Repairing the Healthcare System

Healthcare Insurance Industry’s’ New Business Model Is Wrong.

Stanley Feld M.D.,FACP,MACE

One percent of the people spend 25% of the healthcare dollars. Twenty percent of the people spend 80% of the healthcare dollars.

It would be important to know why this is true. Then figure out what could be done about it Stakeholders need to agree on a course of action.

It would be a good idea to understand what physicians think should be done. 

“One percent of patients account for more than 25 percent of health care spending among the privately insured, according to a new study. Their medical bills average nearly $100,000 a year for multiple hospital stays, doctors’ visits, trips to emergency rooms and prescription drugs.”

The 1% and the 20% are suffering from complications of a chronic disease.

The incidence of chronic diseases is on the rise in the United States. A major precipitating factor for this is obesity.

The incidence of Type 2 Diabetes Mellitus is increasing in both adults and young children, as the incidence of obesity is increasing.

The incidence of complications of Diabetes Mellitus will increase in the future. The result will be an increase in the cost of medical care.

President Obama’s healthcare reform act will expand healthcare coverage to 32 million uninsured in 2014. Obamacare is forcing the healthcare insurance industry to change its business model in order in order to remain profitable.

Premiums are out of the reach of most businesses and individuals. Premium increases are not an option.

High-risk individuals are denied healthcare insurance coverage. High-risk patients automatically get coverage in corporate healthcare plans. The healthcare insurance industry simply raises premiums on corporate groups in order to maintain its profits.

Something must be done to decrease the increase in chronic disease and its complications. 

The government cannot afford to insure its present patient obligations much less the 32 million uninsured.

“As the new federal health care law aims to expand care and control costs, the people in the medical 1 percent are getting more attention from the nation’s health insurers.”

Twenty percent of the population not 1% should be getting the attention of the healthcare insurance industry.

“Studies have already shown that Medicare spending is concentrated on a small group of individuals who are seriously ill.

An analysis by the IMS Institute for Healthcare Informatics, the research arm of IMS Health, a health information company in Danbury, Conn., provides a rare glimpse into the medical problems of people with private health insurance that are under 65.

About three-quarters of them suffer from at least one chronic condition that could spiral out of control without proper care.”

Most of these people were obese.

The healthcare insurance industry cannot avoid these patients after 2014.

“Insurance companies will be required to enroll millions of new customers without the ability to turn them away or charge them higher premiums if they are sick. They will prosper only if they are able to coordinate care and prevent patients from reaching that top 1 percent.”

The healthcare insurance industry realizes it must fundamentally change its business model.

The healthcare insurance industry has a problem developing a new business model that would work. The industry does not want to lose control over patients, their physicians and the monies paid into the healthcare system.

The healthcare industry does not have a clue about how to actually repair the healthcare system. It is focused on its own bottom line rather than looking at business models that will be beneficial to everyone and align all the stakeholders’ incentives.

The healthcare insurance industry is planning on instituting programs that will tinker with the edges. It will not fix the problems.

The new business models will increase the percentage of money the insurance industry receives for direct patient care maintaining a Medical-Loss ratio of 15%. There is no interest in providing patients with financial incentives and a choice.

The net result will be higher costs and system failure. The weird thing is most of the healthcare insurance industry executives know it.

“The reality is if we don’t figure out how to get to the patients, we’re not going to get where they need to be,” said Dr. Lonny Reisman, the chief medical officer for Aetna.

The reality is that the system must be consumer driven with consumers in charge of their healthcare and their healthcare dollars.

At the moment patients have no incentive to decrease the cost of care. Hundreds of patients have told me that they go to the doctor to fix their illness. Medicare or their insurance pays. The patients have no idea of the costs they incur nor do they care. They have no interest in controlling their disease.

My ideal medical saving accounts would give the patients incentive to learn about their disease. They would be interested in self-managing their disease with the physician and his medical care team being the coach.

“The next challenge, say insurers, is to figure out how best to work with a person’s doctor. Because many of these patients seem to be seeing many doctors and taking many medications, there may be no one who is accountable for the patients’ overall health.” 

Physicians have figured out what services get paid by the healthcare insurance industry. They do not get paid for educating patients about their disease.

The healthcare insurance industry and the government have developed a punitive bureaucracy.   

An attempt is being made to penalize or reward physicians for medical outcomes. Pay for Performance (P4P) is a punitive payment system. It will fail. 

Patients are responsible in large part for the onset of their medical problems and in controlling their medical outcomes. Physicians cannot be responsible for patients’ outcomes. It is the responsibility of the patient.

“Insurers are also still grappling with their understanding of human nature — why some people simply don’t take care of themselves or take their medicine or go to the doctor, even when it is clear that they should.”

Patient outcomes have nothing to do with human nature. It has everything to do with financial incentive and effective education.

Spokes 5 and 6 of my future state business model has everything to do with patients’ responsibility for caring for their disease and the physicians’ responsibility to the patients. It has nothing to do with physicians’ and patients’ responsibility to the healthcare insurance industry or government.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone

Please send the blog to a friend

 

Spokes 5 and 6- Future State Of Healthcare Business Model

Stanley Feld M.D.,FACP,MACE

Spokes 5 and 6 of future state business model for the healthcare system’s survival must be understood as one unit.  Chronic Disease Management and Education As An Extension Of The Physicians Care are two simple concepts.

 

 

 

Patient education is a crucial element in the care of patients whether the disease is acute or chronic. Systems must be set up so that education is an extension of the physician’s care in order to be effective.

Education is less effective if it is not personalized and unrelated to the patient’s physician.

