to be left out. ' What passed the Congress will not bring universal health coverage to America; nor does it assure that everyone is entitled to health care as a matter of right.' It simply adds more people to the current system by giving them subsidies to buy insurance they couldn't otherwise afford.' In such a system, there will always be people over the line'they won't qualify for this subsidy or that program either because the government limits its spending on them, or it wants to encourage people to use private insurance to keep those markets strong.
Obama administration officials and the president himself have been on the road selling the benefits of health reform.' The other day in Maryland the president was touting the $250 rebate sent this week to some three million Medicare beneficiaries whose prescription drug expenses have reached the infamous donut hole where there is no coverage.
Do consumers buy health insurance like they buy canned peas? Or should they? That's the big question market place advocates have been trying to answer now for more than a decade. The government and others have thrown gobs of money at this vexing problem trying to figure out the best combination of stars, bars and other symbols that will catch the shopper's eye.
I just completed a series of radio and TV interviews about the extent to which people participate in their health care you know, those three-questions-in-90 seconds blips that currently constitute news for the viewing/listening public.
Have you noticed that when health experts discuss the high cost of care, they often assert that our demands for more and more advanced -- care are driving the upward trajectory of its cost?
A young friend showed me her Explanation of Benefits from Empire Blue Cross Blue Shield. "I don't really understand it," she said. This woman has a master's degree from the London School of Economics but couldn't comprehend what her insurance carrier was telling her...
Dianne Cooper Bridges, a feisty health reform activist in Massachusetts, recently found herself in the hospital for a routine consultation with no tests or procedures. Because Bridges, a self-employed designer, refuses to buy the required health insurance in her state, she has no insurance and occasionally pays a fine. That means she shops carefully for medical care, which she pays for in cash. When she called the University of Massachusetts Memorial Medical Center and asked how much her consultation would be, the hospital quoted her a price between $100 and $200.
In his most recent blog, "How to Pick Good Health Insurance - Your Life Depends on It," Dr. Davis Liu emphasizes how important is it for us to evaluate carefully our health insurance plans. Liu points out that, unlike other companies or products whose efficacy may impact our lives modestly ' your car wash, dry cleaners and choice of movie theater ' the ranking of your health insurance plan relative to others impacts your life greatly. And not all health plans are created equal.
A colleague of mine, Cheryl, has been trying to help a solo physician address a thorny issue. Through the use of 'How's Your Health', an amazing Web-based suite of health and practice tools, the physician realized that many of her patients struggled with maintaining an adequate income. Cheryl went looking for some ideas for the physician, and she came across this: Health Providers Against Poverty, an Ontario-based group that has a toolkit to help primary care professionals address poverty issues.
Some broad questions about how bad it is to be big are raised by the government's new antitrust suit against Blue Cross Blue Shield of Michigan, which allegedly used its market dominance to force hospitals to charge other insurers a third more than the insurance giant paid. One can see how this could help the nonprofit Blues control the market, but it is difficult to determine how this was in the public interest ' or even advantageous to those it was covering.
Federal and state government officials and their opponents in the insurance industry have been busy as beavers these days chewing on that perennially vexing problem: how to disclose insurance information so consumers will be wise shoppers. Since we have a market-based model of health insurance, that's not a frivolous question. What works best, what doesn't, and what do consumers acting as shoppers really care about?
The decision by Metropolitan Life to stop selling long-term care (LTC) insurance once again calls into question the viability of that product as a way to pay for nursing home, assisted living and home care needed by the growing number of elders. MetLife was a solid company'big and reputable, with a knack for selling policies to workers whose employers offered the coverage as an extra benefit. It was a name that people trusted in an industry characterized by many small sellers, some of whom became insolvent.
My friend Ariane Canas, a New York City hairdresser, was eager to tell me about a new health insurance policy she had come across. It was cheap very cheap as such coverage goes. I knew that she and her husband, who is also self-employed, had gotten a notice this fall from their current carrier advising of a 33 percent rate increase.
Oh, those clever insurance agents, always on the prowl for new customers. This time they are using the current period of open enrollment for Medicare to snag customers for other insurance products'products that consumers may not need or want.
Health care reform is a hot topic with yesterday's court ruling that a portion of the Affordable Care Act is unconstitutional.
The new health reform bureaucracy at the U.S. Department of Health and Human Services has announced that it will now require employers, health insurers and union welfare benefit funds to disclose to policy holders that the health insurance they have may not be real health insurance at all. They now have to tell us if their coverage does not meet minimum benefit standards required by law and by how much they fall short. So those who have mini-med policies will now get a notice telling them that their policies cover very little. As if people don't already know.
As Medicare's open enrollment season draws to a close, it's a good bet that seniors are still sifting through all those brochures and flyers that have come in the mail the last several weeks. My husband received 22. Here's a simple rule to make the sifting go a little faster.
An inside look at the cost of health care: a physician confused by the transparency of Medicare reimbursements and a patient in San Francisco unable to afford treatment for an enlarged prostate.
