In this edition of #CareTalk, Carecentrix CEO John Driscoll and I discuss the impact of COVID-19 in the US and around the world. John retracts his earlier claim that the feds are doing a good job, and we go on to discuss the fact that we’re all in this together, universal coverage is a sensible policy, science matters, and government can help.
We agree with Tony Fauci, who said, “If it looks like you’re overreacting, you’re probably doing the right thing,” and we also look for signs of hope on the horizon (or just over it).
Joe Biden said in a recent debate, “one hundred sixty million people like their private insurance.” I agree with Biden’s assessment that it’s foolish to advocate scrapping insurance companies as his rivals Elizabeth Warren and Bernie Sanders want. It’s stupid politically to take such an extreme view and it’s also worth noting that other countries with nationalized health insurance (like the UK and Germany) have private insurers, too.
Still, what does it mean to say people like their private health insurance? I suppose I would be counted in that number. And, by and large I would say I do “like” my insurance, which is with Blue Cross Blue Shield of Massachusetts. They cover the doctors and hospitals I want to use and the drugs my family takes. Their customer service is good. Their website is ok. They’re flexible in their approach to enforcing policies.
The problem is the cost, which soared to about $2800 per month for family coverage, even for a high-deductible plan. At a colleague’s suggestion, I switched to an even higher deductible plan –which is also one where you have to pay for your own prescription drugs within that deductible instead of the first-dollar coverage I had previously. So while the premium dropped by several hundred dollars a month, I ended up with a co-pay on a generic drug of over $1000 –which would have been $100 before.
And did I mention that since it’s an HMO I needed to buy separate insurance for a dependent who’s at school out of state? And that the out-of-state insurance doesn’t cover expenses arising from participation in college sports? So I had to buy a third policy.
I don’t really blame my health insurer for the high and rising premiums. The main driver is the price of healthcare procedures, which continue to go up. I’ve been healthy, but still routinely see bills for my care in the thousands of dollars that would cost hundreds at most in other places. Some of that cost is attributable to the paperwork burdens imposed by the plans.
Warren and Sanders have a point about problems with health insurers and the lack of universal coverage. But in my view, the real way to address problems in the US healthcare system is to build on Obamacare, focusing not just on coverage (which Obamacare provides, especially if Medicaid expansion is fully implemented), but also on the cost, efficiency, and appropriateness of the care provided.
CareCentrix CEO, John Driscoll and I talk #CareTalk on the road to the HLTH conference in Las Vegas, where we interviewed some big names include Obamacare architect Zeke Emmanuel, Former CMS Administrator Andy Slavitt, Former Congressman Patrick Kennedy, Walmart Health exec Marcus Osborne, and Boston Children’s Chief Innovation Officer John Brownstein.
You can check out the whole series on the YouTube playlist.
“We’re seeing more and more consumer awareness every year,” [an insurance executive] told the Globe. “It’s a revolution that’s occurring, but it occurs over time.”
When I read about this ‘revolution’ it brought to mind an expression/poem/song from long ago: The Revolution Will Not Be Televised! The timeframe for the healthcare cost ‘revolution’ is on the order of decades, and I don’t think anyone will be able to sit still for a TV show of that length!
Not surprisingly, the Pioneer Institute’s survey demonstrated that while people with commercial insurance are interested in obtaining price information before receiving a healthcare service, they don’t often get it. Only 2 to 7 percent of people check costs on insurers’ websites, according to the Attorney General.
Although that number seems crazily low, it’s actually easy to understand once you consider the multitude of the barriers:
Patients don’t know what services they’re going to need
Choice of provider often trumps cost as a factor
Their health plans may not reward or punish them for saving or spending more money
Next year’s insurance premiums are unaffected by what they do this year
Those with a high deductible plan are likely to blow through the deductible anyway if they have serious medical expenses
Insurers’ cost estimators aren’t easy to use
The estimates may not be accurate anyway
People haven’t heard about the available tools
I’m an educated consumer with a high deductible plan but I don’t try to check the costs ahead of time.
So there’s no need to be glued to your TV (or other device) watching this ‘revolution.’
A quiet revolution is underway in healthcare data. A decade after the HITECH Act spurred the rapid adoption of electronic medical records, we are seeing the resulting data being integrated with other sources such as insurance claims, clinical registries and social determinants of health to produce richer data sets for analysis and action.
As we’ve noted in our own consulting work, Datavant has emerged as a key player in connecting disparate data sources at the patient level while protecting privacy. The company’s methodology anonymizes patient identifiers with a unique patient key, matches records across data sets, and enables data exchange.
So I was excited to attend Datavant’s Future of Health Data Summit in Washington, DC earlier this month. As one would expect from a company that strives to organize and present data efficiently, accurately, and clearly, it was a quality event. The day featured 40-minute panels with strong moderators and 3-4 expert panelists along with keynotes from luminaries such as former FDA Commissioner Robert Califf, CDER Director Janet Woodcock, and former Senate Majority Leader Tom Daschle.
The closing panel, Healthcare Policy, Value-Based Care and Data Sharing was typical of the program. Moderator Neal Katyal (former Acting US Solicitor General) made the most of the expertise of panelists David Shulkin (Former VA Secretary), Mona Siddiqui (Chief Data Officer, HHS) and Andrew von Eschenbach (former FDA Commissioner).
They were all passionate about the ability to finally leverage healthcare data at scale. Shulkin talked about using data to prevent suicides of veterans. The highest incidence is in the first year after discharge, when they risk falling between the cracks as they transition from the DoD to VA system. Siddiqui bemoaned the difficulties of confronting the opioid crisis with 2-year old data, and von Eschenbach spoke of the potential to transform the whole healthcare system by improving care and reducing costs.
Shulkin seemed the most skeptical about where things are headed in the near term, predicting incremental change in the healthcare system as the most likely outcome of the fight between Medicare-for-All Democrats and Republicans who want to crush federal involvement. When Siddiqui gushed about the potential to use the planet’s largest healthcare data set (from CMS) in hackathons and challenges and system redesigns, Shulkin interjected that working with the government was, “not for the feint of heart,” and “,not a great strategy for a young company.”
There was an interesting back and forth about how to get the public comfortable with data sharing, how to overcome the decline of public trust in general, and how to address privacy from a policy and technological standpoint.
The panelists generally agreed that patients would be on board if they saw how use of data could help with their own care, and that even spectacular data breaches wouldn’t completely erode patients’ trust in the system. We have become accustomed to such breaches with our financial data, after all.
Shulkin thought people would get really upset if they learned that their data was for sale. I disagree -I think consumers are already coming to terms with their data being sold throughout the rest of the information economy; it’s by no means unique to healthcare.
In closing, von Eschenbach said he was “incredibly optimistic” due to the tremendous energy coming into the process right now. It’s a chaotic environment, he said, but we’ll look back in five years and be grateful for today’s chaos.
Shulkin pointed to the large number of healthcare data companies formed over the past three years, using that as an indicator of the level of optimism in the field. It wasn’t evident to me that he fully shares this optimism.
And Siddiqui presented herself as a realist but also a bit of a visionary and optimist, who is thinking about the healthcare system that we want to have. For her –and many of us– it’s one that’s more technology enabled, virtual care enabled, and homecare centric.
I’m heading to the HLTH conference in Las Vegas next week. I hope it’s as worthwhile as the Datavant event!