Both concepts have been devalued by President Obama’s healthcare reform plan. The chronic disease management concept has been devalued with the administration’s pilot studies showing that chronic disease management programs do not decrease the quality of care or cost of care.

The pilot studies were conducted by freestanding clinics. The education was not an extension of the patient’s physician care. Medical care is a personalized endeavor that requires a personal relationship between patients and physicians.

At its core the quality of medical care is enhanced by a strong physician patient relationship. This relationship is critical to a successful patient outcome and decreases in the cost of medical care.

An analogous educational event happened to me in my junior year in high school.

I was on the high school baseball team. Baseball practice started in February. It rained and snowed a lot in New York City in February. If it rained we would practice in the gym. We couldn’t have baseball practice outside one day.

On that day the gym was taken. The baseball team was sent to the study hall the last period of the day. My year before geometry teacher was in charge of that particular study hall.

I was an excellent high school student. I never missed a question on a geometry test.

I loved my geometry teacher. It was easy for me to understand everything she taught.  This was an example of a positive teacher student relationship.

I was taking trigonometry that spring term. The chairman of the math department was my teacher.

I had a poor relationship with that teacher. He was not enthusiastic about trigonometry.

He was detached from his students and their needs. He had no interest in relating to us.

I could not understand a thing he taught.  I figured I could tolerate him.  I thought I had to ability to learn the course directly from the textbook.

To my surprise I could not understand any of the concepts in trigonometry when I was studying at home. I was resigned to the fact that I was going to fail trigonometry.

My geometry teacher saw me in the study hall. She came up to me an asked me how I was doing. I told her I was going to fail trigonometry.

I could not stand Dr. B and I could not retain anything he taught. I also found it impossible to teach myself trigonometry from the text.

She asked me what period I had lunch and which period I had trigonometry. I had lunch the 5^th period and trig the 6^th period.

She said she taught trigonometry the 5^th period and she could transfer me into her class and into 6^th period lunch. She was also a student advisor.

Her words were as if a weight was lifted from my back. She said there was one problem. The departmental first quarter test in trigonometry was being given tomorrow. If you do not know anything you will fail. I said I understood.

After dinner I went into my room to study for the test. I started on page one of the text. Everything I read stuck. All of a sudden trigonometry was understandable and every trigonometry problem was easy to solve. All my anxiety about trigonometry melted away.

The next day I took the departmental test in my new 5^th period trigonometry classroom. I got 100% on the trigonometry test. I received an A+ in trigonometry at the end of the semester and 100% on the New York Regent examination. I did not miss a trigonometry question the whole term.

This lesson stuck with me throughout my medical career. A positive physician patient relationship is just as powerful as the positive teacher student relationship. Both enable patients and students to reach their potential.

Obamacare is interfering and methodically destroying the ability to form a positive patient physician relationship.

The regulations are punitive. Patient care is becoming depersonalized and commoditized.

I predict Obamacare is going to make the medical outcomes worse and the cost of healthcare higher.

After 30 years of practicing Clinical Endocrinology I am convinced that the therapeutic effect of the patient physician relationship is a major factor contributing to the healing process.

Chronic disease management does not work unless the patient physician relationship is intact.

President Obama has proven this with his pilot studies in chronic disease management.

President Obama has not proven that chronic disease management as an extension of physicians care does not work.

Combined with a positive patient-physician relationship, chronic disease management with education as an extension of the physicians care can work.  Patients can be motivated to maintain control of their disease. Patients controlling their disease will decrease the complications, morbidity and mortality of the chronic disease.

The result will be a decrease in the cost of healthcare.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone

Please send the blog to a friend

 

 

 

 

 

 

 

 

 

 

 

 

 

How Could A Social Networking Company Make Money In Healthcare?

Stanley Feld M.D.,FACP, MACE

My last blog about individual healthcare insurance policies generated a lot of comments from young people starting up a business and individuals operating their own business at home. I also received several from entrepreneurs looking to start a business.

One person wrote,

"Dear Dr. Feld

So we have now learned that high deductible plans are what people should be purchasing. We also learned that they should be self insuring for $10,000 which is the highest deductible insurance at the lowest price.

 Over $10,000 is where are at the greatest financial risk. True insurance should cover our greatest risk.

I would like to know where is the business opportunity is for an Internet company that runs social networks?

 

 

 Sincerely

Z"

I said the world belongs to young people 20-50 years old. They also understand the power and mechanics of social networking.

If there was a social network dedicated to describing the advantages and disadvantages of the healthcare insurance options available to the unemployed, self- employed and under insured there would be many members. If those members had the ability to have input it would grow even larger with appropriate marketing.

I have not figured out how social networking sites make money except through advertising. I imagine many companies would like to get the attention of these consumers who are seeking healthcare insurance advice.

It has been reported that people change their job up to 8 times during their career. More and more people are in start-up businesses and need healthcare insurance for their employees. Many people are becoming consultants and are self-employed. They all need healthcare insurance for their family.

President Obama’s answer to the problem is the government will provide the healthcare insurance for you. Healthcare insurance is a right as an American.

There are several problems with this statement. The government cannot afford to provide adequate healthcare insurance for the entire population.

Britain has proved it. They are reverting back to a pay for service system. The socialist democrats in Europe have proved that. Each country is going bankrupt.

The business opportunity would be to teach the people who are self-insured or uninsured about the rip off of the healthcare insurance industry and to teach them how to save money.

How many start up companies do you guess are uninsured or under insured or not insured for catastrophic illness because they cannot afford the healthcare insurance premiums?

The chances are many start up employees will not get sick. True healthcare insurance should be a hedge against catastrophic illness.

If someone gets sick in a company, the company could pay the employee for the amount he spent before they reached the full deduction.

