Tuesday, January 31, 2006

President Bush speaks about HSA accounts

On January 31, President Bush presented the 2006 State of the Union address. In this speech, he reinforced several themes related to expanding access to affordable health care. He also asked that all policymakers renew their attention to advance enhancement solutions to our current health care system. Among President Bush’s specific proposals, and subsequent statements, was the expansion of Health Savings Accounts, electronic health records, extending affordable access for individuals and small businesses, portability of coverage, transparency in health care, assistance to vulnerable populations, and medical liability reform

Read the transcript here

Sunday, January 22, 2006

16 Ways to slash your insurance rates




If you're buying life, disability, long-term care or health insurance, your insurance company wants to know more about you. Depending on the type of policy, it could inquire about your habits, medical records and family history. Based on the answers, it will slot you in one of several categories that will help determine just how much you pay for coverage.

What you say and how you say it can make a difference in how your insurance company sees you and what it charges.

"It's not enough to say you got a good rate," says Randy Herz, senior vice president of Herz Financial, an insurance advisory firm in Farmington, Conn. "You have to look at what their classifications are. Then you have to understand your own health. Health is one of the biggest factors in determining the cost of your insurance."
$100? $200?
$300?
You can't save
if you don't shop around.

• Auto • Health
• Home • Life MSN Money Insurance


Here are some tips from insurance insiders to help you get the best health ranking -- and the lowest rates:

Communication counts
Tell the truth, the whole truth and nothing but the truth. Think that leaving something shady out of your health history might help? Wrong, for two reasons. First, the insurance company will likely find out (it is reading your records, after all), and it will assume the problem is severe because you didn't mention it. Even worse, if you withhold information that the company regards as material, it could cancel your life policy within the first two years, says Bob Hunter, director of insurance for the Consumer Federation of America.

Give your complete health story, but do it on your own terms and give the complete picture. Don't just say you have high blood pressure. Say you were diagnosed with high blood pressure five (or however many) years ago and have successfully controlled it with medication.

"The consumer should think about it from the side of the insurance company," says Robert Hoyt, head of the risk management and insurance program at the University of Georgia and president of the American Risk & Insurance Association. "To the extent you give them good, complete information and reduce the uncertainty, then ultimately you're going to get a fairer price."

If your agent or broker knows what wrinkles might give you a problem, he can shop you to the companies most likely to take you on at a good rate.

Watch your language. Sometimes incomplete answers can paint a bad picture. And insurance underwriters are trained to assume the worst. So be clear and complete in your answers. If you had a nonaggressive cancer removed from your face one time several years ago, don't simply say you had cancer removed, says David Johnson, an insurance agent and board member with the Georgia Association of Health Underwriters. List the specific type -- basal cell, for instance -- and that it was done once with no recurrence.

Sometimes an application will ask the ever popular question, "Which of the following conditions have you been treated for?" Instead of just checking "chest pains," include the fact that it turned out to be indigestion and no follow up was needed.

Know the rules of the game. "You need to ask what the (health) ranking is based on," says Hunter. "There should be objective criteria. And you really should shop a little. The criteria vary."

Find out what your ranking is with a specific company and why, says Hunter. It could be that something they don't know will improve your ranking and decrease your premium.

Shop around. It's common consumer advice, but it can be even more important with insurance. Two different companies can view a person's health and the risk he or she poses very differently.

"Most companies try to put you in the right slot," says Hunter. "But if they make a mistake, you don't want that to be the only one you talked to."

Even the lingo varies from company to company. A ranking of "preferred" or "standard" might mean two very different things, with different rates, at two different companies.

Smart shopping is very important for smokers, especially people who only occasionally smoke a cigar or pipe. While some companies will automatically put you in a less-desirable category with a higher premium, others won't penalize you for that once-a-year stogie.

Your physician can help
Alert your doctor. Insurance companies want to talk with your doctor's office and look at your most recent records. Failing that, they might have to use only the records from the Medical Insurance Bureau (a repository for medical records used by insurance companies), which might not be to your advantage. Sometimes a doctor can give some perspective to a condition that might look worse in black and white (for example, a high cholesterol condition that's being treated successfully).

But a busy doctor's office can sometimes drop the ball, says Dave Evans, vice president and publisher for the Independent Insurance Agents & Brokers of America. And the insurance company will only try so many times before it gives up.

So let your doc know you're applying for insurance. A little advance notice can ensure the call isn't overlooked and give you the best chance at a good rating.

Make sure the company gets all of your records, not just some. To get the most complete, up-to-date picture of your health, the company needs all of your records.