Cost-cutting measures are creeping into the medicine cabinet. We split pills in half or take the drugs every other day to stretch our doses. We stop filling the prescriptions for our most expensive drugs. We buy prescriptions from online pharmacies with questionable credentials. As patients pay more for their prescription drugs ' whether it's through higher insurance co-pays or shouldering the full costs ' many people decide to opt out of taking the drugs altogether. But there are safer ways to cut costs than skimping on ' or skipping 'the medicines you need.
'How to Haggle With Your Doctor' was the title of a recent Business section column in The New York Times. This is one of many similar directives to the public in magazines, TV and Websites urging us to lower the high price of our health care by going mano a mano with our physicians about the price of tests they recommend and the drugs they prescribe. Such articles provide simple, commonsense recommendations about how to respond to the urgency many of us feel ' insured or uninsured ' to reduce our health care expenses.
Someone I know who is just over 65 received an unlikely solicitation'from The Scooter Store located in New Braunfels, Texas, on Independence Drive no less. The outside of the envelope promised a free personal mobility assessment. This person is totally mobile and hardly needs a scooter.
While access to health insurance is a critical component of finding good care and making the most of it, being insured is often just the starting point for frequent users of health care services.
The rapid changeover from traditional mammography'pictures taken with film'to the new digital imaging technology poses a thorny dilemma for women, especially those over 65. The scientific evidence suggests that digital mammography does not improve the detection of breast cancer in older women.
Ask someone what he or she remembers Obama promising during the great health reform debates, and the response might be: 'We can keep the insurance we have.' The president did offer assurances that there would be no socialized medicine with the government dictating where you could go for care. He did not mention, though, that many insured people already have little say in what kind of coverage they get and who can treat them.
In a previous post, I talked about what happens when a radiology practice goes digital for mammography, even though there's scant evidence that more-expensive digital is better than cheaper film for detecting cancer in older women. Yet the higher-priced costly procedure is winning out. That's pretty much the norm for U.S. health care, for instance, when ThinPrep replaced the conventional method for doing Pap smears. I used to pay $9 for the test; the one I had last summer cost $250.
This week's roundup features the patient voices of Brad Wright and Monte Jaffe and the decisions they made when faced with expensive health care costs.
In a development so predictable that it hardly merits being called news, American health care costs continue to rise and opponents of the new health reform law say the Obama plan is to blame. Some small employers report massive insurance premium increases.
During the health care debates, didn't you hear the president repeatedly tell the crowds that reform would mean that people would no longer be forced into bankruptcy because of illness? Insuring people who previously had no insurance does give them a cushion of protection and will mean that some of them will avoid bankruptcy court'but not all.
About 30 years ago I had my first run-in with code creep. A urologist I had visited for a garden-variety urinary tract infection billed $400 to determine that this was what I had. The price seemed excessive, and then I looked at the bill. The good doctor has 'unbundled' his services. He charged for every single thing he did'inserting a catheter, taking a urine sample, writing a prescription and finally adding a fee for a general office visit. I had thought all those things were part of the office visit. I protested. He reduced his charges, and I never went back.
This is the first in a series of posts that examine the process of signing up for Medicare, navigating its rules, choosing supplemental coverage and planning for health care in a program with a very uncertain future.
Health economist and management consultant, Jane Sarasohn-Kahn, discusses a Mayo study which found half of people in the study stopped taking their statins due to cost. Sarasohn-Kahn says, 'Welcome to world of self-rationing in health, where even the lucky health citizen receiving the best acute care money (and third-party health insurance) can buy doesn't follow through with the recommended self care at home.'
Even before I officially signed up for Medicare, sellers of Medicare Advantage plans, prescription drug benefits and Medigap policies began stuffing my mailbox with marketing brochures and lead cards'the kind that ask for your name and address and tell you that a salesperson will call if you return the card. Since the first of the year, I have received five lead cards asking for personal information, four solicitations for Medicare Advantage plans, two for stand-alone drug plans and three for Medigap insurance.
The first step after reading my collection of Medicare Advantage, prescription drug, and Medigap sales brochures was to find a way to fill in core Medicare coverage gaps'the deductibles for hospital stays and doctor care and the coinsurance for physician visits, lab tests, and hospital outpatient treatment that could really leave me with an unwelcome bill. I would have to pay 20 percent of those bills if I didn't have supplemental coverage.
If I were to choose a Medigap policy to supplement my basic Medicare coverage, I would still have to buy a separate plan for prescription drugs, since Medigap sellers can't include drug benefits in those policies.
Ah, those Medicare Advantage (MA) plans! The government can't seem to decide if it loves or hates them. On the one hand, when I tried to learn about my options, there was much more MA plan information available from the government than for traditional Medigap policies. So it seemed like I was being encouraged to select an MA plan.
Sara Collins of the Commonwealth Fund and veteran health care journalist Trudy Lieberman look at how the Affordable Care Act is and is not helping young adults stay covered.
Even though I have written about Medicare for many years, it wasn't until I actually went through the process of selecting an option to cover Medicare's gaps that I realized seniors have an extraordinarily difficult, if not impossible, task. You can't make a perfect decision because so much depends on your future medical needs and no one can predict those with certainty.
