It's Getting Better

In my last blog, I pointed out that my industry —health insurers—takes a lot of heat for what’s wrong with our health care system. I admit that health care insurers have to change, like everyone else. That’s why my industry’s proposal for health reform brings everyone into the system, guarantees coverage for all Americans, does away with pre-existing condition limitations and ends ratings based on health status and gender.

But I also want to point out something that most people don’t realize: Quietly over the last 5 or so years, most health insurance plans have added features and programs that improve health, make it easier to deal with our complicated health care system or cut overall health care costs. These new features don’t solve all our health care woes, but they have made inroads into addressing some of our most complex challenges.

Many of the improvements to health insurance over the past few years result from the application of advanced data processing and other technologies. Here are some examples:

• Real-time claims adjudication. Doctor’s offices can now submit their claims online and know within 10 seconds if a procedure is covered by the patient’s health plan, instead of having to wait days or weeks.
• Medical data synchronization. New data processing software such as the eSync platform collects and synchronizes medical data from a variety of sources, analyzes it and converts it into individual health care recommendations for specific patients.
• The medical swipe card. Patients swipe the medical swipe card through a device similar to a credit card swipe to give caregivers access to all appropriate patient eligibility information and to the patient’s health records. With the card, the physician is able to submit claim forms online and receive approvals from the insurance company in a matter of seconds.

All of these innovations have made maneuvering the health care system easier while reducing administrative costs.

But those aren’t the only changes that have improved health insurance. When I get more time, I’ll list a few more.

Everyone is to Blame

One constant theme in the debate over health care reform has been the laying of blame for all of our health care problems at the door of insurance companies. Now that's just wrong and it's also inaccurate.

Everyone is to blame!

By everyone, I mean everyone! Individuals, physicians and hospitals, drug companies, the government and yes, insurance companies, all are partially to blame for the problems in our health care system, and everyone will have to change in some way to fix what’s broken.

All of us have played a role in making our health care system more expensive and less efficient than it should be, and it will take all of us to fix it.

• Consumers have an important part to play. Many preventable diseases are caused by unhealthy lifestyles, poor diets and little or no exercise. Everyone who pays health care premiums is shouldering the burden of paying for the health care of those with preventable diseases.
• Employers have fallen into the trap of shedding and shifting health care costs instead of thinking about helping employees stay healthy. But if more employers joined the growing ranks of those that create incentives for employees to live healthier lifestyles, health care costs would moderate.
• Health insurance companies should develop reimbursement strategies that facilitate cooperation, such as increasing reimbursements to higher-quality and higher-efficiency physicians and hospitals. Insurers must also become more user-friendly. Transparency about reimbursement practices and benefit levels would help manage the expectations of both consumers and medical professionals.
• Doctors and hospitals also play a critical role in improving the efficiency and affordability of our health care system. Market-based reforms such as physician ratings and reward systems for quality and efficiency could, over time, lead to a system that would improve care and increase efficiency making health care more affordable for everyone.
• Pharmaceutical companies could lower health care costs with one simple step: stop giving consumers misinformation about generics. In many instances the generic is identical to the brand name drug and costs 60-80 percent less. Yet heavy advertising by drug companies influences consumers to view brand name drugs as better. Once convinced, employees pressure their employer to cover the higher-priced brand name drug – driving up the cost of the health care plan.
• The federal government, the largest payer of health care benefits in the country, has perhaps the largest role to play in fixing our healthcare problems. In recent years, the government has engaged in cost shifting by capping or reducing physician and hospital reimbursements and reducing subsidies to the states. This cost shifting has ended up hurting smaller hospitals and people without insurance.

We all hold keys to open new doors to a better and more affordable health care delivery system. But it means that we will all have to give a little more of ourselves so that everyone benefits.

Can We Cover the Uninsured and Drive Down Costs?

A few weeks back I participated in a panel discussion about health care reform sponsored by the Greater Philadelphia Association of Health Underwriters. A few of the questions we were asked I thought were important enough to ask myself again and then answer in my blog.

1. Ignoring the political viability of your solution, what do you think is the best solution to simultaneously cover the uninsured and drive down health insurance costs?
First to covering the uninsured: UnitedHealthcare supports the concept of universal coverage and thinks we can best achieve this goal by building on our current system of commercial insurers. We support reform proposals that guarantee coverage for all Americans and would require all individuals to have coverage. We are also in favor of expanding Medicaid to reach low-income adults.

Now to costs: To some degree covering everyone will help drive down costs, that is, if universal coverage leads to more preventive medicine, which as we know leads to healthier people, which in turn drives down future health care costs.

