High-deductibles pose another problem
October 09, 2016
At DocSpot, our mission is to connect people with the right health care by helping them navigate publicly available information. We believe the first step of that mission is to help connect people with an appropriate medical provider, and we look forward to helping people navigate other aspects of their care as the opportunities arise. We are just at the start of that mission, so we hope you will come back often to see how things are developing.
An underlying philosophy of our work is that right care means different things to different people. We also recognize that doctors are multidimensional people. So, instead of trying to determine which doctors are "better" than others, we offer a variety of filter options that individuals can apply to more quickly discover providers that fit their needs.
October 09, 2016
The world of prescription drug distribution can be complicated and confusing. Bloomberg reported on an interesting angle: the world of large manufacturer rebates may be coming up against the world of high deductibles. For historical reasons, many pharmaceutical manufacturers end up pricing their product expensively, but offering a significant rebate to offset some of that cost. As long as the insurer was paying for the medications, it made sense that the insurers would also receive the rebates. However, as deductibles have risen, more patients are paying full-price for their prescriptions, and the distribution system is not set up to send the rebates to the people who actually paid, but rather the traditional recipients, the insurers. The result certainly seems incorrect, but I can also see how the solution would be non-trivial.
The healthcare industry has had decades of assuming a third-party payer, and now that patients are increasingly responsible for a significant portion of their own costs, the industry finds itself needing to course-correct.
October 02, 2016
Earlier this year, Kaiser Health News reported on a study conducted on provider directories. People posing as patients called provider offices to try to make appointments with providers using information listed in the directories of some large insurers. The study found that the callers could only schedule an appointment with a primary care doctor less than 30 percent of the time.
Somewhat alarming is that about a third of the time, callers were told that the doctors' specialty information was listed incorrectly. A reasonable case can be made for how difficult it can be to update changing information such as whether a doctor is accepting new patients and even phone numbers, but doctors' specialties do not change that frequently.
The insurers were fined what seemed like relatively small fines for the size of their operations. This summer, a new law in California took effect, requiring insurers to update their directories more frequently. It'll be interesting to see whether such the government will effectively enforce such regulation.
September 22, 2016
Earlier this year, we participated in a contest sponsored by Robert Wood Johnson Foundation (RWJF) and ProPublica to leverage data from Medicare to help patients select physicians. Health 2.0 announced today that we won first place. We're grateful to the sponsors and organizer, and we're delighted at the result. This was a fun contest to participate in, and we hope to incorporate our work from the contest into our publicly available service.
The key data set that we have not yet integrated into our public website yet is the demographics and conditions data set that Medicare recently released. This data set includes information about the patients that specific physicians treat, aggregated at the physician level (e.g. 15% of Dr. Smith's Medicare patients are Hispanic or 5% have asthma). This detailed information gives patients a powerful tool to help them find physicians that have treated other patients like themselves.
In this context, we were also able to experiment with some innovative ways of visually representing data. We look forward to integrating those displays in the coming months.
Thanks to Ningning for spearheading this effort, and thanks to Robert Wood Johnson Foundation and ProPublica for their sponsorship!
September 18, 2016
Mylan has been in the news a lot recently, mostly being criticized for the pricing of their popular EpiPen product. Mylan's CEO has responded by blaming health insurance plan design, saying that the rise of plan deductibles has exposed consumers to higher out-of-pocket costs. Congress has called in Mylan's CEO for a hearing, and people have suggested that a price cap of some sort should be imposed. With all of the current unpopularity, Mylan is reported as seeking another way of shielding itself from criticism: by getting EpiPen formally recognized as a preventative drug. If such a designation were to occur, most insurance companies would be required to cover the cost without imposing a co-pay on patients, leading to a classic example of a third-party payer problem (when a different party pays than the party receiving the benefit). Instead of patients trying to find more cost-effective alternatives, insurance companies would likely pass on the cost to everyone through higher premiums. As scary as it might be for current patients who are exposed to the actual price of EpiPen, the current outcry is a step forward in patients learning about the actual sale price of drugs, which might spark a broader conversation of how and which drugs are covered. If Mylan were successful in getting the desired designation, such conversation might get delayed until another drug or procedure takes its place or until premiums rise too much --which might not be that far off.
For all of the maneuvering that may have happened in the background, it is noteworthy that two non-profits declined industry funding because of a conflict of interest (and presumably putting patient interests first).
September 11, 2016
Medicare has been trying to move away from the traditional fee-for-service model that encourages over-treatment. The push has been to get providers interested in a new payment model where they take on additional risk, but are rewarded when their patients incur less medical spending. In part to ease the transition, Medicare pegs reimbursement rates to the participating institutions' prior performance metrics. Hence, organizations that were inefficient wouldn't be held to an industry-wide benchmark. Likewise, organizations that are already efficient would have an incentive to do better. Unfortunately, it can be difficult to get these policies correct, as evidenced by Dartmouth's departure from the program and return to the traditional fee-for-service model.
It appears that even though Dartmouth did better, they did not do better by enough to profit financially (there is a threshold that must be crossed before the savings are shared), in part because they were efficient to begin with. It's easier for the less efficient provider organizations to benefit from adopting the new payment model.