With 80% of their 115,000 employees currently on one of the company’s self-insured health care plans, the cost of covering 100% of primary care visits could be steep.  However, IBM believes (via their director of health benefits Marianne Defazio) “very strongly that employees should have a primary care physician who’s sort of the quarterback to help coordinate all of their care.”

It will be interesting to see what the initial results of this benefit design change look like next year as they begin to track and compare utilization and prevention metrics.  I would imagine in some way or another this new coverage is going to impact employee behavior.  Bottom line – it’s always good to see large employers taking risks and trying new things.  A small part of me still believes companies like IBM and others are really going to pave the way for change in health care, driving and creating sustainable ways to improve the current health care crisis and our approach to wellness.

Co-Founder and COO Robert Hendrick spent a few minutes with the local TV crew to share tips on how to save money on your prescriptions. Easy steps that can add up to huge savings. You’ll be surprised!

Thanks for all of the support, and for trusting us to help you make smarter healthcare decisions and save money in the process.

Below is a video from the Nashville NBC affiliate WSMV. The clip shows change:healthcare COO and co-founder Robert Hendrick working with the reporter to show people 4 ways to save on their medical costs.

All in all a very good week at change:healthcare! Thanks for all of the support, and for trusting us to teach you how to save money on your doctors visits and prescriptions, and to help you make smarter healthcare decisions.

As we head off for Health 2.0 in SF next week, I begin to have visions of history repeating itself. Too many of us remember those business plans of the dot-com era that were brilliant yet the market for them had not reached critical mass.  They became the casualties of the dot-com bust. Now, a decade later, many of those business plans are being dusted off and successfully rolled out.

I remember the dot-com days when we talked about live radio broadcasts and streaming video. Today we have YouTube and Mevio. It happened, just not when we envisioned it. At Health 2.0, I will look around for some old friends, and they will not be there any longer. Why? Bad economy. Bad business model. Bad management. Bad timing. Or simply bad luck.

Casualties.

It’s ugly, this war to achieve healthcare data liquidity. And, like any war, it’s so senseless.

3. Change your coinsurance ratio: Raise your ratio to cut your monthly premium.

Find more information on co-insurance here. Increasing your co-insurance ratio will help to spread out the payment responsibility between you and your insurer, in turn reducing your monthly premium.

6. Don’t take no for an answer: Go through appeals processes with your insurance company if they deny your medical claims.

change:healthcare offers a field guide on “How to handle a denied medical claim.” You can access it here. This guides walks you through the necessary steps associated with appealing a denied medical claim.

30. Go to federally funded clinics: You can get immunizations, checkups, and dental care, while paying what you can afford through special clinics.

Often community health centers, and now even retail based clinics, offer vaccinations for a flat fee such as $10 to $30 depending on the type.  Going to see your doctor for this type of care can cost as much as $120.

36. Pay today: Offer to pay immediately with cash or credit card to get a discount.

It’s true!  If you are a cash-pay patient you can often get a 10-20% discount on your care. If you are uninsured and have never offered to pay up front, give it a shot – and if they do not offer you a discount, ask for one! Sometimes, even providers that accept your insurance, but do not offer a negotiated rate, will provide a discount off charges. You just simply need to ask!

54. Use in-network providers: Avoid using providers that are outside of your network.

This is a no-brainer! When you use an in-network provider not only will your insurance company cover a greater portion of the expense, but you will most likely also receive a discount on your care through the contractual agreement between your insurer and provider. To learn more about in vs. out-of-network providers check out our field guide (located near the bottom of the page).

97.  Lose weight: Fight obesity, and you’ll save on your insurance premiums, as well as prevent weight related conditions.

Though this is often easier said than done, losing weight will not only help to decrease your risk level for weight related conditions such as diabetes, heart disease, and hypertension, but it can also improve your mental health and wellness.  Find a friend to help you set a goal and stick to it.  Losing weight is easier when you have support from family and friends.  Remember to start small too!  Take it one pound at a time, and reward yourself for milestones such as 10, 20 and 30 lbs.

To find out more information on change:healthcare’s help tools such as our field guides and health term glossary visit help.changehealthcare.com.