The high deductible individual policy is not tax deductible. If it were made tax deductible by citizen demand to congress through social networking the voice of the individual could be heard. Congress might be forced to act.

Start up companies and other companies would save money. These companies would be placed on the same playing field as companies who pay for employee insurance with pre tax dollars. The social network could even form an association of self-employed companies and enjoy the tax benefits and purchasing power of large corporations.

This would represent a threat to the healthcare insurance industry. They would do everything to stop. So would the government.

If you do the math for the government, the government would be saving much more money than it would collecting taxes. 

An appropriate social network could stop the healthcare insurance industry's grotesque business model in its tracks.

It could save billions of dollars. It could create incentive for people to take better care of themselves. 

Many large and small companies are self-insured. The law lets these companies deduct their healthcare insurance with pre tax dollars. These companies could offer my ideal medical saving account with a $7,500 trust account. They could then reinsure employees for over $7,500 with a reinsurance company. 

Employees would obtain first dollar coverage after the deductible is reached.

In the worst case the company would save $6,000 per employee. In the best case it would save $13,000 per employee.

http://www.lijit.com/search?uri=http%3A%2F%2Fwww.lijit.com%2Fusers%2Fstanleyfeld&start_time=&p=g&blog_uri=http%3A%2F%2Fstanleyfeldmdmace.typepad.com%2F&blog_platform=&view_id=&link_id=7386&flavor=&q=ideal+medical+savings+accounts&x=0&y=0 

I suspect even the traditional insurance companies would provide the re-insurance.  These healthcare companies have already negotiated fees with physicians, hospitals and drug companies. 

If the healthcare insurance industry did not provide re-insurance its negotiated fees could be obtained easily.

A bank or a mutual fund could adjudicate the claims instantly.

The large corporations, who are self-insured, all have HR officers. The HR officers I have met either do not seem to have the bandwidth to investigate the possibility of the ideal medical saving account structure or they are trapped into outsourcing the details of the corporation’s self-insured healthcare plans to middlemen. I have a feeling the commitments of some with middlemen are long term.  

If all this could happen it would be an important first step in the development of social networking in healthcare and medical care.

Consumers need education for the care of their chronic disease such as diabetes, asthma, chronic lung disease, heart disease and chronic gastrointestinal diseases. Many of these diseases are a result of obesity.

If social networking could discourage the ever-increasing incidence of obesity, society would decrease healthcare costs dramatically. 

If patients learned how to manage their own disease the cost of medical care would decrease precipitously.  

Why?

Because 80% of the healthcare dollars spent on direct patient care are spent on the complications of chronic diseases that are not well managed by patients.

Many drug companies and medical device companies would advertise on these social networking sites.  

Consumers must drive the healthcare system in order for the healthcare system to be repaired. Not government or the healthcare insurance industry.

Consumers feel powerless at present. Empowering consumers through social networking will disrupt the entire healthcare systems supply chain for the better.

Consumers are up against a government that wants to tell them what they have to do. They are up against healthcare insurance companies that charge obscene premiums. They are up against hospitals, physicians and emergency rooms that have exorbitant charges.

Consumers are up against diseases such as obesity which precipitates many chronic diseases.

Consumers are frustrated and need leadership and guidance.

The phenomenal growth in social networking can give consumers the tool they need to control their health and drive the healthcare system.

Social networking is the only way to start a consumer driven healthcare movement. It has to happen before the medical care system is destroyed.

The young people expert (20-50 years old) in social networking have to become engaged. 

Those young people have to understand physician mentality and the importance of the patient physician relationship.

I will be happy to help in any way I can.

 

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone

Please send the blog to a friend

 

 

 

 

 

 

 

I Left My Job: What Do I Do Now For Healthcare Insurance Coverage?

Stanley Feld M.D.,FACP,MACE

“Dear Dr. Feld

My wife and I are 43 years old. We have a 7 year old daughter. All three of us are in excellent health. We have minimal medical bills and yearly checkups. 

I just left an executive position in a company that had excellent healthcare insurance.

 I am in the process of hunting for a new executive position. I am currently uninsured. I have the option to buy COBRA insurance for the next 18 months or until I get a job with good healthcare benefits.

The COBRA premium quoted to me to be $1600 per month or $19,200 per year. My former employer told me he was paying $15,000 for the same insurance.

I cannot afford $19,200 per year. Neither can I afford not to have healthcare insurance coverage for my family in case of catastrophic illness. I searched the Internet for the best option.

There were at least 97 healthcare insurance policies offered for individual coverage. After I got through understanding the fifth policy I was exhausted. None seemed to be a good deal.

I have been a reader of your blog and always say to myself thank God I do not have to deal with the dysfunction you describe. I could not believe I would be in this situation.

You seem to understand the problems in the healthcare system. What do I do next?

Thank you in advance for any help you can offer.

Sincerely

H”

I have received other letters of disbelief from young people. They did not appreciate how unfair, non transparent and truly dysfunctional the healthcare system was until they encountered the problems.

The future belongs to the 20 -50 year old age group not seniors. They are all consumers and potential patients. They are are going to need a viable healthcare system at some point in their life.

This age group must take an interest in developing an understanding of and take responsibility for getting involved in fixing the dysfunctional healthcare system now.

In general 20-50 year olds are not sick. Only 20% of the population is involved in dealing with the healthcare industry at one time.  Eighty percent of the population does not interact with the healthcare system. When they do they realize how dysfunctional it is.

100% of the consumers must demand, simultaneously, the healthcare system become transparent and equitable.

The structure of Present Obama’s healthcare reform plan has not yet delivered nor does it have a chance to deliver is promises. In fact, it has made the healthcare system more dysfunctional and unfair.   