"If you've moved or migrated doctors, the fact of the matter is you probably have to be more proactive," says Evans.

Shop quietly. Similar to a lot of inquiries on your credit, a lot of inquiries on your insurability can throw up a red flag, says Herz. Instead, choose an agent or broker who can quietly do some informal shopping to narrow your options before you do anything official. "It avoids you getting declined or rated," says Herz.

In addition, if you use several different agents or brokers, let them know you're shopping around. That way, "everyone knows what they're working with and it might make them more competitive," says Herz.

Pick your insurance professional carefully. Not every agent is up to the task, especially if you've had some health problems in the past.

"If you're dealing with someone who does this a lot, they can help coordinate and shepherd you along because they are comfortable with the process," says Evans.

If you anticipate problems, it's especially important to have someone who knows the system. This can be an agent or broker who knows which companies are likely to give you the best rates and someone who knows how to talk to underwriters to convey the true risk -- or lack of risk -- you would pose.

"The worse your health is, the more this matters," says Herz.

About your vices: Cut them out
Develop good habits. The insurance company probably won't ask how many times a week you work out, how many grams of fat you consume or how many glasses of water you drink. But all of those things impact the criteria they will examine. So hit the gym, lose those extra pounds and keep yourself healthy.

"These things can make a difference for people, not just in getting coverage but in the price you'll get," says Evans.

Want to drop 30% from your life insurance premium? Kick the cigarettes.

"Smoking can add up to 30% to the cost of your life, disability and health insurance premiums," says Johnson.

Avoid drugs and alcohol. If you take illegal drugs, you're not going to find an insurance company that wants to take you, says Johnson.

"If (a person) has a recent history of drug use, they're not going to be able to get insurance," he says.

If you're a recovering alcoholic, "You're probably going to be able to get coverage, but it could be a higher premium," says Johnson. Emphasize, with medical records to back you, how long you've been sober. The insurance company could see a relapse as a risk to them, so the more you can show how unlikely that is, the better for your rates.

Prepare for your exams. In some cases, the insurance company will require either a physical or a short exam by a paraprofessional, which can include taking your vital signs and drawing some blood.

To get the most accurate reading, schedule it first thing in the morning on an empty stomach. (Obviously, if you have a condition that makes that tricky, talk to your doctor first.) Give up vigorous exercise like that three-mile run 24 hours in advance. Get a good night's sleep. And some experts recommend forgoing your morning coffee, or even water.

Follow up on the details of your medical records. Do your records contain a recommendation for a test that you never got? The insurance company could see that as a bad sign, says Herz. "Have the doctor note in your records that you didn't need it after all -- or get it done," he says. Otherwise the company is likely to think that you could have some undiagnosed problem.

Think about your future. If you're healthy now and considering buying term life insurance, make sure that it's renewable and convertible, says Evans. "What that means is that you can convert to permanent coverage without a physical. That would be worth paying extra for," he says.

Keep trying and keep asking questions
Try to get coverage even if you've had health problems. Work with a professional you trust and have him quietly look into what kind of ratings you would get, says Herz. Bear in mind that a number of conditions aren't the black marks they used to be.

"A person who had open-heart surgery used to be declined," says Herz. "Now they can get regular rates."

Ditto for folks who are using medications to control conditions such as high blood pressure and high cholesterol.

"I've seen people who have cancer, heart (problems), all sorts of things, get insurance because they were able to get a favorable prognosis," says Evans.

Ask why. If you are declined or end up with rates higher than you were expecting, find out why. Talk with your agent and ask how to get a copy of your records from the Medical Information Bureau, says Evans.

Don't give up. "Don't consider a (lower health ranking) or decline in the past as indicative of future events," says Herz. It could be that last time around your agent didn't work hard enough for you, or it could be that today, with new drugs and treatments, your condition wouldn't pose as much of a risk, he says.

And time does heal -- even in the insurance business. "Sometimes, the further you get from (an event)," says Herz, "the better off you are."

Wednesday, January 18, 2006

Become a health care shopper


Unfortunately, medical care doesn't come in packages with clear price tags. Often, finding out exactly how much you'll pay to get the care you need requires perseverance and -- no pun intended -- patience.

The California HealthCare Foundation recently had a small army of "mystery shoppers" -- people posing as uninsured patients -- call or visit hospitals in the state asking for specific medical procedures. The mystery shoppers found that pricing information often resides with off-site billing personnel whom few hospital staffers could identify.

In more than 600 calls and visits, fewer than one-third of the mystery shoppers could get a firm price or estimate with a single inquiry. In an extreme example, one mystery shopper was routed to 17 different people before getting any pricing information.

