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KFF Health News published a happy story about a manufacturing company reducing its healthcare costs. A major step was establishing its own clinic -- staffed by a local health system -- where basic primary care is provided for free for employees and their families. Another step that the company took was to reduce costs for patients who needed to visit specialists and hospitals if they agreed to visit providers who are highly rated in terms of quality.

KFF Health News published a happy story about a manufacturing company reducing its healthcare costs. A major step was establishing its own clinic -- staffed by a local health system -- where basic primary care is provided for free for employees and their families. Another step that the company took was to reduce costs for patients who needed to visit specialists and hospitals if they agreed to visit providers who are highly rated in terms of quality.

The article notes that not all companies who have experimented with running their own clinics have seen positive financial results. One potential factor is whether a company's workforce is sufficiently centralized. Although not stated in the article, it also seems that the size of the workforce is important to attaining economies of scale. It is also possible that manufacturers of physical products would benefit more from an onsite clinic than a company of knowledge workers. The article notes that "savings can take a while to materialize," suggesting that the move is likely more palatable to companies who have enough to invest for years. It would have been interesting to know how much of the company's savings were attributable to the clinic, and how much of it might be attributable to other parts, such as steering patients towards higher quality specialists or having insurance plans without deductibles.

In the current highly polarized political landscape, the two main US presidential candidates have found something to agree upon: moving to lower drug prices. KFF Health News reported on various actions each candidate has previously taken to reduce prescription drug costs. While the specific policies may differ, expensive medication seems to be a theme that resonates with voters.

In the current highly polarized political landscape, the two main US presidential candidates have found something to agree upon: moving to lower drug prices. KFF Health News reported on various actions each candidate has previously taken to reduce prescription drug costs. While the specific policies may differ, expensive medication seems to be a theme that resonates with voters.

The current vice-president cast the tie-breaking vote to allow Medicare to negotiate drug prices. Somewhat in contrast, the former president wanted to allow importing drugs from Canada.

Sometimes, it's easy to overlook the business challenges that some doctors face in running a small practice. KFF Health News published an article about how some pediatric clinics ordered too much COVID-19 vaccines, and had to throw out expired inventory. Although pediatric clinics face similar questions for some other vaccines, it seems that COVID-19 vaccines have a relatively short shelf life, exacerbating the situation.

Sometimes, it's easy to overlook the business challenges that some doctors face in running a small practice. KFF Health News published an article about how some pediatric clinics ordered too much COVID-19 vaccines, and had to throw out expired inventory. Although pediatric clinics face similar questions for some other vaccines, it seems that COVID-19 vaccines have a relatively short shelf life, exacerbating the situation.

It seems that some of these concerns can be solved systematically if manufacturers were willing to shoulder more risk and make enough vaccines available on short notice (for example, by streamlining their manufacturing process to be "just in time"). Given that pediatricians might be stocking smaller quantities of the vaccine -- which might lead to shortages at those clinics -- manufacturers might have a financial incentive to figure out how to reduce the uncertainty that pediatricians face when deciding how much to order.

The government frequently has a reputation of being inefficient, so one can imagine how proponents of Medicare Advantage probably pitched the idea of letting private insurance companies take over: let private industry, unshackled by government bureaucracy, innovate and find new ways of improving quality while also decreasing costs. However, KFF Health News reported on a civil fraud case against the health insurance company administering the largest Medicare Advantage plan. Although Medicare was to pay a predetermined dollar amount per patient per month (thus potentially leaving private insurance companies with extra costs if patients needed more care), it turns out that the dollar amount per patient could vary, depending on how sick the patient was. On one level, it makes sense that sicker patients will need more treatment (and therefore cost more) than healthy patients. Practically, however, this policy gave insurance companies a strong incentive to find reasons to classify their patients as sicker than average. The fraud case against this particular insurance company started in 2011 and was taken over by the Department of Justice (DOJ) in 2017. At the heart of the case is whether or not the insurance company improperly claimed that patients were sicker than they actually were. In one case, for example, "the insurer billed Medicare nearly $28,000 in 2011 to treat a patient for cancer, congestive heart failure, and other serious health problems that weren't recorded in the person's medical record." Notably, this insurer was not the only one accused of wrongdoing.

The government frequently has a reputation of being inefficient, so one can imagine how proponents of Medicare Advantage probably pitched the idea of letting private insurance companies take over: let private industry, unshackled by government bureaucracy, innovate and find new ways of improving quality while also decreasing costs. However, KFF Health News reported on a civil fraud case against the health insurance company administering the largest Medicare Advantage plan. Although Medicare was to pay a predetermined dollar amount per patient per month (thus potentially leaving private insurance companies with extra costs if patients needed more care), it turns out that the dollar amount per patient could vary, depending on how sick the patient was. On one level, it makes sense that sicker patients will need more treatment (and therefore cost more) than healthy patients. Practically, however, this policy gave insurance companies a strong incentive to find reasons to classify their patients as sicker than average. The fraud case against this particular insurance company started in 2011 and was taken over by the Department of Justice (DOJ) in 2017. At the heart of the case is whether or not the insurance company improperly claimed that patients were sicker than they actually were. In one case, for example, "the insurer billed Medicare nearly $28,000 in 2011 to treat a patient for cancer, congestive heart failure, and other serious health problems that weren't recorded in the person's medical record." Notably, this insurer was not the only one accused of wrongdoing.

So, does Medicare Advantage save the government money? Apparently not. The Commonwealth Fund reports that "Older and more recent studies alike have largely found that Medicare Advantage plans cost the government and taxpayers more than traditional Medicare on a per beneficiary basis. In 2023, that additional cost was about 6 percent, down from a peak of 17 percent in 2009." In addition to sampling patient records for appropriateness, perhaps Medicare should consider a policy where insurers that consistently cost more than Medicare's average would either be ineligible to continue operating Medicare Advantage plans, or would need to charge its patients the difference in higher premiums.

Consumers are well aware of companies with difficult customer service experiences in a variety of industries, and health care is not an exception. KFF Health News published a piece on how a woman went in for one procedure and the surgeon decided to complete a separate preventative procedure while she was unconscious. Although the entire operation completed in the original time allotment for the initial procedure, the surgery center billed her twice, once for each procedure.

Consumers are well aware of companies with difficult customer service experiences in a variety of industries, and health care is not an exception. KFF Health News published a piece on how a woman went in for one procedure and the surgeon decided to complete a separate preventative procedure while she was unconscious. Although the entire operation completed in the original time allotment for the initial procedure, the surgery center billed her twice, once for each procedure.

From a systems perspective, it makes sense that the surgeon completed the second procedure instead of having her undergo anesthesia again and to make another incision. However, the surgery center's decision to double bill -- even though the entire operation completed in the originally allotted time -- seems unreasonable. For a case like that, it feels that the patient should have some agency in deciding whether to incur the additional cost. Beyond that, the surgery center was unwilling to negotiate with the patient, handing her bill to a collections agency, which sued her in court. If cases like these persist, the general public might ask for additional regulations around medical billing.