Change in the system has to be consumer driven in order to force the government to reform the system so it is affordable and accessible to all. This means honestly eliminating waste at all levels.

President Obama’s waivers to favored groups and concession to vested interests political pressures will not improve the system.  

I totally understand that when dysfunction affects the other guy, young busy unaffected consumers have no interest in being involved in actively changing the system. However, they are going to be the other guy at some point.

In answer to the reader’s question “What do I do?”

He could sign up for COBRA. The COBRA system is a flawed system. It is a dishonest promise.  COBRA was accepted by congress and consumers without understanding its underlying consequences.  

“The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. “

Nothing in the Department of Labor’s document covers how the premiums are determined by the healthcare insurance industry.

A consumer electing to take COBRA is charged the calculated premium for an individual healthcare plan. The premium is very high.  

Actuarial calculation is designed to the benefit of the healthcare insurance industry. The calculation is not transparent. I suspect the government does not oversee the calculation.

COBRA is about the only option good for a 50 year old obese male with hypertension and hyperlipidemia who has a wife and a 7 year old child. He would be rejected for all private insurance plans.

The individual state’s “high risk pools’” premiums are even higher than COBRA’s premium. The high risk insurance coverage is less inclusive because it excludes any possible risk from underlying conditions.  

I felt compelled to help this reader.

He needed coverage in case of a catastrophic illness in his family until he obtained a new position. At his age and health history he should not have any trouble getting accepted for a high deductible policy.

I told him to check which insurance company his family’s physicians accept. It was UnitedHealth.

The 8^th plan down the list of UnitedHealth options for high deductible was a $10,000 called Plan 100. The premium would be $318.82 a month. The deductible was $10,000. The plan provides full first dollar coverage after the $10,000 deductible is met up to 1 million dollars.

UnitedHealth Plan 100 underwritten by Golden Rule also had a $7,500 deductible for $417.

I thought this was the plan for this family. Their routine healthcare costs were less than $1000 year. The premium for the $7,500 deductible is $5004 per year. Total savings vs. COBRA is $19,200-$6004= $13,196.

If there was a catastrophic illness in his family and it cost more than $7,500 his total cost would be $7500 plus $5004 for his premium for a total cost of $12,504. He would still save $6,696 (19,200 for COBRA vs. $12,504= $6,696).

The big disadvantage is his premium costs are not tax deductible as it would be for an employer. At a 30% tax rate this consumer would have to earn $27,429 in order to pay $19,200. 

The adjudication of claims is simple. The physicians send the bill to UnitedHealth. UnitedHealth allows physicians their negotiated fee. The consumer is then sent an explanation of benefits for allowable fees.

Since the consumer has not reached the deductible, he is required to pay the physician’s allowable fee. This fee is credited toward his $7,500 deductible.

When the deductible is reached the full allowable amount for services is paid. This is the best deal under the present healthcare insurance options for this family of three.

He bought the high deductible Plus 100 insurance. He also complained about the confusing array of options and prices, the lack of transparency about these options, and difficulty in easily understanding the options.

He said he is a pretty smart fellow. He had difficulty in figuring out what to do and was ready to pay for COBRA coverage.

He asked, “How could people of average intelligence figure it out?

It would be easy if there were a questionnaire that would automatically determine consumers’ healthcare policy needs and direct them toward healthcare insurance policies that would fix their needs.

I told him the game is rigged. The insurance industry does not want you to figure out what policy is best for you. It wants you to buy the most expensive policy that might not address your needs.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone

Please send the blog to a friend

 

 

 

 

The Fourth Spoke In the Business Model For A Successful Healthcare System

Stanley Feld M.D.,FACP,MACE

The fourth spoke of a successful healthcare system’s business model is my Ideal Electronic Medical Record (EMR). I have been speaking about the Ideal Electronic Medical Record since 2006.

I have been an advocate of EMRs since 1992. An appropriately designed user friendly EMR would improve workflow efficiency, increase physicians ability to communicate with patients, hospitals and other physicians and reduce costs. Presently it costs physicians $7 to pull a chart.

There have been many EMRs built by many technology companies in the last 20 years. The price of an EMR has ranged from $ 5,000 to $120,000 per physician. The practice disruption to install a new system has been unbelievable.

Hospital system costs to install EMRs have ranged from $500,000 to $5 billion dollars.

In 2007 the deficiencies in Kaiser’s EMR were exposed to the chagrin of the Kaiser board of directors.  

“Kaiser: Critical Need To Cut Rising Costs”

“$7 billion in losses if no action taken, HMO report says”. Kaiser has invested $3 billion in data system created by Epic Systems Corp. Kaiser’s project supervisor e-mailed 180,000 employees detailing his frustration with Kaiser’s Electronic Health Record System, which he considers inefficient and unreliable. The project supervisor brought his concerns to the Kaiser HMO’s board. He said the information was not taken seriously “because of conflicts among top executives.” Doesn’t this sound typical of the hierarchical bureaucratic systems we live in?  

The creation of a fully functioning electronic medical record is extremely complicated. Physician practices and hospitals have different needs.

If hospital administrators are choosing a company to build the EMR invariably the software company builds the EMR for the payer (hospital). The hospital is their customer.

The physicians on staff are not their customers. Patients and physicians are their real customers but they are not considered the customer. The EMR should be built for patients’ benefit. It should be built to improve the patient physician relationship.

The EMR must be designed so that it does not interfere with the physicians' workflow and improves physicians’ care of patients.

The only way this is going to happen is if consumers are responsible for their health and healthcare dollars. Consumers will then drive their physicians to obtain a fully functional EMR.

Little progress has been made in getting large numbers of hospitals and physicians to install EMRs. There are many reasons for this dilemma.  The principle reason is cost.