I once thought that when I signed up for Medicare, I would never again have to worry about paying for health care. But I will. Medicare's future shape and substance is uncertain.
The Costs of Care blog, "Hidden Costs of Medication", reinforces the importance of asking, 'How expensive is this treatment?" and "Is a less expensive option available?'
"There is a better way - structural reforms that empower patients with greater choices and increase the role of competition in the health-care marketplace." Rep. Paul Ryan (R-WI) August 3, 2011
. The highly charged political debates about reforming American health care have provided tempting opportunities to rename the people who receive health services. But because the impetus for this change has been prompted by cost and quality concerns of health care payers, researchers and policy experts rather than emanating from us out of our own needs, some odd words have been called into service.
Blue Cross just advised a twenty-six-year old woman I know that it will cut off payments for the physical therapy that was making it possible for her to sit at a keyboard for eleven hours a day. Her thirty sessions were up.
It's official now. The government has proposed that descriptions of health insurance policies will resemble those nutritional labels on canned and packaged foods'the ones you look at to find out how much sodium there is in Birds Eye peas versus the A&P brand.
I didn't expect to write a sequel to my seven-part series about signing up for Medicare. Just when I thought I was on the program, and all was fine, it wasn't. After I submitted two bills for routine exams, I learned Medicare would not cover them as my primary carrier. That threw me into a tizzy. All my years of reporting about the program taught me that once you retire Medicare is primary.
Cigna launched a $25 million 'GO YOU' national branding campaign last week signaling that they are gearing up for tons of new customers as health reform rolls towards 2014. That new business will come from the millions of Americans now uninsured who will start getting government subsidies as an encouragement to buy health insurance coverage.
While shopping in a market on an exotic trip, a friend of mine picked up an appealing item, but the price seemed high. When she paused to consider the purchase, the shopkeeper asked, 'Don't you want to know if I can do better?' But with health care, we can't predict what the final negotiated payment will be without knowing who is paying and what kind of bargaining position that person is in.
A couple weeks ago I walked the streets of Lincoln, Nebraska, talking to men and women about whether they thought Washington was listening to their economic concerns. Jeff Melichar manages his family's Phillips 66 gas station on the city's main street, and one of his big financial problems happens to be health insurance.
The Obama administration has dealt a mighty blow to one part of the health reform law by effectively killing off the CLASS Act, which was to be a baby step in the development of a national program to pay for long-term care.
The American people, long protected from the price of health care by insurance, are now forced to act as consumers. This situation is a free marketer's dream.
A couple of weeks ago, I was asked to speak as a patient about 'consumers and cost information' while being videotaped for use in the annual meeting of the Aligning Forces for Quality initiative funded by the Robert Wood Johnson Foundation. Here's what I had to say.
Who doesn't think preventive health care is important? Probably nobody if you ask this question abstractly. But when it comes to getting it - well that's a different matter.
Katie Ryan-Anderson, a health reporter at the Jamestown Sun in Jamestown, North Dakota, had a question. What did all that gobbledygook on the Explanation of Benefits (EOBs) from Blue Cross Blue Shield of North Dakota mean?
It's always interesting to watch health reform concepts move from policy shops and peer-reviewed papers into the mainstream. Provider report cards have surfaced in venues as diverse as Martha Stewart Living and The Examiner, a supermarket tabloid that promised to reveal 'America's 50 Best Hospitals.'
My wife and I are expecting our third child, and our new insurance plan requires us to pay 20% coinsurance for all non-preventive care. Given the rapid rate of health care inflation, we thought it prudent to find out how much it would cost this time around. So, we asked for an estimate of the charges. It seemed like a reasonable enough request'
It's said that time is money. In this case, health care insiders argue that Americans and U.S. health insurers are spending too much of both.
Harvard Pilgrim Health Care has moved deeper into the business of transforming health care into a commodity governed by the rules of the marketplace. Plan members can get cash rewards'.if they use facilities for outpatient medical procedures and diagnostic testing recommended by the health plan, not their doctors.
On a chilly New York day, a sales agent for UnitedHealthcare stood on a noisy street corner in Spanish Harlem pushing Medicare Advantage (MA) plans. He was engaging in table marketing a way to snag new customers, converts from other MA plans, he hoped.
Your parents still might be willing to do your laundry, but if you're over 18, they can't make your medical decisions. Are you ready to navigate the adult health care system? This updated Prepared Patient feature offers advice for young people who are just starting out in managing their health care, including information on important provisions from the Affordable Care Act.
I'm skeptical that price transparency about health services will make the health care market more competitive, more honest, or less dysfunctional. After all, health care simply does not work like other markets.
Labels describing key features of health insurance policies will become a reality this fall fulfilling a provision of the health reform law that called for more disclosure and transparency. The idea was to copy the labeling for food products'
Nora, a third year medical student, came to me in moral distress. Ms. DiFazio, one of the hospitalized patients on her Internal Medicine rotation, was frightened to undergo an invasive (and expensive) medical procedure: cardiac catheterization.