The problem is not limited to California, nor is it something only the uninsured face. A survey by the Kaiser Family Foundation and USA Today found that 52 percent of people polled nationwide said their doctors never or rarely discuss the costs associated with the procedures they recommend.

What's more, employee benefit plans are raising deductibles and co-pays, forcing individuals to bear more of the burden of medical care. As this trend deepens, individuals will need to be able to compare prices before committing to medical procedures.

"People need to be better shoppers for health care because more of their health care costs will be paid directly from their pockets or will come from health savings accounts," says Maribeth Shannon of the California HealthCare Foundation.

Among other things, Shannon recommends that people get plenty of information from doctors before visiting hospitals. "It's important to have as much information as possible to help the hospitals identify what you need," said Shannon. "This way they can price procedures accurately." A key piece of information is the diagnostic code that doctors assign to ailments.

Shannon also recommends phoning the hospital before visiting. Mystery shoppers who called were able to get pricing information faster than those who visited.

Finally, Shannon recommends asking for discounts and payment plans to reduce costs and space out bills. "If you don't ask for a discount," she says, "it almost certainly won't be offered."

Resources

Visit these sites for more information on health-related issues:


Health & Wellness Information, Physician Locator from WebMD

Read about today’s most current information and news on healthy living and medical issues by visiting WebMD. Find a quality physician near you by using the Physician Locator.


FirstGov’s Comprehensive Site for General Health Information

Stay informed about health issues with this comprehensive site targeted especially for consumers.


Reliable Health Information from Healthfinder

Search this government-backed, one-stop information source for health issues, using the health library, news, lists of organizations, online check-up and more.

Visit these sites for more information on choosing quality health care:


Hospital Quality & Safety Survey Results from the Leapfrog Group

Find out how your hospital ranks in the most recent quality and safety measures recommended by the Leapfrog Group.


California Healthcare Quality Rankings from HealthScope

Searching for quality health care in California? Visit HealthScope, one of the top independent resources for information on doctors, health plans and medical groups.


Physician, Hospital & Nursing Home Ratings from HealthGrades

What grade did your hospital receive? Find out with HealthGrades, the leading independent health care ratings company. More than 125 of the nation’s largest employers and health plans rely on HealthGrades’ ratings and advisory services.


Top 100 Hospitals from Solucient

Did your hospital make the Top 100? Find out by visiting Solucient’s list of Top Hospitals with information on benchmarks for success.


Guide to Choosing Quality Health Care from AHRQ

Find the information you’re looking for using the Agency for Healthcare Research & Quality (AHRQ). Search this comprehensive guide for information on choosing health plans, doctors, treatments, hospitals and long-term care providers.


U.S. News & World Report: Best Health Rankings

Find out which hospitals ranked the best nationally for treatments in cancer, geriatrics, psychiatry and many more areas.

Visit these sites for more information on choosing the right health plan:


Q-Biz
Using the latest technology, Q-Biz is a leading provider of retirement programs and employment benefit programs to small- to mid-size corporations and public organizations. Find out how Q-Biz can help your company today!




Family 1st Network

Designed for families & individuals without access to employer benefits, Family 1st Network is a resource for individual insurance coverages. Access plan info, get quotes, and apply online for a variety of coverages. Great service is always available online, over the phone, or in person!



Health Plan Report Cards from NCQA HealthChoices

How does your health plan stack up? Find out by viewing report cards issued by the National Committee for Quality Assurance (NCQA).


Health Plan Comparison Checklist from CMA

Need help when comparing health plans? Use the California Medical Association’s Health Plan Checklist to compare plans or summarize your current plan.


Family Health Budget Generator

Keep health care costs under control by budgeting ahead. Use Humana’s step-by-step guide to create a family health budget.

Tuesday, January 10, 2006

New survey shows low level of satisfaction with consumer-directed health plans


Americans enrolled in a relatively new type of health coverage designed to make them more cost-conscious are less satisfied with their health plan than those with comprehensive health insurance and are less likely to recommend the new plans to a friend or colleague, according to a new survey released by the nonpartisan Employee Benefit Research Institute and The Commonwealth Fund.

High-deductible health plans of $1,000 or more for individuals and $2,000 or more for families can be combined with tax-preferred savings accounts, such as Health Savings Accounts or health reimbursement arrangements. Employers can contribute money to HRAs and both employers and individuals can contribute to HSAs, which can then be used to pay for health care expenses not covered by the health plans. These consumer-directed health plans frequently have been called the latest big idea in health insurance in the United States. By giving more responsibility for costs to the consumer and theoretically providing cost and quality information about providers, the plans are designed to encourage participants to make informed, cost-conscious decisions about their health care.