As the government and the healthcare insurance industry decrease reimbursement to hospitals and physicians, hospitals and physicians are hesitant to make large capital investments for EMRs.

As of 2010 only 12% of US hospital have installed at least basic EMRs. Only 2-3% might qualify for having fully functional EMRs. A fully functional EMR has to meet 23 to 25 of government imposed criteria. In 2012 these criteria define “meaningful use” developed by President Obama’s healthcare administrators.

The "minimal use criteria" will become more complex by 2014. This means the cost of upgrading an EMR will increase. Converting from ICD-9 to ICD-10 will add to the upgrading costs.

The government bureaucracy has added another gigantic hairball in the middle of the patient physician relationship.  

Government bureaucrats looking at the healthcare system believe in fully functioning EMRs. Some hospital and physicians in small practice cannot afford the prices of EMRs despite the $27 billion dollar subsidy President Obama included in his Economic Recovery Act.

The $64,000 dollar maximum per physician subsidy, if they qualify, is less than the cost of the functioning EMR cost. The millions of dollars in hospital subsidy don’t match the billions of dollars in costs, service, upgrades and maintenance needed by hospitals for a functioning EMR.

No one in President Obama’s ever expanding government healthcare bureaucracy ever thought of putting an Ideal Electronic Medical Record in the cloud and charging the physicians and hospital 1 penny per click per month.

This formatting of the Ideal EMR would align the incentives of the government, hospitals, physicians’ practices and patient care.

There would be a universal EMR with automatic upgrades, maintenance and service.

Organizations that have spent a lot of money would move over to the system because they would avoid service contracts, maintenance fees and the cost of upgrades.

All the software the government felt was necessary to make the Ideal EMR completely functional would be in the system. New regulations necessitating added software would be incorporated into this Ideal Electronic Medical Record.

Practice Fusion is a new website that provides an electronic medical record for free to physicians. It is sponsored by ad revenue.

 

 

This website might have struck gold. It has grown from 10,000 users to 50,000 users in the last two years. It has meaningful use criteria embedded in the software program.    

The You Tube and its accompanying You Tubes explains the system. It is easy to set up. It is free and seems secure. I still have some questions. However Practice Fusion might be right on target.

Remember, online banking did not take off until it was free.  

 Practice Fusion might be the disintermediator of the electronic medical records industry in healthcare just as ITunes was the disintermediator for the music industry.

Whoever said physicians are not computer literate was wrong. The only way the healthcare system is going to be fixed is if patients and physicians take the initiative without government and its bureaucratic complexity or interference.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone

Please send the blog to a friend

 

 

 

 

 

 

 

Practice fusion

 

 

 

 

Practice fusion tours.

http://www.youtube.com/watch?NR=1&feature=endscreen&v=pVYdPcqlSf8

 

http://www.youtube.com/watch?v=PCk1V2uuq1o&feature=related

 

 

Ideal Medical Savings Accounts For Everyone: Encourage Patient Responsibility!

Stanley Feld M.D.,FACP,MACE

The third spoke in the future states wheel is Patient Responsibilty for their health and Healthcare dollars.

The Ideal Medical Saving Account would decrease the cost of the Healthcare System because it would dis-intermediate the Healthcare System’s complex and convoluted business model.

The Ideal Medical Savings Account should be an option for all consumers who have all types of insurance coverage. The Ideal Medical Savings Accounts would create competition for patients among physicians. It would create competition among healthcare insurers.

Medicare, Medicaid, corporate self-insurance plans, association healthcare plans, individual healthcare plans and ordinary healthcare insurance plans provided by employers could all offer the Ideal Medical Savings Account.

If MSAs were structured as my Ideal Medical Savings Account is structured the result would be a decrease in the cost of healthcare, a decrease in premium costs and an increase in healthcare quality.

The Ideal MSA must be paid for by pretax dollars as all other healthcare plans are.

If the government, individual or employer puts the first $6,000 of insurance in individual trusts for the consumer the entire healthcare and medical care supply chain would be disrupted by consumers.

An immediate argument is Medicaid patients are not smart enough to determine their own healthcare needs if they were responsible for the first $6000 of healthcare insurance coverage.

This is rubbish. It is condescending to patients on Medicaid. If the government is so worried they should provide education to help these Medicaid consumers make wise healthcare choices using available social media.

 

 The entire goal of the Ideal Medical Savings Account is to provide incentives for consumers to become responsible for their health and healthcare needs rather than be entitled to medical care.

The mechanism for this reversal from a dysfunctional system’s business model to a functional system’s business model is patients’ owning their healthcare dollars and having financial as well as medical incentive to be responsible for their health, maintaining their health, and choosing the most efficient and effective medical care.

Consumers would become Prosumers (Productive consumers) of health care rather than passive consumers of healthcare.

This mechanism has worked in many industries using the Internet as a facilitator.

The Internet can become an extension of the physicians care.

At present there are many web sites offering advice to patients. The defect is they are not an extension of the physician’s care of the patient.

Physicians would be motivated through competition for the patients’ owned healthcare dollars to choose the sites for his patients that would be an extension of their care.

Physicians associations could create web sites for their members.  Social networking between physicians and their patients could direct their patients to that site. This would be the meaning of an extension of the physician’s care.  

Patient responsibility is the third spoke in my formulation of the future state business model of a functional healthcare system.

 

It must be remembered that the present state’s business model is dysfunctional. It must be repaired.

The future state must not be encumbered by any of the baggage of the dysfunctional present state business model.

If the future state model is made clear to patients, potential future patients and recovered patients (consumers) they will demand for this future state model.  