You may have seen the billboards or gotten a message on your smartphone: Come to our emergency room; our waits are short.
If you or a family member is on Medicare, you would assume that if they are in the hospital their care would be covered under Medicare's Part A hospital benefit. Right? Well, not always.
Last week's drama at the Supreme Court and most of the media coverage that followed omitted crucial information: how a decision either upholding or junking the Affordable Care Act (ACA) will affect ordinary Americans. Because the health reform law is not well understood by most people, it's worth recapping what might happen.
Several years ago, DeAnn Friedholm had to shop for her own health insurance. The prospective insurance company discovered she had had a couple of benign tumors more than a decade before and so denied her coverage because of her preexisting condition. Just like that, Friedholm had no good option for insurance in case she needed to see a doctor. Whether you are like DeAnn with a preexisting condition, are new to shopping for insurance or trying to figure out what coverage you do have, there are resources to help with this often complicated but important purchase.
The decision to buy long-term-care insurance and how long to keep it is among the toughest people make as health-care consumers. The product is difficult to buy'confusing, complicated, and costly.
Virginia was particularly concerned that she would not get medical treatment after she turns 75. She had heard at that age, 'they send you a letter. They are going to start sending you literature on death.'
9 out of 10 sick people, (those with a serious illness, medical condition, injury or disability), are worried about the costs of medical care according to a new poll from RWJF/Harvard, 'What It's Like to be Sick in America'.
The new buzzword in Medicine these days is "value based purchasing". It's not a new concept...everyone wants to get their money's worth, whether it is a new car, a meal at a fancy restaurant or the best medical care. Without clear information on quality, however, many patients assume that more expensive care is better care.
People have a right to receive in plain language a summary of what doctors bill, what insurers pay and how much they themselves must pay.
A few years ago, a good friend of mine who holds bachelor's and law degrees from Ivy League schools lost his job and became one of the estimated 50 million medically uninsured persons in the U.S. Over the course of several days, he developed increasingly severe abdominal pain, fever, and vomiting.
Mailers from a New York City dentist piqued my interest last week offering zero percent financing ' the same come-on that car manufacturers have used for years to entice you to buy Chevys and Toyotas.
Many of us have vivid memories of tying a thread to a loose tooth and wiggling it back and forth with our tongue all the time hoping for a profitable visit from the Tooth Fairy. Facebook is full of school and family photos of kids with cute, gap-toothed smiles. But increasingly, children are losing their baby teeth not due to the budding of their permanent teeth but to the ravages of early decay and cavities. There are a number of reasons kids and adults don't make it to the dentist regularly. For some parents, it's a lack of understanding about the importance of oral health, even at an early age.
'If gas stations worked like health care, you wouldn't find out until the pump switched off whether you paid $3 or $30 a gallon." ' Consumer Reports
Buzz about the recent Supreme Court's health reform decision has hovered mostly over the individual mandate---the requirement that everyone carry health insurance---and over push back on Medicaid expansion....But what about the 160 million Americans who have coverage from their employers?
In some surveys, U.S. consumers seem primed for health engagement, liking the ability to schedule appointments with doctors online, emailing providers, and having technology at home that monitors their health status.
If you don't have enough money for retirement, from income and assets, you probably are going to have trouble paying for medical care.
I was reminded of a conversation I had a few years back with Marilyn Moon '?¦.. The best advice she gave for people not yet on Medicare was to '??Save, Save, Save'?? because even with Medicare, seniors would be paying more for their coverage and for their health care. Moon was right.
“Health care costs are sky-rocketing!” “The percentage of the U.S. GDP devoted to heath care costs is the highest in the world.” “The cost of Medicare is unsustainable.” For most of us, the cost of health care (i.e., the dollars required by the system to produce and deliver care) isn’t what brings us the most anxiety.
Selling health insurance on Twitter? Yes indeed. Not long ago a simple tweet about a blog called Medicare Made Clear alerted me to this new way to find sales prospects for Medicare Advantage Plans and Medigap policies
Americans find health insurance decisions the second most difficult major life decision, only behind saving for retirement and slightly more difficult than purchasing a car. Why are health insurance choices so tough?
Seniors need more Medicare choices, or do they? The answer depends, of course, on who'??s doing the asking.
I am embarrassed. I am a specialist taking care of patients with inflammatory bowel diseases...Until recently I thought I was doing a pretty good job at this. However, I've had an awakening that I've been ignoring an entire aspect of the patient's decision. The aspect of cost.
Last week, the health care and political pollster Humphrey Taylor received a scary email about rising Medicare premiums from a friend. He was skeptical and wanted to know what I thought. It turns out I knew a great deal and had seen a similar version a few months ago.
Currently, Medicare Advantage sellers are engaged in heavy marketing due to the MA open enrollment period that ends on December 7th. The ads don't say much but give enough clues to tip you off that you must ask lots of questions and dig deep to find out what you're getting.
The twists and turns of recent political conversations over the federal deficit have explored a variety of changes to Medicare. The most likely ones are raising the eligibility age for benefits to 67 from 65.
