Birth Control

So Feds have ordered insurers to cover birth control free of charge for women. HOW would like to know what your thoughts are on this.


Feel free to read a full article here:



The McKinsey Report on health care reform

Why is everyone talking about the recent McKinsey report on how the new health care reform law will affect employers and employees? Because in 2014 many companies will drop their health insurance plans, leaving their employees to find coverage on the state exchanges. For example, the Congressional Budget Office (CBO) estimated that once reform takes effect in 2014 around 7% of employees will lose their insurance. However, after surveying over 1,300 employers, McKinsey’s research found that number to be very low and instead determined that about 30% of employers will drop the health insurance they offer their employees.

The reasons for this have to do with achieving economic efficiency. For those companies who employ over 50 employees, the new law requires them to offer health insurance to all full-time workers or pay a $2,000 fine per full-time employee. The issue is that in many cases, employers are currently paying well over $2,000/employee for their health coverage and welcome this provision of the law as it will serve as a way to reduce their costs. In fact, as evidenced in McKinsey’s research, many employees welcome the opportunity to receive a higher salary, forgo their health benefits, and instead receive their insurance through the state exchanges. This of course assumes employers will compensate their employees to do so. The problem is, what will the level of care look like for these employees, and what will the true cost be?

The overall issue is employers will make changes to their health insurance benefits. I agree with the McKinsey report and believe there are two likely scenarios of how companies will do this. One will be to decrease the number of full-time workers (as discussed above) and the other is to restructure their company into two separate entities. One would include higher-level employees such as managers and executives who would continue to have employer-sponsored health insurance while the other would consist of lower-salaried workers who would not receive any health coverage.

Regardless of what happens, in order to bring costs down and give people the kind of care they need and deserve we need to focus on a more value-based system. Looking at almost every other sector in our economy, such as telecom and hi-tech, when done correctly, streamlining economic efficiencies will reduce costs and improve the goods and services people receive. We must replicate those efforts into the health care sector so all parties involved, especially patients, can be better off.

Relatively unknown, the IPAB or Independent Payment Advisory Board that was created in the health care reform bill is potentially powerful.

This group is an independent panel consisting of 15 members appointed by the president and confirmed by the senate. With their primary responsibility in implementing a ceiling on how much the government spends on Medicare each year.

This panel has the power to make recommendations that will ultimately cut Medicare’s spending to make sure it stays within the annual limits. Now here’s the important part, this group is so powerful that it will literally take an act of congress to change the IPAB’s recommendations.

Here’s where it gets a bit tricky. Given all of the power that the IPAB has, they’re actually limited as far as to what changes they can recommend. They only way they can realistically reduce spending is by cutting the payments made to the health care providers who treat Medicare patients. This will cause a real problem, both financially and logistically for the hospitals, doctors, and many others who treat these patients.

What’s most likely to happen is that we’re going to face an even greater shortage of physicians who are willing to accept and treat Medicare patients. These folks are going to find it harder and harder to get the necessary access to care that they need. So unfortunately what we’ll be left with are fewer doctors to choose from, waiting rooms filled with a long list of people trying to get seen, and the potential for a decrease in the quality of care. The reason for this is quite simple. Because doctors will be paid so little to treat Medicare patients, they only way it’ll make sense for them to do so is to see as many patients as possible. In order to this they’ll be forced to limit the amount of time they spend with each patient in exchange for a higher quantity of patients. And a model like that is a prescription for errors and problems to occur.

Why the controversy of ACOs

ACO’s are organizations that are supposed to bring physicians and hospitals together so they can share resources to cut costs and improve the quality of care. When an ACO can show that they’ve increased care and generated a savings, they receive a percentage of those savings.

The Health Care Reform law requires the adoption of ACOs, however many folks don’t think there’s a strong likelihood of them working correctly. The reason being is that historically, hospitals and docs have two very different business models. Hospitals are in the business of keeping patients in the hospital while doctors try to keep patients out of the hospital.

Another problem is that ACOs will most likely only be affordable and therefore available to large provider groups. You see, if you’re a large group you have a better chance of being able to purchase the expensive technology and infrastructure required. On the other hand, if you you’re a small mom-and-pop group then you’re most likely not going to have the funds to make the necessary investments. Unfortunately, ACOs will be driven by the big large groups at the expense of the small local health care providers and clinics.

Typically, when something of this magnitude occurs it results in less choices and services for the consumer, which in this case is unfortunately the patient.

Watch the Youtube Video here:

How to cope with higher medicare premiums

I recently came across a great article that gives 7 great suggestions on ways that you can really control your Medicare premiums and hold down your overall health care out-of pocket costs in retirement. Some of the 7 suggestions might seem like things you may already know, but it is definitely worth a read.

You can read the full article here

In case you missed our webinar “Wellness Strategies: An Employer’s Key to Reducing Long-Term Medical Costs” you can view it now on our Youtube Channel Goldi’s Guide to Healthcare

The webinar covered wellness and how using incentive and other programs can help to increase employee participation, most wellness programs are typically underutilized. Implementing a successful wellness plan can help to engage employees into managing their healthcare risks which will ultimately reduce surgical spending.

Why all the buzz about medical tourism? It’s quickly going to become an estimated $40 billion industry!

Many countries have been making serious moves to capitalize on this by building new, stat-of-the-art hospitals, brining in experts from all over the world to practice at these facilities, and have partnered with elite U.S. institutions such as Johns Hopkins and Harvard Medical School.

Who are they trying to attract? Well, as patients from the U.S., Canada, and the U.K. are getting frustrated with long wait times for care becoming even longer, they’re traveling abroad for care. This year alone we’ll see about 1.2 million Americans leave this country to receive treatments overseas. They’re traveling to places like India, which is speculated to earn around $2 billion next year from medical tourism or to Turkey which is expected to grow their medical tourism market by 32% over the next 3 years.

Will the day come when we see 20 million Americans leave our shores each year to receive care abroad? Probably not as U.S. providers are beginning to take actions to capture these patients by reducing their rates and providing more services.

What we do know is that the day is quickly approaching when most people will leave their local community to receive health care services somewhere else.