“Have you heard of tiny Melinda Mae,
Who ate a monstrous whale?
She thought she could,
She said she would,
So she started in right at the tail…”

- Excerpt from Melinda Mae by Shel Silverstein

Healthcare reform is a “monstrous whale.” The federal government could learn a little something from the childrens’ tale about Melinda Mae. Instead of trying to cram ALL of healthcare reform into one big bill and get everyone to swallow it all at once, smaller bites would be more manageable.

Smaller bites might actually pass.

What Do Small Bites Look Like?

Let’s start with some easy small bites that most Americans are eager to agree on. How about a bill with just these points in it to garner support and get something/anything passed.

1. No more pre-existing conditions
2. No more pulling of policies for large claims
3. Same premium rates for all with premium adjustments only on the basis of tobacco use, age, family size and geographic location
4. Banish all attorneys to…erm…I mean…malpractice suit limitations

Those are things most all of us can get behind. Once we get that, let’s go for the next bite. Eventually we will finish the whole whale, or at least we’ll eat what we’re able to stomach.

That’s how Melinda Mae would do it.

Let us know your thoughts on healthcare reform in the comments! Your voice matters.

Photo by Kevin Dietsch for Time

Details on the health care reform plan being pushed by the gang of six and headed up by Senator Baucus are coming out.

The BIG Question: Will it Add to the Deficit?

The stock answer is NO, it will not add to the federal deficit. Note the qualifier – the FEDERAL deficit…FEDERAL. Now your personal deficit and that of your employer, well, that’s a different story. The government won’t speak for business. Government only addresses the federal cost issue.  Hmmmm.

The Next Question: How will it impact Your Pocketbook?

Funny you should ask. The plan calls for 50% reduction in Medicare Part D prescriptions at a cost of $8B to the pharmaceutical industry. If you are naive enough to think pharma is simply going to cut $8B in profit to cover this expense out of the goodness of their heart – think again. The price of prescriptions to the private insurance portion of the population will rise to compensate. It’s called cost-shifting. It happens every time the government lowers Medicare rates on what it pays for medical services and products – the lost revenue has to be made up somewhere, and it is made up in increased rates to the private health insurance industry. This is also known as the healthcare policy your employer pays for and that has been eating your cost of living increase for the past few decades.

In addition, there is a law that prevents exclusion on pre-existing conditions. That HAS TO COST MORE for the insurance company to cover. Rates HAVE TO GO UP to cover services that, well, they were not covering before. And plans now HAVE TO OFFER WELLNESS PROGRAMS. Those incur costs that have to be covered as well, so that will increase insurance plan costs.

But the good news is all rates HAVE TO BE THE SAME for all groups. Insurers can only discriminate based on tobacco usage, age, family size and geographic location – all fairly legitimate adjustments to cost. More good news is that the rates for the oldest people can only be as much as 5x (five times) what they are for the youngest members on a plan. That’s a good way to keep costs within an artificially controlled range. But what does that mean will happen to costs? The cost for the youngest in the population (the very folks who put Obama in office) are going to go up – just so the insurance companies can get the 5x rate to cover the exponentially higher utilization of the older population. In other words, the most expensive portion of the population to cover will increase the cost of the lowest portion as they “drag the bracket upward.”

Sounds expensive for those of us on private insurance.

Is this the plan perfect? No way. Is it a step in the right direction? In some ways. Many ways. Is it going to cost more? No. Well, at least it won’t cost the government any more.

If your company is trying to find out how they could save their employees and themselves money now, and after the reform, check out some of the change:healthcare tools for employers. We have some interesting programs that help everyone save money on healthcare.

“If you knew what the price of items were at Wal-Mart before you went into the store to buy them, it would put Wal-Mart out of business.”

That has to be one of the single most insane statements ever written.Yet that’s exactly what many doctors and hospitals would have you believe about healthcare. If you knew the price before you went into the doctors office or hospital, it would put the healthcare provider out of business.

Excuse me?

No. It would not. In fact, it might make the patient consider whether they needed that service or not. It might make them question if they really need all 8 prescriptions.It might make the provider find ways to offer the procedure more cost effectively as John Stossel so elegantly pointed out about Lasik eye surgery.

When someone hesitates to tell you the price of an item, why do they do it?

