When Death Spirals Occur

Death spirals occur when younger, healthier members abandon private health insurers and leave behind costly, chronic, older members. The healthy jump ship exponentially over time and that’s happening in Australia today. It’s a cautionary tale for BUCAH — a worst nightmare for their CSuite.

Not sure we have all the signs below but enough of them to pay attention. They too have a dual system. Federal is outgrowing private. And the young there are functionally uninsured with deductibles they simply can’t afford.

2019 will be remembered as a tipping point:

◾️Over half don’t have liquidity equal to their deductibles So no ladder to the treehouse of care. Forget homeownership. The Dream. The Promise. Dead.
◾️Health costs (48%)almost equal the rest of the federal budget.

Addressing the National Press Club on Wednesday, Duckett succinctly summarized his findings: “When we looked at the private health insurance industry, we found an industry ◾️strangled by red tape, ◾️riddled with perverse incentives, ◾️suffering learned helplessness, ◾️turning to government to fix all its problems, and labeled by the regulator as ◾️complacent.”


What is Direct Primary Care?

Direct Primary Care…it’s like private jet ownership for every employee lucky enough to work for employers who cover the monthly fee. It’s top-shelf care for all wage levels. Eliminates

  • #burnout
  • #functionallyuninsured
  • #factorymedicine

Only about 4 percent of family doctors reported working in direct primary care practices last year, according to a survey by the American Academy of Family Physicians. There are 1,200 practices in the US, according to the Direct Primary Care Journal. Typical patient fees are about $75 per month or $900 annually, studies show. Some patients who have tried direct primary care say they’ve gotten their money’s worth.

Susan Meyer, a 55-year-old attorney, didn’t have any pressing health issues when she had her annual physical this year. But she noticed a blemish on her wrist. Scott recommended a biopsy. It turned out to be skin cancer. Meyer’s monthly fee covered the physical, diagnosis and surgery to remove the cancer. She paid $100 for the biopsy.

“It was exactly the way health care should be: remarkably efficient and cost-effective,” she said.

The Devious Surprise Bill Game

Here’s the devious surprise bill game:
The health insurer sends you to the provider, who sends you to the health insurer. Each threw up privacy roadblocks, claiming they can’t talk. Copies of power of attorney and “appointment of representative” forms routinely disappear. Insurer refers to a claims processor. Voice-mail menus now are a diabolical purgatory. More surprise bills arrived. Phone calls threatening collection start.

Stanford researchers found of 13.6 million ER visits in 2010, 32.3 percent resulted in a surprise medical bill averaging $220. By 2016,42.8 percent-the average bill at $628.

Of 5.5 million inpatient visits, surprise bill percentages increased from 26.3 to 42 percent, the average bill rose  from $804 to $2,040.Federal legislation is going nowhere.

Twenty-eight states are passing laws that offer at least some restrictions on surprise billing, but federal regulations limit their reach. For example,  self-insured group health plans, which apply to employees of most large corporations, are not protected by state laws.
Washington Post

Want to eliminate the PCP shortages in a blink?

There are three ways to eliminate the PCP shortage:
Nurses represent the largest category of caregivers in primary care with 250,000 graduates annually but fallout rates are half after only two years. Wow and wow. Undervalued they say. And only 2% of articles mention nursing in the healthcare press. So invisible, too. In most states, NPs have restrictions to their scope of practice. Why? Docs say they lack the 10,000 hours of training Malcolm Gladwell counts to become the Beatles or Steve Jobs. Residencies are 12-15,000 hours so there you go, Docs.
So why can’t nurses provide a wider scope after 10,000 hours in practice? They are after all, a Doctor of Nurse Practitioner, today. Well, it’s economic. Long as docs can bill these providers higher than they cost it’s too profitable to let them fly.
I learned last week Chief Nursing Officers are a lovely title with little budget authority and the true path to make a difference almost always involves an MBA, not DNP alone. So a VP of Nursing with a budget trumps a pretty title.
Not the case for MDs. They don’t need that MBA to advance.
Here’s nursing beef I disagree with —
Training is not federally subsidized (which should be yanked from silly MD residency slotting since $60k residents we pay for are billed out at $2.4m on average )