Consumers don't know what health services or procedures cost, so they can't make informed decisions about where and whether they receive care. As it turns out, there are many ways for consumers to get pricing information. So if these tools exist, why don't consumers use them?
Hudson Health Plan, a nonprofit Medicaid plan owned by MVP Health Care, is taking steps to ensure its members get important preventive health screenings like mammograms. Since 2012, the Hudson Valley-based insurer's customer service representatives have been calling members to encourage them to get their mammograms. And to incentivize their members, Hudson Health gives them a $25 gift card when they undergo a mammogram.
I did a lot of shaking my head as I wrote about Honeywell's wellness program last week. The New Jersey-based company is planning on penalizing employees who don't participate in health screenings. And a federal judge just sanctioned those penalties, which include fining employees $500 fine for not undergoing biometric screenings and withholding $1,500 annually in company contributions to employees' health savings accounts for not undergoing wellness screenings like blood pressure, glucose and cholesterol tests.
I have a friend, let's call her Amy, who casually told me last week how she struggled to find a pediatrician for her children since moving to our town. She said all the doctors she had called either weren't accepting new patients or "don't take Affordable Care Act plans."
Can you imagine a time when you go to the doctor and he or she asks, "Would you like some weed to help ease your symptoms?" Obviously, that scenario isn't occurring now, but it's possible that it will be a common conversation happening in doctors' offices in the near future--especially if insurers start covering medical marijuana.
Medicare Advantage plans are frequently lauded for providing high-quality insurance coverage. And they're widely popular among Medicare-eligible consumers. But there's a dark side to these plans as well.
In fact, dozens of federal audit reports indicate that Medicare Advantage plans are making the same kind of deficiencies year after year, especially when it comes to inappropriately rejecting claims. The Centers for Medicare & Medicaid Services found that in 61 percent of the audits, insurers turned down claims for prescription drugs when they shouldn't have.
This is not something to take lightly. Many seniors take prescription medications, and many of those drugs are vital to their health and medical conditions. To potentially block their access to those drugs could prove extremely detrimental.
I'm rarely one to advocate for fighting instead of finding peace, but every now and then, you just have to stand up for what you think is right. And that's how I view the recent decision from Blue Cross Blue Shield of Illinois to not negotiate with hospitals that affiliate with each other. I recognize the right of providers to work together and address the problem of ever-rising healthcare costs. And I certainly don't think that provider consolidation is the only driver to those increasing costs. Insurers have their share of blame, as well.
The recent announcement that Anthem Blue Cross is partnering with seven major hospitals in the Southern California area to launch an integrated care program has been met with lots of publicity, including our own coverage of the venture. The collaboration, which is called Anthem Blue Cross Vivity and includes UCLA Health and Cedars-Sinai, will offer large employers less-costly coverage for members who use in-network hospitals and doctors. That in and of itself isn't particularly innovative or unique, since insurers and providers have shared savings and risks for years across different markets. But what is so special about Vivity, as a California Healthline article points out, is the way it's structuring the financial model.