The New Year'??s Day deal between the White House and Republicans postponed the long-awaited debate over cutting Social Security and Medicare. But in the next few weeks, Beltway talk will again turn to slicing these interrelated social insurance programs.
It’s hardly a secret that the U.S. is spending close to 18 percent of its GDP (or $8,362 per person) on health care — more than any other country. So it’s fair to ask exactly what we’re getting for our money.
Consumerism in health care is coming to mean patients must shop around for the best price — for a doctor’s visit, Cipro, health insurance and maybe even your next operation.
It turns out Japan has much to teach us about improving health…In many ways, Japan scores much higher than the U.S. when it comes to the health of its population.
Somehow, I don’t think of money-back guarantees when I think about going to the doctor. Yet as textbook marketing principles creep into health care, a few medical providers are beginning to look like sellers of toothpaste and detergents.
Let’s face it. Despite all the rhetoric about health care transparency, most health care providers really don’t want patients to know the price of their products and services.
The movement is growing, it seems, for making people who rely on Medicare have more skin-in-the-game. In the minds of some, seniors and the disabled pay too little for their health care and their Medicare benefits…
Americans have embraced their role as consumers in virtually every aspect of life: making travel plans, trading stock, developing photos, and purchasing goods like cars and washing machines. That is, in every aspect of life but health care.
Wherever you turn, there are complaints about health insurance rates. A Pennsylvania woman tells me her monthly premium will soon be $100 more than it used to be. A New Yorker finds the premium for retiree coverage rising 24 percent...
The president’s budget proposals released last week call for more seniors to pay more money for their Medicare benefits. While the president’s plan to require beneficiaries to pay higher premiums came as no surprise to Washington insiders, it probably was to people who will feel the pinch.
One could easily make a case that health care is today’s biggest consumer problem—not unlike those that sparked the consumer movement of the 1960s and 70s. Back then, consumer issues centered on problems with using credit, buying cars and home improvement services, and obtaining the best price for food, appliances, and just about every other new-fangled and expensive product that sprang from the post-war economy.
A few days ago, Empire Blue Cross Blue Shield sent me one of those Medigap sales brochures that seniors usually expect during the fall open enrollment season.
The revelations by the Centers for Medicare and Medicaid Services on Wednesday that hospitals vary widely in what they “charge” for the same procedure—sometimes as much as 10 or 20 times more than Medicare reimburses—confirms what health policy wonks have known for a long time. There’s no consistency in pricing for health care services…
In America, the conventional wisdom is that we don't ration health care. But we do, and there's no better example than patients rationing themselves when it comes to the medicines they take.
Maligned over the last decade as places to avoid because of the price of the care they delivered, last week’s release of a study by the RAND Corporation goes a long way toward improving the image of hospital emergency rooms.
Will consumers buying coverage in the new state shopping exchanges find lower or higher rates? On one side are those who say the newly insured will see lower premiums for coverage.
Yesterday the blog of WIFR-TV in Rockford, Illinois, featured a small story about community groups in the state applying for federal grants to help educate customers coming to the new health exchange in October.
On July 1, Medicare begins a second round of competitive bidding for medical equipment and supplies, such as diabetes testing strips that beneficiaries use to check their blood sugar levels. There’s nothing remarkable about any of this except that the industry is fighting to make sure that competitive bidding does not happen...
Giving health consumers more skin in the game doesn’t always lead to them making sound health decisions.
I’m not a big fan of bargaining and my half-hearted attempts to get a better price for a used car, garage sale find or contractor’s service have been mostly unsuccessful. There’s always that nagging feeling that the seller is laughing with delight once I’m gone, thinking, “I really pulled one over on that rube!”
And so it has come as somewhat of a shock to me that medical care has become the new garage sale, as far as haggling goes.
As health care becomes increasingly unaffordable, many believe quality would improve and costs would decrease if we treated health care like other consumer-driven markets...If only that were true...
It’s hard to say it was a surprise last week that the Obama administration delayed implementation of the employer mandate — that pillar of health reform requiring employers with more than 50 employees to provide health insurance or else pay a fine.
The specter of loss of choice and freedom to select the doctor you want haunts again. This time it’s being raised on the airwaves with an ad from Americans for Prosperity…
People continue to struggle finding information on how much health care services cost. Toni Brayer, Barbara Bronson Gray and Ray Burow weigh in.
The main purpose of health reform, the president said at his press conference last Friday, was to provide health insurance to people at affordable rates…Whether that coverage will be affordable or comprehensive for families remains to be seen.
My husband and I returned from a weekend away to find a message on our answering machine saying that we owed money to the hospital and that if we didn’t pay it within 10 days, they would send the bill to a collection agency.
The media has discovered another delay in another provision of Obamacare, and the new delay affects consumers’ pocketbooks directly...
It’s the silly season again for Medicare. It comes around whenever a political campaign is about to begin as it is for next year’s mid-term elections….Politicians love to play ball with benefits for seniors.
Hospital charges are essentially like car sticker prices. Insurers use them as a starting point to negotiate what they actually will pay providers on their policyholders' behalf.