4 Reasons Why People Hesitate to Tell you the Price:

• They are ashamed at having to charge that much
• They do not believe the product is worth the cost
• They prefer you make an emotional commitment to purchase before knowing the price
• They simply do not know the price (the fallback reason in healthcare)

Fortunately, rational thought does occasionally prevail. The recent post from KevinMD.com points out (from the physician’s perspective – no less) that price transparency won’t effect health care costs.

It won’t adversely impact the cost of healthcare. It will force providers to be more cost effective and up front about their costs. It will force consumers to be more selective and engaged in the purchasing decision.

But will knowing the price put healthcare providers out of business? Not likely. In fact, knowing the price seems to be working wonders for Wal-Mart and…oh…just about every other business model in the U.S.

As long as we’re herding cats on healthcare reform, let’s ask a critical question…What is the timing for the changes being made for healthcare reform? Not “when will it get passed” but rather “when will the changes, whatever they end up being, go into effect”?

Logistically, it’s a nightmare.

Healthcare Reform Will NOT be here by January 2010

Employee populations have already been underwritten for 2010. Rates have already been set. Policies are already in place. Open enrollment has already begun. Surely no one would jump in front of that rolling momentum even though the government has the authority to do so. It takes a full year to do all that needs to be done for a health plan when it is business as usual.

[cats like big balls of yarn, and this is a BIG one]

Imagine the implications of just two details…

1. Insurers Have to Cover Pre-existing Conditions
2. Insurers Cannot Drop Clients with Extreme Expenses.

In short, the very business practices on which insurers, doctors, hospitals and every company that provides health insurance have built their business are undermined. Wow!

[think two wild feral cats left to their own devices in the barnyard]

Insurance companies would be SCRAMBLING…

• to change rates.
• to underwrite to new standards.
• to negotiate new provider agreements
• to develop new policies.
• to train people on the changes.
• to print new materials.
• to engage countless attorneys to understand and interpret changes.

[think of the crazy old cat lady with 72 cats in her one-bedroom 650 square foot apartment]

At the same time, employers would be scrambling to understand and reevaluate their business model as their health plan costs changed. They would be looking to alter their plan in an effort to control their rates and protect their business. They would be struggling to educate their employees. And struggling to meet a bottom line with new rules on one of their single largest line item expenses – health insurance.

[think of the animal shelter stuck with the crazy cat lady's 72 cats - what the hell do we do with these?]

Docs and hospitals and other care providers are little better off. They would have new rules on what is or is not covered. They would be left to figure out how much they could expect in income on those “Good Samaritan” services they had been providing for “free”. They would have new systems and rules to evaluate. Their very business model would shift.

[think of the vet trying to provide services out of the goodness of their heart, but faced with the financial implications of having to spay ALL 72 cats]

Cats would be living with dogs. And January 2010 would be here.

A Similar but Not Related Video that Conveys my Thoughts on This…

Image Courtesy aflcio2008 on flickr

Senator Jim Cooper (D) of Tennessee has been one of the most prominent politicians traversing the country on the idea of healthcare reform. In his early presentations on the subject, the approach was a hard line push to get universal coverage (covering the uninsured) with NO FOCUS ON CUTTING wasted expense that could have paid for the program. Cooper is clearly the most articulate and knowledgeable politician I have run across with an in-depth perspective of healthcare AND business. I am convinced that he has a hand in the movement of the healthcare reform to something that will be more beneficial to Americans that earlier plans.

The modifications that have been made in the past few weeks are significant. Socialized healthcare (a wholly government run program) is giving way to government incentives for consumerism coupled with universal healthcare (getting the uninsured covered), and more ethical treatment of members by health plans (no pre-existing conditions and protection from being kicked off of a plan for large claims).

It is encouraging to see that questioning of Senator Cooper and other prominent members of congress have started to take root in D.C., either as a result of that meeting or others. I hope the plan is not finished evolving. Private business needs to get behind the idea of making healthcare more efficient and some are fighting for the opportunity to do that through organizations like SIIA.

For far too long, companies have been passive about healthcare as an outsourced expense and did not get involved preferring to push the burden of understanding this to the insurance companies. The insurance companies obliged and took the power that came with that responsibility.

The government is pushing employers to get involved. Getting employers MORE involved and not less involved is what we help us drive the cost down while improving quality. If employers continue to wholly outsource their healthcare without actively addressing it, look for us to wind up back at the sort of option that Senator Cooper had originally presented.