There’s a gap in the proverbial health care safety net that’s big enough for a whale to swim through.
People who are incarcerated, on probation, or on parole — what a recent study calls the “justice-involved population” — make up 22% of the 13 million newly eligible people.
“The justice-involved population has a higher disease burden than the general population, yet as many as 90% of justice-involved people lack health insurance at the time of their release from incarceration,” says the study, published in Health Affairs. “This disparity between disease burden and access can drive up the cost of health care, result in worse outcomes, and cause patients to seek care later than appropriate and in care settings that are often isolated and lack care coordination.”
Remember when many predicted that accountable care organizations (ACOs) will save health care? A study by the Health Research and Educational Trust (HRET) states that “ACOs are entities willing to be held accountable for the costs and quality of care for a defined population of patients. When the ACA [Affordable Care Act] became law, such would-be organizations were likened by some observers to unicorns — they exist in our imagination, but no one has actually seen one.” (Certainly not Regina Herzlinger, PhD, as we reported here.)
Harsh, perhaps, but a recent study by the Centers for Disease Control and Prevention searched in vain for the cost savings in Medicare ACO pilots. The HRET says that “only 25% of physician practices have joined or formed ACOs, and another 15% plan to do so.”
Health reform means that much of what health insurance plans did is being taken on by providers. An obvious example is the Choosing Wisely campaign, an effort by physician professional organizations to cut down on overtreatment and overtesting.
Everybody else always knew that they weren’t really invincible, and now they seem to be grasping that fact as well. More than 70% of people 30 and younger say that having health insurance is very important to them, according to a poll by the Kaiser Family Foundation (http://tinyurl.com/insured-youth). These have historically been called the “young invincibles” because of their belief that chances are slim that they’ll suffer serious illness or injury and that, therefore, they don’t need to buy insurance.
New prescriptions were given to 232 patients from April to August 2010 at St. Michael’s Hospital in Toronto. Twenty-eight percent exhibited primary non-adherence at 7 days after discharge; 24 percent at 30 days. Perhaps more surprising is that patients discharged to home had a better adherence rate (26 percent) than those discharged to a nursing home (43 percent). There were no significant demographic differences between the adherent and non-adherent groups. Participants were all 66 or older; the average age was 78.
The appropriate cliché at the appropriate moment can have an impact. For instance, hearing “the right hand doesn’t know what the left hand is doing” in a hospital might be enough to spin you right back out the revolving door. You know the horror stories. Wrong limb amputated. Forgotten utensils cozying up to innards for the long haul. Those are the sensational examples, but care coordination — or lack of it — was and remains a vexing problem.
Many economists wonder if health insurance exchanges will actually perform one of their primary functions when they open in October — increasing the competition among health insurers offering products to millions of new beneficiaries. This according to Stateline, a wire service for the Pew Charitable Trusts (http://tinyurl.com/Pew-exchanges).
Sisyphus had to roll that boulder up the hill as punishment for deceit. Telling the truth has its own rewards, thankfully, because sometimes that too can seem a Sisyphean enterprise. Yet another warning that antibiotics are being overprescribed, this time in a letter in the April 11 issue of the New England Journal of Medicine (http://tinyurl.com/antibiotic-prescribing). The authors note that over 50 percent of antibiotics are distributed unnecessarily and find — surprise!
Clinician executives at health insurance plans can stop worrying about whether consumers are savvy enough to navigate the changing landscape of coverage and start worrying about how small businesses will fare under the Affordable Care Act. (Well, keep worrying about both because both will continue to be problems.)
Let’s just look at small businesses for now. Expect a learning curve, to say the least, according to a study by EHealth, the parent company of eHealthInsurance, a private health insurance exchange. (See:"Small Employer Health Insurance Survey" )
Steve Jobs famously staked his claim at the intersection of technology and creativity. Health insurers are looking for the intersection of technology and benefits knowledge, but are not quite sure how to get there. Do you hire information technicians and train them in the ways of health coverage, or do you hire (or promote from within) people who know insurance and train them to be IT savvy?