The survey also found that those covered by these new plans, both with and without savings accounts, are more likely than those with comprehensive insurance to avoid or delay needed care. When they do get care, those in consumer-directed plans encounter larger financial burdens, compared with those with comprehensive insurance.

But individuals in the new plans do exhibit more cost-conscious behavior in their health care decisions – as the new plans intended – compared with those having comprehensive insurance, the survey found.

A full report on the study can be found at www.ebri.org and www.cmwf.org.

Top Ten Healthcare Trends of 2006, Forecasted by HealthLeaders-InterStudy

NASHVILLE, Tenn., Jan. 10 /PRNewswire/ -- HealthLeaders-InterStudy, a leading provider of managed care industry intelligence, announced its list of the ten most important managed health trends to watch in the coming year.
    1. The year 2006 will mark the biggest change -- and biggest free-for-all
-- to hit the Medicare program since its inception -- Between 11 and 20
organizations are offering Medicare Prescription Drug Plans (PDPs) in
each Medicare-defined region. Nine organizations are offering PDP
coverage nationwide. In addition to PDPs, seniors face a huge range of
coverage choices, from Medicare Advantage PPOs and HMOs to private fee-
for-service plans. The Centers for Medicare & Medicaid is heavily
promoting regional PPOs as a way to extend access to rural areas, but
local health plans are still drawing the most interest.
2. Health plan mergers and acquisitions will continue -- In 2005, the
largest plans, UnitedHealth Group and WellPoint Inc., increased market
share through purchases of other health plans. Expect to see further
activity in 2006: CIGNA and Aetna have spare cash, and Coventry Corp.
seems ready for another acquisition.
3. Consumer-directed plans generate more media coverage than healthcare
coverage -- A lot of health plans and financial institutions like the
new Health Savings Accounts (HSAs) and their associated high-deductible
health plans. However, traditional first-dollar-coverage health plans
have loosened their restrictions in recent years and remain the first
choice among consumers. Despite a lot of discussion, this is unlikely
to change in 2006.
4. The uninsured remain uninsured -- Employers and government tried a
variety of innovative ways of getting healthcare coverage to the
uninsured in 2005. Attempts included "three-share" style plans in which
government, employers, and employees each kicked in a third of premium,
and Maine's launch of its Dirigo Health, but both saw poor uptake.
Small-scale attempts to deal with a large-scale problem are no more
likely to succeed in 2006.
5. Medicaid moves back toward managed care -- Texas, Ohio, and Georgia all
extended their managed care Medicaid programs in 2005, moving large
numbers of beneficiaries out of fee-for-service. This won't sweep the
country in 2006, but expect to see several companies, including Aetna,
extending their management of Medicaid.
6. Health plans continue their progress on encouraging electronic medical
records (EMRs), and 2006 could be a break-out year -- Health plans love
EMRs, which make tracking and quality checking of healthcare easier and
cheaper, and want providers to love them too. So the upgrading of
systems will continue, with dramatic initiatives by Kaiser, Blue Cross
and Blue Shield of Massachusetts, and others.
7. HMOs decline -- HMOs have been losing market share. A few bastion
states, like Michigan and Massachusetts, will have high HMO
participation, but, as employers move more and more to self-insurance,
HMO market share nationally will continue its decline.
8. Disease management expands -- Health plans will rely on disease-
management programs to attempt to control costs, and are beginning to
see results. The newest programs are in managing complex chronic
conditions such as hemophilia, scleroderma, and multiple sclerosis.
Such conditions are relatively rare, but greater oversight of each
expensive case can show good financial return.
9. Individual insurance plans with basic benefits increase market share --
As the cost of health insurance rises for employers of all sizes,
insurance is becoming more of an individual game. Health plans are
tapping into this market with basic-benefits plans for recent college
graduates, early retirees, and people between jobs.
10. Pay-for-performance shows its hand -- Health plans have been pushing
pay-for-performance measures on physicians for several years. 2006
will be a critical year for measuring return on investment now that
some P4P programs have several years' worth of data to evaluate. Does
P4P improve physician performance or pay already high-performing
physicians more for work they would do anyway? Results in 2006 will
help answer these questions.

Friday, January 06, 2006

ABC's of Healthcare


If you're still mulling over the alphabet soup of health coverage options, here's a quick primer.