Using social media consumers can drive the healthcare system to the future state business model.

It is similar to what ITunes did to music publishing, Amazon did to book publishing and Netflix did to the movie industry.

 It turns out everyone is better off and the system is more efficient and costs less for consumers. 

The consumers would own the first $6,000. They would be responsible for the management of there healthcare dollars. They would also be responsible for choosing their physician.

I have found that when physicians and patients sign a patient physician contract the treatment results improve. Both physicians and patients have their responsibilities clearly defined.

The patient physician contract motivates patients to be responsible for their own care. Patients responsible for their care is critical to successful clinical outcomes.

If there were a financial incentive attached to this physician patient contract along with a potential bonus the results would be even better.  

This was especially true in the treatment of Diabetes Mellitus.

In treating chronic diseases such as Diabetes, physicians must be the teachers, prescribers and coach. Patients must become the professor of their disease. Patients live and care for their disease 24/7.

Financial incentives would motivate patients to take an active role in their medical care.  

Obesity is a major problem in America today. Patients and patient education is the only solution to the “The Obesity Epidemic.”

The only way to decrease obesity is by burning more calories than is eaten.  Society must encourage exercise, and reducing intake. It turns out society encourages the opposite.

Mayor Bloomberg is doing the right thing in New York City. He uses simple transit Subway advertisements to increase awareness caloric intake. He has required each restaurant to publish calorie counts.

It is a simple educational message that everyone can understand. It is amazing how intelligent people misjudge their caloric intake.

Constant repetition of calorie counts of various foods along with estimates of calories burned can result is a cultural change for the need to burn more than we eat.  

Companies such as FitBit are building simple products to help us achieve this goal. 

Obesity contributes to the onset of many chronic diseases. The treatment of the complications of chronic disease result in eighty percent of the healthcare dollars spent for direct patient care.

If a consumer abuses his health and ends up spending the initial $6,000 he has no money left to put into his retirement account.

If a patient has a chronic disease and has excellent control of his disease he can avoid the complications of his disease. If the patients take the appropriate medical care avoids hospitalization and the emergency room for the year, the provider of his Ideal Medical Saving Accounts can afford to give that person a bonus for his retirement account.

This would add an additional financial incentive for consumers.

As a society we are smart enough to solve the problem of a dysfunctional healthcare system. The present course is unsustainable.

The future state’s business model with consumers responsible for their healthcare dollars and the patient physician relationship restored can achieve the goal of a sustainable healthcare system. 

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone

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The Second Spoke Of The Wheel: The Ideal Medical Savings Account

Stanley Feld

"Dear Dr. Feld

If your ideal Medical Savings Account is such a good idea why has it not become more popular?"

The reason is simple. The Ideal Medical Savings Account does not exist as a healthcare insurance option. The healthcare insurance industry has obfuscated the purpose of creating financial incentives for consumers with the offer of Health Savings Accounts.

The Health Savings Accounts keep premium dollars in the healthcare insurance industry’s control at the end of the year. Consumers are able to use unspent money on healthcare deductible in the future.

The Ideal Medical Saving Account puts the money not spent in a separate tax-free trust for consumers’ retirement. The logic is to reward consumers for good health financially and to encourage consumers to be responsible for their health and healthcare choices.

The goal is not to reward the healthcare insurance company it is to reward consumers. The healthcare insurance industry is controlling the consumer’s money for its own profit.

Despite its faults HSA’s are becoming very popular. It is the fastest growing healthcare insurance product in America.

President Obama wants to eliminate HSAs. His goal is to increase government control over consumers’ healthcare choices. He does not want consumers to control their healthcare dollars. He wants to control consumers.

The healthcare insurance industry’s goal is to maximize its profit. It is not concerned about the consumer’s health. The more consumers in the healthcare system the more premium dollars the healthcare insurance industry controls. 

 Using the power of lobbying and the influence of lobbyists it has been able to rig the game against the consumer.

    "Wendell Potter, former senior executive^[1] at Cigna turned whistle-blower, has written that the insurance industry has worked to kill "any reform that might interfere with insurers' ability to increase profits" by engaging in extensive and well funded, anti-reform campaigns."

"This is nothing new. However, as consumers (patients in all three categories) the Internet and social networking can empower us to have more influence over the politicians than lobbyists."

"After all, we are the people who give them their jobs. Some might say this is a naïve view. However, recent events have shown the effect of People Power and its ability to disrupt the establishment and its lobbyists.

The industry, however, "goes to great lengths to keep its involvement in these campaigns hidden from public view," including the use of "front groups." Indeed, in a 1998 effort to successfully kill the Patient Bill of Rights at that time, “the insurers formed a front group called the Health Benefits Coalition to kill efforts to pass a Patients Bill of Rights.

While it was billed as a broad-based business coalition that was led by the National Federation of Independent Business and included the U.S. Chamber of Commerce, the Health Benefits Coalition in reality got the lion’s share of its funding and guidance from the big insurance companies and their trade associations."

The question is why would the National Federation of Independent Business or the U.S. Chamber of Commerce do this? They either don’t understand the healthcare insurance industry’s motives or they received grant money from the healthcare insurance industry. Both groups are working against the benefit of it own people.

"Like most front groups, the Health Benefits Coalition was set up and run out of one of Washington’s biggest P.R. firms. The P.R. firm provided all the staff work for the Coalition. The tactics worked. Industry allies in Congress made sure the Patients’ Bill of Rights would not become law."^[2]" 

Obamacare and the Democratic congress have also yielded to the demands of the healthcare insurance industry. President Obama’s goal is to control all medical decisions for patients to keep healthcare costs down. Most advocates of Obamacare overlook this fact.