Sumanah was a 26-year-old event planner in New York City when she was suddenly diagnosed with congestive heart failure. After learning that some pharmacies can be upwards of 16 times more expensive than others, Sumanah was able to price shop for the right pharmacy and save a lot on her prescription costs. You can too...
What people pay for medicine can vary widely. And a recent study found that 20% of Americans take five or more prescription medications. These 'Be a Prepared Patient' resources can help people pay for and manage their medications.
We want to have choices about the health care we get and who provides it. Many of us think we have that now...
For most of us, the "cost" of health care isn't what brings us the most anxiety. It's when we're patients or helping a loved one find care that so many of us are deeply concerned about the price of our health care: what we – personally, individually – pay to acquire the services, drugs and devices we need...
In a lecture hall of fellow clinicians-to-be, I was told that my job as a physician is not to be concerned with costs but rather to treat patients. What an odd message. Does medicine's unique role of saving lives exempt it from keeping an eye on the register?
Will all the White House messages, the stream of breathless Twitter updates on the number of hits and enrollments, and the press hype surrounding opening day send the uninsured public into panic mode?
It's a widely accepted truism that increasing patient engagement in health care leads to lower costs and better outcomes. And really, it shouldn't be a problem to convince us to act on our own behalf and engage in the behaviors that support health, right? I see two problems with this viewpoint and with the assertion that patient engagement will lower the cost of health care...
On Monday, Charlie Ornstein of Pro Publica provided the latest word on the usefulness of hospital ratings, an issue that seems never to disappear despite the growing body of work that raises questions about the methodology used to create them, their conflicts of interest with sponsors, and most importantly, their usefulness to the public.
Last week, I was interviewed by Dr. Pat Salber and Gregg Mastors on their BlogTalkRadio show, This Week in Health Innovation, about patient-centered care, patient engagement, shared decision making and the cost/quality trade-offs involved, and what all of this means for health care delivery.
At Home/Chez Soi, a Canadian program for the mentally ill, is built on the concept that providing housing is the first order of business. An approach that reinforces the truism that good health is more than swallowing the latest wonder drug.
My ultrasound came back "likely benign" with the recommendation that I follow up in six weeks to be sure. Over the next few weeks, I received one bill after another that totaled $1,000. Unable to pay, I felt abandoned by the system to which I had committed my career and did not call to schedule a second ultrasound...
Buying health insurance through the state shopping exchanges was supposed to be a breeze — like buying an airline ticket from Travelocity. But it isn’t, and the reason why has nothing to do with the technical glitches of HealthCare.gov...
Last week at a New York City meeting of the Association of Health Care Journalists, Elisabeth Benjamin, a vice president of the Community Service Society, tried to explain the New York health insurance exchange to a group of skeptical journalists who had more than a passing familiarity with the topic...
In part one of our series, we look at the basics of picking a health insurance plan that's right for you, your family or a loved one. Our 'Be a Prepared Patient' resources can help you find the best coverage at the best price for your health needs...
In part two of our series, we look at the difference between Medicare and Medicaid. Our 'Be a Prepared Patient' resources can help you figure out if you qualify for either of these or other special health care programs...
In part three of our series, we look at insurance terms that are used most often to describe or explain how much you’ll pay and what your benefits are. Our 'Be a Prepared Patient' resources clarify these common phrases...
In part four of our series, we look at a few ways to estimate the cost of your care ahead of time so you can make the best choice for you and your loved ones. Our 'Be a Prepared Patient' resources offer trusted websites and tips to get started...
What's the key to reducing costly emergency room visits and readmissions? People who lack convenient access to a health care provider, with or without insurance, return to the emergency department or hospital out of need and desperation...
We know that the U.S. has the most expensive health care in the world. But beyond noting that dubious achievement, we seldom ask why...
It's unfair to advise people to find out the price of a treatment when the price-transparency deck is stacked against them. So who will help patients find reliable price information and (hopefully) bring down the cost of care?
Last fall, a Pennsylvania woman, frustrated by the snags and snafus of healthcare.gov, turned to the website of Independence Blue Cross, the biggest insurance carrier in Southeastern Pennsylvania, to make sense of her health insurance choices...
During my senior year in college, with medical school acceptance letter in hand, I was diagnosed with metastatic testicular cancer. Early in my treatment I received a letter that my health insurance had been exhausted and I would no longer receive any health benefits. Needless to say, this was a problem...
A couple weeks ago, the Medicare Rights Center, a well-known New York-based advocacy group, released a report card showing that seniors on Medicare are struggling to pay for their health care. This finding brings up an important question: Why aren't seniors using the variety of state and federal programs that have been set up to help people in this situation?
Seniors are starting to realize that fewer doctors and hospitals may be available to them if they select a Medicare Advantage plan. Restricting these choices – in theory – is a way to control the price of health care. There's just one problem: Consumers still want to choose their doctors or stick with the ones they've got...
The idea that knowing the price of our care will encourage us to act like wise consumers is a hugely popular topic on blogs, in editorials and in the news. But relying on access to price information to drive changes in our health care choices is full of false promises to both us and to those who think that by merely knowing the price, we will choose cheaper, better care...