HMO (health maintenance organization): A prepaid health plan in which you pay a monthly premium and the HMO covers your cost of care to see doctors within its network at negotiated rates. Co-pays usually apply. You must choose a primary care physician who coordinates all of your care and makes referrals to specialists. If you don't use the doctors, hospitals and clinics in your plan's network, you usually will bear the cost.

PPO (preferred provider organization): A network of health care providers that provide medical services to a health plan's members at discounted costs. PPO members typically make their own decisions about their health care rather than going through a primary care physician.

POS (point-of-service): A type of managed care plan combining features of an HMO and PPO. You can go to a network provider and pay a flat dollar amount or go to an out-of-network provider and pay a deductible and/or a co-insurance charge.

HSA (health savings account): Lets you set aside pretax dollars for future medical, retirement or long-term care expenses. The funds roll over from year to year, and you can take them with you when you change jobs. You must be enrolled in a qualified health plan with high deductibles, which you pay out of your savings

Wednesday, January 04, 2006

U.S. healthcare tab growing faster than the economy

America's healthcare bill rose to nearly $2 trillion in 2004, or about $6,280 for every man, woman and child, a team of government economists reported today.

Healthcare spending grew faster than the output of the economy, siphoning off a disproportionate share of increasing incomes.

But the 7.9% rate of increase was a little lower than in 2003, the experts said, because some efforts to control prescription-drug costs were succeeding.

"Medical spending continues to rise faster than wages and faster than economic growth, and workers are paying much more in healthcare premiums than just a few years ago," said the report by economists from the Centers for Medicare and Medicaid Services, published in the journal Health Affairs.

Although polls show that increasing medical costs and diminishing insurance coverage are leading concerns for voters, it's unlikely that a Congress bitterly divided along partisan lines will succeed in any comprehensive effort to control costs or expand coverage for an estimated 46 million uninsured people.

"What you see is ongoing pressure," said economist Deborah Chollet of Mathematica Policy Research, which conducts technical studies for government and business. "There is an agreement by most observers that the private health system is crumbling."

The report warned: "Continued spending growth will require difficult trade-offs for businesses, households and governments as other spending also rises. These trade-offs are more stringent for those with fewer resources."

As the government's annual accounting of healthcare costs, the report found that spending is growing not only in dollar terms, but as a share of the economy. Healthcare represented 16% of the economic pie in 2004, compared with 13.8% in 1993 and 9.1% in 1980.

For those concerned about costs, prescription spending was a bright spot.

Americans paid $188.5 billion for prescription medications in 2004, about $14 billion more than the year before. But the 8.2% increase was the first time in a decade that drug costs have risen by less than a double-digit percentage.

The drug industry hailed the statistic as evidence that companies were not overcharging. But the report attributed the slower cost increase to a rapid rise in the use of generic drugs and mail-order pharmacies, as well as conversion of allergy and indigestion medications to over-the-counter status and safety fears that have reduced consumption of some painkillers.

Relief from increasing rates of healthcare spending may be only temporary, said John L. Palmer, one of the trustees appointed to oversee Medicare and Social Security finances.

"It's encouraging in the sense that it is a little bit of a slowdown, but we seem to be stuck at a pretty high level of continued increases," said Palmer, who also holds the post of university professor at Syracuse University's Maxwell School of Citizenship and Public Affairs.

Hospital care accounted for 30% of all healthcare spending, the report found, and physician services 21%. Because hospitals and doctors represent such a big share of the healthcare marketplace, price increases for their services drive most of the overall rise in costs.

Insurance premiums increased by 8.6%, with the cost of family coverage approaching $11,000 a year. Consumers' out-of-pocket spending grew by 5.5%, slower than the overall trend.

Two giant government programs together paid a little less than 40% of the nation's healthcare bill. Medicare, which covers the elderly and disabled, and Medicaid, which covers a broad cross-section of low-income individuals, both grew in 2004, but Medicare spending increased more rapidly.

The report did not take into account the impact of the Medicare prescription-drug benefit, which began this month.

In a separate technical analysis, the government economists concluded that households pay about 32% of all healthcare costs, a bigger share than either employers or federal and state governments. But that calculation involved counting individuals' Medicare taxes as healthcare costs -- something most consumers probably would not think of doing.

Economists say there is no clear limit beyond which continued growth in healthcare spending could endanger the overall economy. But it may become politically untenable to keep putting healthcare ahead of other priorities, such as education, housing and transportation.

"I don't think there's any magic tipping point," Palmer said. "Whether this is sustainable politically is a different question. In all probability, there is going to have to be some political action to address these broader issues. I don't think the political climate is such that we are ready."