President Obama’s individual mandated purchase of healthcare insurance would increase the number healthcare industry’s customers. Its profits would increase. 

Medicare and Medicaid are totally dependent on the healthcare insurance industry for administrative services. This results in keeping the healthcare insurance industry in control of healthcare spending. The 2.5% overhead for Medicare and Medicaid continuosly repeated by government officials is completely bogus.

The healthcare insurance industry receives at least 30% of every Medicare and Medicaid dollar spent.

The administrative services costs are supposed to be no more than 15%. However, large sums of administrative costs are applied to direct patient care. Each administrative cost has a profit center attached to it.

These profits center increases the healthcare industry’s profits. In turn the salaries of the executives increase.

The Ideal Medical Savings Account eliminates all these layers of bureaucracy, profits and abuses.

It is a perfect opportunity for “People Power” to demand through social networks that the Ideal Medical Saving Account be added to healthcare insurance choices.

The Ideal Medical Savings Account puts the power back in consumers’ hands.

Neither traditional insurance plans or Medicare or Medicaid provide financial incentives for patient to be responsible for their disease nor their healthcare needs.

 

 

Financial incentive for all categories of patients (consumers) can serve to increase adherence to physician’s treatment instructions.

Financial incentives can stimulate consumers to be educated consumers of both healthcare and medical care.

Financial incentives can serve to incentivize patients to become professors of their chronic disease. Self-management can avoid many emergency room visits and hospitalizations.

Instant adjudication of claims can decrease many of the excessive administrative costs.

The Ideal Medical Savings Account is simple and transparent to consumers.

IMSAs revives the patient physician relationship. It drives the government and the healthcare insurance industry to the edge of the medical care transaction. It disrupts the hairball and will instantly disrupt the food chain that is failing under the weight of healthcare costs.

The Ideal Medical Savings Account is a perfect healthcare insurance product if deployed properly. Social networks must be formed to demand its availability in order to permit consumers’ (patients) to drive the healthcare system.

Social networks on other levels can force physicians to be more competitive.

The result would be a reduction in the healthcare system’s cost while eliminating administrative abuse, waste and fraud.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone

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Consumer Driven Healthcare As A Result Of Social Networks

Stanley Feld M.D.,FACP,MACE

To Reader, You can increase the size of slides to read them by double clicking on the slide.

Social networks can express the feelings and preferences of various groups. They have given people an individual voice. If there is universal agreement on a social network, the social network can change the supply chain of any organization, government policy or even government.

We have seen it this week in the rapid reversal of policy by Nancy Brinker and the board of directors of the Susan Komen Foundation toward the funding of Planned Parenthood of America.

 Ms. Brinker and the board were not very transparent for the reasons of its policy change in the first place. The original defunding policy was probably the result of the Foundation’s own funding pressures by pro-life contributors.

The rapid reaction of the Susan Komen Foundation social network, which was so skillfully developed by Ms. Brinker, was the probable reason for the switch back to the original policy.

 The new policy was to withdraw funding for Planned Parenthood’s providing mammograms for needing women. The new policy contradicted the mission of the Susan Komen Foundation. The social network reacted and the new policy was rescinded.

It took only a week to change the policy back to the old policy.

Social networking caused congress to abandon SOPA and PIPA in two weeks.

Both examples prove the power of the people.

The real question is how do you mobilize the power of the people to fix the healthcare system?

Everybody of all age groups knows the sound bite,“the healthcare system is broken.” 

Not many people understand the reasons it is broken. Nor are many people interested in creating the bandwidth to know those reasons until they become sick.

People who are not sick really do not care as long as they perceive they have adequate healthcare insurance coverage.   

Many President Obama fans think he is doing a great job reforming the healthcare system because of his use of well-known sound bite that the healthcare system is broken. He has promised to fix it.

He has promised to decrease healthcare costs and provide adequate access to healthcare for all people.

I have shown that President Obama’s healthcare reform act will increase healthcare costs, increase the budget deficit, decrease access to care and ration care.

Even before his healthcare plan is fully implemented it has resulted in an increase in cost of care, decrease access to care and rationed care.

Below is a comment from a neurosurgeon who was returning from a CMS seminar about restriction of access to healthcare.

It is a worthwhile to listen to his comment on new HHS regulations limiting access to care.

https://mail.google.com/mail/ca/?ui=2&ik=5b73a6d1b7&view=audio&msgs=1354467a5b029c30&attid=0.1&zw

A way to mobilize “the people power” is get people 20 to 50 years old to understand what is being done to destroy the healthcare system. Everyone is going to need the healthcare system eventually.

These younger people understand how to develop social networks and get them to have a desired effect.

In order to reduce the cost of healthcare and increase the quality, the system must be converted from a government and healthcare insurance industry driven system to a consumer driven system.

I was “called out” by a reader because I called the new system a consumer driven system. He wants to call it a patient driven system. He defines all consumers as patients.

 “ In my opinion, everybody is a patient, and a member of one of three groups: The first group is composed of

"Patients in waiting" (the well, who require periodic screening and health information to stay well, and the worried well, who are coping with issues of some sort for which they have yet to seek professional advice); 

The ailing, composed of people who are actually coping with conditions of one sort or another that make them less than well; and 

The recovered, those who have regained an adequate measure of good health and functional capabilities after having experienced and recovered from a spell of illness. 

What we need to do is to work to make all three publics (to use a marketing term) aware of the fact that regardless of which group they may currently occupy, they are all stakeholders in the mess we currently call the healthcare system.”

This is a great point. It might inspire the “patients in waiting” to get involved now before it is too late.

In my 2020 business plan for the future state, patients are in charge not the government or the healthcare insurance industry.