But we also believe that there are a lot of unnecessary costs in the system that can be eliminated by implementing advanced technologies and modernizing procedures and policies. In fact, UnitedHealthcare has contributed two well-researched studies based on real world case studies that clearly demonstrate how the government and private sector could save hundreds of billions of dollars while improving the quality of care. For example, over the next 10 years, an estimated $540 billion in federal savings can come from implementing changes in four main areas:

1. Incentives to patients for use of high-quality physicians
2. Improved Care Management
3. Physician Incentives & Information to help drive quality care
4. Evidence-Based standards applied to reimbursement

2. Are there any negative implications associated with mandating that all U.S. citizens be covered by at least some standardized level of coverage? There is a deep and profound interconnectedness between the various aspects of health care reform and nothing illustrates this interconnectedness more than mandating universal coverage. As long as we remember this interconnectedness and pass a global program that addresses both accessibility and cost, we should be able to address any negative implications. A personal mandate also requires targeted funding for lower income consumers, which in turn requires new revenues and cost containment. If we address these issues in an integrated manner, we will be able to deal with any potential negative implications. But if we address these issues in isolation, we could run into difficulties.

Open Enrollment Season is Here

The next few months will be a busy time for everyone at UnitedHealthcare because it’s “open enrollment season,” which in the health care profession is as exciting as ski season is to my friends who ski.

The open-enrollment period gives employees the opportunity to re-evaluate the health care benefit plans that are available through their employers. For most companies, open enrollment occurs annually, usually at the end of the year for plan benefits effective the following calendar year.

Employers should look at open enrollment as an opportunity for both the company and its employees to make sure available health care plan options meet health and financial needs.

The first step that employers should make in preparation for open enrollment is to review the past record of health insurance claims. A claims review will identify treatments that employees rarely use and clusters of benefits that employees use frequently. This information can help the employer make adjustments to the health care plans they offer so that the plans truly address the needs of its workforce.

Claims review information may also suggest when it makes sense to bring in speakers for wellness seminars. For example, if there are a growing number of diabetes claims, the employer may want to hold classes in diabetes prevention and management. Employers can also help employees in open enrollment by having their benefits consultants make group presentations about the differences among the various plan designs.

Control the Cost of Drugs

Perhaps the fastest growing factor in health care costs is the cost of filling prescriptions. Many health insurance policies have a prescription drug benefit, but both those with and without health insurance can save money if they:

• Select generic over brand-name drugs. Beside many brand name drugs on the shelf are equally effective and equivalent generic versions. Equal in everything but name recognition, these drugs offer the same level of quality, purity and strength as their brand-name counterparts and cost 30- to 60-percent less. Ask the pharmacist for a generic version and we can save substantially on our prescription medications.
• Mail it in and split it. Prescriptions delivered via the postal mail vs. buying them at retail locations may help reduce drug co-pays and even offer a 90-day instead of 30-day supply. Or consider pill splitting. By following the doctor’s instructions and using a special device to split and take only half of a pill prescribed at double the dose each time, we can save hundreds of dollars a year on medications.

Armed with the 10 suggestions I’ve listed over the last week or so, it’s now time to lace up the running shoes, go for an annual check-ups and, most importantly, know the options you have for reducing health care costs.

Work Your Health Care Plan

It’s amazing how much money you can save on health care once you start to think about it. One thing I notice is that many people spend more money on their health care than they should because they don’t take the time to review their health care plan documents. Here are some suggestions:

• Understand our health benefit plan. Read the fine print, or log on to the health insurance company’s Web site. Know what is covered and what is not, and learn about any available wellness programs that can help improve health, reduce overall costs or even provide monetary incentives.
• Use in-network providers. Seeing a doctor outside of the health care plans network costs more than seeing one in-network. Most health plans have thousands of doctors in their networks. A quick visit to the insurance company’s Web site can help avoid a more costly visit to the doctor.
• Review the doctor’s bill. Making sure we have been billed correctly after an office visit or procedure is a simple routine that can save money and reduce stress.
  

Keep it locked…I’ll give still more cost-savings tips next time post a blog entry!

Prevention, Prevention, Prevention

Lately I’ve been thinking of ways that people can save on health care. In my last entry, I mentioned two ways to lead a healthier life, to stop smoking and lose weight. By living healthier, you need the health care system less and therefore spend less on health care.

Other ways to save money by living healthier have to do with keeping tabs on your medical condition:

• Make primary prevention a priority. Primary prevention is a proactive approach that helps cut costs by helping maintain good health in the first place. By keeping up with immunizations and going for regular check-ups you can take preventive measures to stop health problems before they have the chance to start and have a major impact on the price you pay for health care in the long run.
• Take control with secondary prevention. If you can’t keep a health condition from arising, you can still fight the cost of its effects. Secondary prevention aims for early detection and interventions that slow the progression and onset of chronic diseases such as diabetes and heart disease. Keeping up with screenings, never missing doctor visits and taking medications correctly will help minimize the cost of needing additional care.
• Know your conditions. When you make the effort to listen to your doctors, take notes and fully understand your medical conditions, you are working together with your physicians to manage your illnesses more effectively and therefore cut costs.

More in a few days!