tag:blogger.com,1999:blog-32053362.post6113965509849723765..comments2024-03-26T00:25:34.026-04:00Comments on Not Running a Hospital: The Great Train Robbery, version 2.0Paul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger9125tag:blogger.com,1999:blog-32053362.post-61696495997832269702012-09-09T21:34:32.410-04:002012-09-09T21:34:32.410-04:00Why not just pay the providers directly if there i...Why not just pay the providers directly if there is capitation? What purpose do insurance companies serve in that situation except for little more than money collectors who then hand fees to providers who assume the risk. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-78495194884896172412012-08-06T22:16:21.806-04:002012-08-06T22:16:21.806-04:00A nice set of blogs, Paul. Keep on hollerin’ – th...A nice set of blogs, Paul. Keep on hollerin’ – this exercise of market power is abominable! Exemptions from antitrust should be reassessed.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-22726868924472881602012-08-06T15:29:44.293-04:002012-08-06T15:29:44.293-04:00I agree with Paul that insurers should not be paid...I agree with Paul that insurers should not be paid for risk that they don’t assume. Self-funded employers assume all cost risk of providing health insurance for their employees except to the extent that they purchase stop loss reinsurance. Insurers earn very modest fees per employee per month (PEPM) or per member per month (PMPM) to administer claims and provide a network. If an ACO accepted all of the medical cost risk inherent in a true global payment arrangement, insurers should be paid on an administrative services only (ASO) basis only.<br /><br />Alternatively, we could see the spread of a model similar to Kaiser Permanente or Geisinger Health System (for one-third of its members) where some of the providers and the insurer are on the same team and under the same ownership.Barry Carolnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-50210107247274629452012-08-06T12:32:28.137-04:002012-08-06T12:32:28.137-04:00The Affordable Care Act created a mandated minimum...The Affordable Care Act created a mandated minimum medical loss ratio for insurers; I believe that many states, including Massachusetts, have such a rule in place as well. The federal rule has resulted in some rebates to premium payers, publicized by USDHHS recently.<br /><br />It seems to me that your beef with the new law could be addressed in a couple of different ways (which have varying probabilities of ever happening): (1) Increase the mandated medical loss ratio (i.e., further limiting the insurer profit margin), perhaps on a temporary basis tied to reducing the reserves you've characterized as unneeded. (2) Take us back to the bad old days of rate setting, so that payor-provider deals would not be an option. (3) Work to ensure that implementing regulations at least place the issues you describe on the agendas of the new and newly-renamed state agencies charged with implementing the new law.<br /><br />In the last iteration of health reform in Massachusetts, the regulators were careful to create the framework for separation (at least in theory) of insurance risk -- properly belonging to insurers -- from quality risk -- properly belonging to providers, assuming minimally-adequate reimbursement. It seems to me that these concepts can, and should, be brought forward into the current framework.<br /><br />I'm trying to read the new law in my spare time, so I may have further thoughts on this subject as I slog through it .... For anyone who wants to join me in this effort, I've embedded the full text, and an official summary here: Massachusetts Health Reform Bill Tackles Cost Control and More (HealthBlawg) – http://vsb.li/J58MNjDavid Harlow (HealthBlawg)http://healthblawg.comnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-83262934319320105312012-08-06T00:38:23.893-04:002012-08-06T00:38:23.893-04:00Or is this bill introducing risk where previously ...Or is this bill introducing risk where previously there was very little? In a system where insurers have been readily able to pass spending increases to employers, how much burden of risk have they been under?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-55384126155980020312012-08-05T20:51:19.105-04:002012-08-05T20:51:19.105-04:00You totally nailed it. My only wish it that your b...You totally nailed it. My only wish it that your blog could get even more play. The people who need to see it don’t or won’t acknowledge the reality of the situation. They all are hand maidens to the demise of the system and BCBS is laughing all the way to the bank. Egregious.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-54667875246762971342012-08-05T20:50:22.108-04:002012-08-05T20:50:22.108-04:00Sorry, but I do not understand both comments. My ...Sorry, but I do not understand both comments. My point is that risk has been shifted to providers compared to whatever baseline you would like to use. The degree of risk increases each year in the contracts.<br /><br />BTW, why shouldn't I assume lax state oversight? That is what has existed and will continue to exist.Paul Levyhttps://www.blogger.com/profile/17065446378970179507noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-16919248651856523662012-08-05T20:28:12.649-04:002012-08-05T20:28:12.649-04:00I agree with comment below. Your analysis assumes...I agree with comment below. Your analysis assumes lax state oversite and MCO revenue as usual. Could happen, but it might not. If cost growth decelerates, hospitals make less, but so do insurers. Again, if the books are open and the state presses, the scenario you describe may not materialize.<br />BradBrad Fhttps://www.blogger.com/profile/10366408815395434941noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-72755608349204164652012-08-05T15:59:23.822-04:002012-08-05T15:59:23.822-04:00You're right but I think you are describing an...You're right but I think you are describing an extreme and not the current reality. Most if not all groups continue to share risk with the insurers and have caps on total risk, upside and downside. Also in some cases if a group owes money back to the insurer it may be due to their own increased FFS revenue. Thistir still FFS with a reconciliation to a budget and not true capitation... yet.Anonymousnoreply@blogger.com