Basic Health Access

When given a chance to operate the entire payment package, what do Health Insurance Companies (HICs) do? For the past 8 years HICs have been given the freedom to operate Medicare Advantage - the high prestige seniors plan from CMS. HICs helped design the complex payment formulas for MA HICs found a way to upcode higher patient complexity for MA patients HICs shoveled in the profits using the design that they helped to shape their way The  Center for Public Integrity  indicated, "For instance, audits of six plans found that health plans couldn’t justify payments from the government for 40 percent or more of their patients. The resulting overpayments were pegged at nearly $650 million for 2007 alone — just for those six plans." When is it "gaming the system" and when is the line crossed to fraud? The inconsistencies in HIC, GAO, and CMS efforts span the range of health care delivery. There is a pattern to the result. Some payment formulas benefit those with ...

This headline is amazing in numerous dimensions - Bipartisan, 33 Senators together, showing concern for rural health! But why have these 33 Senators not done more. More importantly, why have 70 Senators from 35 states not stood up for health care in their states - states left behind by the US health care design. The health care design developed over recent decades clearly favors 6 states.  What have Senators in 30 - 35 states been doing all of this time? The Senate may well hold the key to addressing needed health care reform. The reform that is needed is not about insurance reform or penalizing more providers for meaningless reasons. The reform that is needed is to redirect spending from few states, providers, and locations to many states, providers, and locations - all who are in greater need of care.  Like it or not, the design of the Senate favors numbers of states, even when the states have low levels of population. Senators could do more for thei...

Commonwealth indicated six areas where the US is behind compared to the United Kingdom.  Actually fixing health care requires fixing far more than health care or distributions of health care. The truth is that nations have better or worse health care due to distributions of income, economics, education, and other factors that shape health, health care, and health care outcomes. It is often not possible to fix health care woes by health care focus. For the United States to actually improve in health, the substantial populations of Americans that are behind would have to be addressed. What happens to 40% of Americans in 2600 counties with lowest concentrations of clinicians is paramount to recovery of health care. If the US does not address situations in 2600 counties, it will not improve American health care. United States Health Spending Excesses Direct attempts to cut health spending have typically resulted in across the board cuts in spending with small health ...

Frontliners hang in there! It is indeed a tough time for 40% of Americans and those who attempt to care for them. Further deteriorations in access mean difficult times for primary care, emergency rooms, mental health facilities, and urgent cares. The end of this year brings new changes. In the Arizona media there has been discussion about increasing behavioral health presentations to hospitals. I spared the link due to the usual excessive advertising. But after all, this is only the tip of the iceberg. The Report from Arizona East Valley ERs and Urgent Cares Mental health issues are being multiplied at the current time. Even though there is the potential for more care, the factors driving increases in mental health problems are up, access appears up (insurance) but is in decline (workforce changes), and there is even less ability to "fix" the problems.  The country appears in an unsettling disarray with enemies foreign and domestic,  The US has designed wors...