In the health care reform debate, political leaders, including President Barack Obama, promised the “elimination of overpayments” to Medicare Advantage plans that provide more comprehensive coordinated care to patients in place of the traditional fee-for-service Medicare program. We have heard a lot of concern from our members about the impact these cuts might have on their coverage and premiums. So how did things end up and how will these provisions affect Group Health?
Monthly Archive for April, 2010
As our country seeks to fix what’s wrong with health care, we’re hearing a lot about a concept called the “medical home.” In fact, my colleague Dr. Robert Reid and I published a commentary on the topic in this week’s issue of the Journal of the American Medical Association. And I’ve been invited to describe Group Health Cooperative’s experience with the medical home at a National Press Club Forum titled “Reinventing Primary Care.”
But here’s something that may surprise you: The Medical Home is not a new idea. In fact, some say that it’s Continue reading ‘Back to the future of good primary care: The Patient-Centered Medical Home’
Expansion of Medicare in 2006 to cover some drugs costs was good news for seniors. But the expansion of coverage contained the controversial “donut hole.” For 2010, coverage stops when total prescription costs – including both plan and individual-paid portions – reach $2,830. The next $1,720 is not covered until patients reach the total prescription drug spending level for the year of $4,550.
The reform law sets out to close this gap, with the first step taking effect immediately. Medicare recipients who hit the gap will get a check for $250 mailed directly from the federal government. The law proceeds to fill the donut hole by 2020, with a step-by-step reduction in the cost-sharing that seniors are responsible for – both generic and brand-name drugs – from the current level of 100 percent down to 25 percent.
Sometimes science does not have all the answers. Treatments for conditions from back pain to breast cancer sometimes involve weighing different options with pros and cons for each. Often these treatment decisions are best determined by the patient’s preference as she weighs the impact on her life of surgery, pain, and daily functioning.
At Group Health we have identified a list of preference-sensitive conditions and have begun a more formalized approach to involving the patient in these treatment decisions. Part of experience for patients is watching a carefully balanced video presentation developed with scientific rigor by the Foundation for Informed Medical Decision Making. In a video for cardiology, a patient learns the pros and cons of getting angioplasty. In general surgery, another video educates breast cancer patients about the differences in lumpectomy versus mastectomy.
Patients are encouraged and given time Continue reading ‘New tools empower patients to make decisions’
Leaders of the health care reform effort built consensus on two conflicting goals. First, the promise that those with good health insurance would not see dramatic change — “if you like what you have, you can keep it.” Second, to reform the insurance industry and improve insurance coverage.
The result is that the legislation promises to grandfather existing plans while at the same time creating new rules that affect all plans. There are dozens of questions about how this aspect of reform will work. The answers will come over the next few months as federal and state regulators hammer out the specifics.
Continue reading ‘What’s a grandfather and is it good to be one?’
The health care reform law provides some immediate relief for small business who provide health insurance to employees. Small business is defined as any business with less than 50 employees. Nationally, 96 percent of all businesses fit this description. Group Health covers about 35,000 people through our small business plans.
Small businesses have been hit the hard by the rising costs of health coverage in recent years. Here are some statistics that tell the story:
• In the past 10 years the percentage of firms with less than 10 employees offering coverage fell from 57% to 46%, a direct result of the 129% increase small businesses have seen their premiums.
• Small businesses pay up to 18 percent more than large firms for the same policy because the risk pool is smaller.
• Twenty-three percent of the uninsured (11 million people) – are employees of firms with less than 25 workers.
• Half of workers in small firms that do not offer health benefits remain uninsured.
The law includes a tax credit Continue reading ‘Health reform and the impact to small business’
Group Health leaders participated back in the late 1980s to create Washington state’s Basic Health program to provide state subsidized health insurance to low income people who do not qualify for Medicaid or Medicare, often referred to as the working poor.
Group Health provides care to about 13,000 Basic Health members. The program is a good deal for members as well as for the state. In 2009, the average enrollee paid $34 a month, and the state paid the remaining $211.
Group Health remains committed to doing our best to make this essential program work because we believe it’s part of our mission and simply the right thing to do.
The health care reform law contains provisions Continue reading ‘Saving Washington state’s “Basic Health” program’
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