 

Patients would own their healthcare dollars. They have incentive to be wise consumers of healthcare and take responsibility for their health and healthcare. They would also have the incentive to make prudent healthcare and medical care choices.

The consequences of this ownership would change the behavior of the government and the healthcare insurance industry.

Both would become facilitators at the edges of the healthcare system and not the gigantic hairball in the middle of the system obstructing the patient physician relationship.

Social networking could force the government to relinquish its quest to control everybody’s choices and access to care.

 A consumer driven system would decrease the demands for expensive excessive care by the patients because they have “skin in the game.” The result would be to decrease the cost of healthcare.

These results would occur if all the other spokes of my 2020 business plan on the wheel were accomplished at the same time.

Many of you may remember the hope of a physician in Brooklyn.

“I cannot finish my career in Medicine without finding a way to integrate experienced people with great ideas and insight with young people who know how to create the tools to bring innovative approaches to actually create a functional healthcare system.”

It is my hope also.

Innovative software can be built for the future state that empowers patients in waiting, the ailing patients and the recovered patients (consumers) with the tools to express their needs.

Patients in all three groups can accept and take responsibility for their care.

In order to transform the healthcare system you do not need all the consumers in the country to be in the social network. It simply has to be compelling enough for people to join as the goals get the attention of others.

Consumer (Patient) Driven Healthcare along with the Ideal Medical Savings Account will be the foundation of this transformative healthcare system.

 

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone

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It Is All about How You Look At Things

 Stanley Feld M.D.,FACP,MACE

 My son Brad Feld wrote in response to my blog“How Software Innovation Can Cause Creative Transformation Of The Dysfunctional Healthcare System”,

Outstanding blog post dad.

 And I think your punchline is completely correct - the healthcare software innovators should focus 100% of their energy on the patient and the physician (their customer). That would quickly transform everything in the healthcare supply chain.

Can you imagine what would happen if the government subsidized Borders and Barnes & Noble? Yup - pretty easy to see that they'd be doing fine and "bookstores would be classified as a public good." What nonsense.”

Healthcare policy makers are trying to reform healthcare using a defective business model.

 

The business model of 1945 to 1965 was a model that put the patient and physicians in the center of care.

Post Medicare in 1965 the business model changed because lots of government money came into the healthcare system. The secondary stakeholder began to devise ways of taking that money out of the system before and after the money was spent on direct patient care.

The relationships between patients and physicians became distorted. A giant hairball of vested interests by secondary stakeholders came between the patient physician relationships.

Well-intended policy makers tried to fix the system by making revisions and updates to a broken business model.

These revisions only made the healthcare system more expensive and less effective in the care of patients.

 The 2011 business model is a jumble. The secondary stakeholders control the healthcare system and interfere with the patient physician relationship.

 

 

President Obama’s healthcare reform law is making the healthcare system worse. It is pasting regulations and restrictions on top of a failed business model.

It does not consider a way to get back to the effective business model of 1945-1965 for the 21^st century.

It reminds me of Microsoft and Windows. Microsoft is pasting revisions on top of the DOS operating system of the 1980s rather than revising the operating system.

Obamacare has added complexity to the system. There are many bad ideas such as Accountable Care Organizations and pay for performance rules to name just two. It does not deal with tort reform or patient responsibility for their own care and their own healthcare dollars.

Rather than pushing the secondary stakeholders to the edges of the healthcare system, Obamacare gives these stakeholders increased control over patients and physicians and destroys the patient physician relationship.

The critical turn is necessary now.

The 2020 business model of Obamacare will increase the velocity of healthcare system collapse. The result will be an increased budget deficit. Healthcare spending can escalate beyond GDP in 40 years.

 

 

At this critical turn we must go in a sustainable future state direction. The business plan must be exchanged with a completely new business model. The new business model must be unrestrained by the present business model.

This is where software innovation comes in. Software must be built that redirects the model to a consumer driven healthcare system.

It has been a disaster for the government, healthcare insurance industry and hospital systems to control the healthcare system.

It must be controlled by consumer choice, responsibility and actions with consumers owning their healthcare dollars. Legislation must be written to provide consumers with choice, responsibility, and incentives for compliance.

Consumers are the only ones that can demand this option. Consumers changed the course of SOPA and PIPA. Consumers can change the course of healthcare.

 

The secondary stakeholders will not give up their power easily. It will only come as a result of the Internet and innovative software that teaches consumers about their power.

 

Steve Jobs did it with iTunes, iPods, iPhones and iPads. Apple is about to do it with TV. Jeff Bezo did it with Amazon and the publishing industry.

 

The 2020 business model in the future state must have the following advocates, software developers, healthcare policy wonks, CEO’s of large corporations and small businesses. Most importantly, people 20-50 years old who are ell must start becoming engaged now so they can have a viable healthcare system when they get older. All these groups must think about the future state without present government restrictions. Steve Jobs did it for Apple. It can be done for healthcare.

 

The components of the future state should be,

• The Ideal Medical Savings accounts,
• The Ideal Electronic Medical Record,
• Patient Responsibility for their care and healthcare dollars,
• Patient education as an extension of physicians care
• A team approach to chronic disease management with the patient becoming a professor of their disease, the team leader and the physician the coach with his healthcare team assistant coaches,
• Tort Reform
• Integration of specialty care.

All of these components must be executed at the same time. Consumers must be taught to drive the system.

Skeptics who are try to hold on to power and protect the validity of past policies will fight hard just as the music industry, the publishing industry and the movie industry have.

In the end the skeptics will realize the virtues of Pareto efficency. All the healthcare industry secondary stakeholders will thrive, as the patient physician relationship once again will be revitalized.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

Please send the blog to a friend