The Obama administration and Affordable Care Act supporters have not bothered to explain how the law includes cross-subsidization, missing an opportunity to talk about the "we" aspects of the law. As one 58-year-old woman put it: "The chances of me having a child at this age is zero. Why do I have to pay an additional $5,000 a year for coverage that I will never, ever need?" Here's how it works...
The Prepared Patient Blog published over two hundred articles in 2013 about what it takes for people to get the most from health care and how the system can be improved to make it feasible for us to do so. Here's a recap of what engagement looks like to us – whether we are sick or well, whether we are caregivers or loved ones: Engagement is not easy and we can't do it alone. Patient engagement is not the same as compliance. It is not a cost-cutting strategy, and it is not one-size-fits-all.
Shoppers searching the Internet for health insurance coverage can be forgiven if they are confused.
Opponents of health care reform, especially those who resist moving to a single payer system like Canada’s, have often used a very powerful argument to sway public opinion. Any significant changes, they warn, to America's private insurance system would mean that the government will come between patients and their doctors by making decisions about the care Americans receive. But what if it's not the government that is inserting itself between you and your doctor?
By now it's hardly a secret that insurance companies have canceled the policies of millions of Americans whose old coverage did not comply with new benefit requirements of the Affordable Care Act. But after hearing all the backlash and requiring people to buy newer and, in the eyes of ACA supporters, better policies, the administration took another U-turn and changed the rules once again...
I'm impressed with the health care that is now available to treat diseases that – even a decade ago – were a death sentence. And I'm so very grateful for them. But we and our doctors and nurses often overlook just how much the success of these tools depend on our active, informed participation. And many of us don't fully understand what it takes to participate well in our care...
"I walked in a person, and out a cancer patient," my dad said as we filed home. Crossing this threshold, we found ourselves on the other side of medicine – the side on the exam table or gurney, as opposed to the one standing over it. In time, it became clear we were running out of money...
A few days before the recent deadline for Obamacare sign-ups, I visited with one of the exchange navigators in Colorado, a state that expanded its Medicaid program and is working hard to enroll uninsured residents. This visit got me thinking of the millions of other people who live in states where they can't get access to Obamacare because they are too poor and yet are also not eligible for Medicaid...
As the health care system changes in the coming years, one particular trend that will negatively impact consumers' out-of-pocket costs is the use of co-insurance (instead of a co-pay) for expensive specialty medications. Approximately 57 million Americans rely on these drugs to maintain their health, and it is disheartening to learn that many people are suffering because their medications have become too expensive...
A couple weeks ago, the Obama administration handed sellers of Medicare Advantage plans an increase in government payments for next year. While this may seem like a good thing for the 16 million beneficiaries who have MA plans, it may not be good for Medicare as a whole.
Dedicated to promoting behavioral medicine research and the application of that knowledge to improve the health and well-being of individuals, families, communities and populations, Society of Behavioral Medicine created this award to recognize an individual who has made a pivotal contribution to research, practice or policy in the field of health engagement.
Bewildered, panicked and disheartened, I watched my mother's eyes dart back and forth as she read the pharmacy's prescription cash price list, knowing she could not possibly afford her monthly medicines. We drove home, not saying a word, but I knew she was deeply distraught. When we arrived, she began cutting each tiny elliptical or rounded tablet into halves and quarters...
Are we finally doing something about the high prices of prescription drugs? Maybe. At the end of May, the Washington-based National Coalition on Health Care launched "Sustainable Rx Pricing," a campaign to "spark a national dialogue" about the high cost of drugs. Will it work?
Never before have I seen such intense interest from the press about health insurance rates, normally considered a snoozer of a story. For the public, this may be a good thing. If the stories are done well, consumers might learn something about the mix of factors that go into determining the premiums they will pay. But in the last couple of weeks, some stories have been downright misleading...
For ages we've all known that the U.S. health insurance system works splendidly for those who have good employer-provided coverage, slide smoothly into Medicare when the time comes and seldom get sick. But evidence is beginning to trickle in that this seamless pathway for some people who've signed up for Obamacare insurance may be more illusory than real...
What is patient engagement and what does it take to accomplish? With the support of the Robert Wood Johnson Foundation, CFAH set out to explore this concept as it was viewed by various diverse stakeholders. Our interviews with 35 key health care stakeholders lead to an impressive unity of opinion...
Insurance companies and a group of senators headed by Alaska Democrat Mark Begich think they have a great idea for getting more young people to sign up for health insurance...
"When I think of patient engagement, I think of a partnership where people work together to figure out what the patient wants and how to support the process. Engagement is the knowledge base, working through the decisions and helping people to become full partners in their health outcomes." – June Simmons, MSW — Founding President and CEO, Partners in Care Foundation, San Fernando, CA
A mother takes her teenage son to an urgent care center that is part of her insurance plan's network. A clerk quickly refers him to the emergency room, across the street, which just happens to be part of the same hospital system as the urgent care center. Is this UCC sending some patients to its related hospital ER, clearly a place of high-priced care, to gin up revenue for the system's bottom line?...
