Saturday, April 18, 2009

With more doctors not taking Medicare payments, why would government health insurance work for all of us?

As President Barack Obama pushes for a socialized medicine plan, I found this recent editorial by Dr. Marc Siegel, an internist and associate professor of medicine at the NYU Langone Medical Center of interest.

Writing in Friday's Wall Street Journal, Doctor Siegel noted: "Here's something that has gotten lost in the drive to institute universal health insurance: Health insurance doesn't automatically lead to health care. And with more and more doctors dropping out of one insurance plan or another, especial government plans, there is no guarantee that you will be able to see a physician no matter what coverage you have."

Siegel noted that recent market survey conducted by the Medicare Payment Advisory Commission has shown 28-percent of Medicare beneficiaries looking for a primary care physician are having trouble finding a primary care physician. Here in Texas, according to a 2008 survey by the Texas Medical Association, only 38-percent of primary care doctors are now taking Medicare patients.

The problem, Siegel adds, is that the government requires an extensive amount of documentation to file a claim. And it's not just a government issue. Dr. Siegel noted that 11-percent of his colleagues at NYU Langone are not accepting Aetna or Blue Cross because of the administrative requirements and what he terms "diminishing reimbursements."

At my company, we help our clients understand the network of physicians that accept their private insurance plans. When needed, we also help our customers get through the morass of claims denials and processes.

However, I hope someone in Mr. Obama's administration sends Dr. Siegel's op-ed piece to him so he can question how the government will change the claims acceptance process that will help the medical community get the payment they deserve for treatment. If Mr. Obama truly wants to make a change in the health insurance industry, he must first clean up the administrative processes within his government.

Friday, April 17, 2009

How Whataburger and other companies can offer entry level health benefits that work for most workers

A comment on Twitter from xkot noted: "Free uniforms and discounted food are listed as benefits on Whataburger's hiring poster. Missing: health insurance."

More and more, companies are not using health insurance as a recruiting enticement. Yet, with the right management processes, health insurance can serve as an effective recruiting tool as well as a retention tool.

I have been working with several companies to design what I call "Mini Meds" plans for them. These programs typically are lower in cost, and they don't provide the same level of benefits as a plan from Blue Cross or Aetna.

To me, an effective employee policy provides a basic Mini Med plan after 30 or 60 days of employment. However, for those that stay with the company for a year or more, their employer can offer a more extensive plan.

With other forms of health risk management such as an emphasis on healthy lifestyle choices, a company can lower their workers' exposure to sickness and illness. Add a good generic drug plan that encourages people to use their meds, and most companies can provide an entry level health benefit plans to their workers that will save money and keep their employees on the job.

Saturday, April 11, 2009

Obama's support of EMR could lower health benefit claims

President Barack Obama's decision to create an electronic medical record for the Department of Defense and VA is something that every health insurance professional should look at as a way to cut down on the costs of medical claims.

One of the benefits from electronic medical records is that it eliminates errors in medical treatment. For example, a pharmacist can verify a doctor's decision to renew a prescription without having to fax it or call the doctor's office.

However, in time, EMRs could also notify a person to take a medication or to call into their doctor for a routine checkup. By setting up a request on a person's cell phone, a doctor can remind someone to take their meds.

As someone who has worked in health benefits, I know the power of people following a prescribed course of medication for treatment of ailments. Studies have shown that people who follow the prescribed course of medication typically remain in good health than those who don't continue their medical treatment.

Saturday, April 4, 2009

With health benefits proving a major factor in negotiations, ATT and union should address these issues to lower the cost of health benefits

With a possible strike between ATT and the Communications Workers of America set to begin tonight at midnight, the issue of health care serves as a major focal point between management and union leadership.

According to an article in today's Wall Street Journal, the union is upset that management wants to charge them for health benefits. Until the contract expires tonight, union workers did not pay for their health insurance premiums. That may change if a strike settlement occurs.

As someone who has designed health benefits plans for major companies, I would bet that neither mangement or their union counterparts have looked at the details of their health insurance plan. In fact, I would guess that neither side could name the carrier that provides the union with their health, dental or vision plans.

A thorough audit of the plan and its coverages would help both sides understand the scope of the issue. Once they look at the costs, they should evaluate these factors to reach an agreement.

1) Most workers rarely need major medical hospitalization. Studies have shown that for most companies, only three-percent need major hospitalization. Having a higher deductible for each worker will lower the costs. With the savings from this program, ATT could establish a Medical Expense Reimbursement Plan that would pay for the small number of people who require hospitalizaton.

2) What has ATT done to promote a healthy lifestyle? Companies that promote healthy lifestyles tend to have lower health benefits claims than those who don't promote them. Having a gym onsite or educating a work force on diabetes and stroke prevention are just a few of the variables that could decrease the costs of health insurance.

3) Know that claims paid to premium ratio. As most companies hover at a 30-percentage range for the typical claims to premium paid ratio, ATT can negotiate with their carriers to keep them from increasing the cost of health coverage every year.

4) Understand which carriers provide the most "in-network" coverage for specific areas. By using regional plans with different carriers, ATT could lowers it costs. For example, AETNA may have the best network of medical providers in Georgia, while Blue Cross could provide a more extensive network of providers in San Antonio.

5) Communicate how the company is doing with its claims to premium ratio. If ATT union memebers have a high rate of claims redemption, management should stress healther lifestyle options in their corporate communications program.

ATT and the CWA are not unique organizations when it comes to health benefits. Few truly understand the risk or costs involved with their employee benefits program. Yet, companies could change this by bringing in an outside broker who can work with their financial and human resources team to help them comprehend the nuances of their corporate health benefits packages. This effort could help them lower their health benefits costs.