Receiving bad health news can spark great upheaval. It is a time when nothing is certain and the future looks dark. The new, free app 'AfterShock: Facing a Serious Diagnosis' offers a basic roadmap through the first few days and weeks, providing concise information and trusted resources to help you regain a bit of control during this turbulent time...
"Employers have an opportunity to reduce barriers and support engagement because they sponsor health plans and can provide access to information, tools, technologies, incentives, and more. Employers have more ability to influence engagement than they often believe they have." – Michael Vittoria, Vice President, Corporate Benefits, MaineHealth, Portland, ME
"Most health plans view engagement as important and want to support it. But they recognize that they are only one (relatively weak) factor in supporting patient/consumer engagement... Their customers want their insurance premiums going to medical care, not a bunch of mailings about things they already know they should do..." – Arthur Southam, MD – Executive Vice President of Health Plan Operations, Kaiser Foundation Health Plan, Oakland, CA
That the government overpays sellers of Medicare Advantage plans is well known in Beltway circles, even if much of the public remains unaware…
Recently the Department of Health and Human Services proposed that most of the federal health exchange policyholders be automatically re-enrolled next year in the same policy offered by the same company. That's right, no shopping around...
"There's a prevailing attitude on the side of clinicians that looking for and using [our own] information is not good behavior on our parts. I think that attitude is a big barrier; people don't want to be seen as troublemakers for asking too many questions, disagreeing with a clinician, or bringing information to the table." – Kelly Young – Patient Advocate, President of the Rheumatoid Patient Foundation, and Founder of Rheumatoid Arthritis Warrior blog
"Reality is the leading cause of stress among those in touch with it," Lily Tomlin once quipped. So it's no surprise, then, that one-half of the people in the U.S. have had a major stressful event or experience in the last year. And health tops the list...
"At the end of the day, there is a growing recognition that we need people to take better care of themselves. Too much money is being spent on the consequences of unhealthy choices and on health care. We don't think that patient engagement is just the flavor of the week. The concept of how we can take more responsibility for our health and health care is not going away." – Janice Prochaska, PhD, President and CEO of Pro-Change Behavior Systems in South Kingstown, RI
American health care has become a gigantic game board with players of all sorts strategizing to win. Winning, of course, means getting more money from payers...
As we head into health insurance enrollment season, which opens in November, consumers/patients will face yet another challenge in selecting the best health plan...
Finding good health care and making the most of it is critical for each of us. Yet all too often, reliable, unbiased information is hard to find and understand. On the redesigned Be a Prepared Patient website, we have collected trusted resources and tips to help people navigate their way through health and health care decisions and experiences...
A friend of mine suddenly learned the importance of patient engagement a few weeks ago when a matter affecting his pocketbook grabbed his attention. For the last several years the mantra has been "buy generics" as a way to lower the cost of drugs for consumers but also for the nation. For a while insurers did that. Not anymore...
I have just done something I said I would never do: shop for a Medicare Advantage plan to cover my gaps in Medicare. The usual flyers and brochures from sellers of Medicare Advantage plans began to arrive in the mail with their enticing sales pitches, and one nearly fooled me. Short of having a Medicare representative on the phone, you're stuck in an information swamp. No wonder studies show that beneficiaries are not eager to shop around even if they can get a new policy with a smaller monthly premium...
Many cancer therapies now cost over $100,000 a year. Obviously, this expenditure is not sustainable for the majority of patients. At age 64, I am approaching Medicare coverage. Will I have the 20 percent co-pay to shoulder? As more people survive cancer and remain on ongoing medicines, the U.S. has to have a fair and open discussion about the cost of these medicines...
As narrower insurance networks begin to limit where we can get our care and contradict the American notion of abundant choices, I thought about the Canadian health care system and rumors of its long waiting lists that grab U.S. headlines. Yet, narrow insurance networks, sky-high deductibles, co-insurance and co-pays are ways of controlling our medical expenditures. Instead of rationing with waiting lists, America rations with price...
I am a pharmacy student and was recently sent home with a prescription to treat a very painful earache. I do not recall the name of the medication, but I do remember my reaction when I went to pick it up. I was shocked that the drug would cost me over two hundred dollars! I could not afford the medication, so I went home without it...
More than 44 percent of Americans regularly take a prescription drug. And according to the 2013 Consumer Reports Best Buy Drugs Prescription Drug Tracking Poll, 57 percent of people reported taking steps in the last year – some of them potentially dangerous – to curb high medication costs: not filling a prescription, skipping a scheduled dose, and taking an expired medication. Why? And what can be done to help?
Receiving bad health news can spark great upheaval. It is a time when nothing seems certain and the future may look dark. Since its release this summer, the free AfterShock: Facing a Serious Diagnosis app has provided users with a basic roadmap through the first few days and weeks after a serious diagnosis, providing concise information and trusted resources to help regain a bit of control during this turbulent time. As one reviewer wrote, the AfterShock
app is "a standard for empowered patients"...