Kaiser's Costly Improvement

Kaiser reported this week that they have completed implementation of their Electronic Health Record (EHR)system with all of their 8.1 million members in 9 states. They call their EHR "Health Connect" and over 13,000 physicians and medical professionals can access data about members at any time. I applaud this effort and encourage other health systems to do the same. It only cost Kaiser 4 billion dollars to implement and 1 billion per year to maintain.

Couple of issues...only 13 of the 36 hospitals have adopted this technology at this point. Seems to me that the most important part of access is the hospital access. It is at the time of an emergency that most medical professionals need to know what the history has been. It's great to see that on a routine basis that you may have missed your mammogram but the Kaiser ER doctor who is about to give you medication that you are deathly allergic too really needs that information immediately. Also, the information is not transferable. For example, I have clients that have moved their health plan to another insurance carrier. Kaiser at this point will not allow you to download or keep your EHR to be able to give to another medical professional or personal EHR system. I find that to be insulting. My information is my information. Why does Kaiser feel that they "own it". I know that they want to keep members at all costs, but this is ridiculous.

While prescriptions are getting more efficient with this system and it might generate some savings, the cost for maintaining it seems a bit high compared to what they might save. With quarterly earnings down and membership in key areas low, look for another round of significant rate increases in the next 12-18 months. The money has to come from somewhere.

A Younger Population May Not Be A Healthy One!

I think that over the years, the perception has been that if you have a young workforce, that it is typically a healthy one. Well, I believe those days are gone. Not only are employers facing the rising cost of health care as we "seasoned" employees deal with the health concerns of getting older, the employees that are entering the workforce are the most chronically diseased group that we have had yet.

What the heck is she speaking about? I am sure that you are asking yourself that right now. Statistically, we have the worst rates of childhood chronic disease that we have ever measured in the US. We have issues dealing with obesity in children, asthma in children and diabetes - both type 1 and type 2. As these children are now growing up, they are entering the workplace with chronic conditions. Conditions that we did not usually see in a young workforce. We normally saw in an older one.

Therefore, especially now, are really important to companies that employ typically a younger population. Those companies may really be able to see the ROI on thier wellness dollars and have employees that are young and may be with them a long time, avoid some of the claims that they would have experienced without an awareness on health and wellness.

Personal Health Information Compromised - Here We Go..

PHI - a big buzz word in my industry. It means personal health information. Many carriers are trying to help insureds have access to this on-line. A single source to store information about one's health, immunizations, conditions, allergies, etc. Kaiser Healthplan actually does this inside of their captive staff model HMO environment very well. Other healthplans, such as Anthem and Healthnet, are partnering with other companies to try and capture this data for their insureds. It's not a bad idea. I rather like a single source not only for myself but my other family members. In the event of an emergency, this is very valuable info for a medical provider to have (however, most don't know where and how to look for it so getting in on line is really on the first step - but that's a different discussion).

Now the problem - Wellpoint, parent company of Anthem Blue Cross, just released information to the fact that over 130,000 members had their personal health records hacked into and social security numbers and prescription information may have been compromised. Now, we all know that middle age people in their boxer shorts sit home all day in mom's basement trying to hack into anything that they can for kicks but someone has to stop this. Personal data of any type needs to be safe and out of the hands of those that might use it against us. In order for the carriers to continue to promote this type of information, they are going to have to do a better job of making sure that people that we don't want to see this information, can't!

Yes, You May Discriminate!

Finally! HR professionals everywhere have been waiting to hear those words. Recently, the Supreme Court refused to hear additional testimony as it relates Retiree health insurance plans. Up until now, the EEOC felt that offering different benefit plans with different pricing was a violation of ADEA. Hogwash - but that is what we get when we have a government agency that does not understand what they are ruling on. They neglected to look at the coordination of benefits with Medicare when they dreamed up this violation. So guess what happened? Most companies froze or discontinued offering retiree benefits altogether. Oops! That was not what the EEOC had hoped would happen.

With this latest confirmation from the US Supreme Court, what can happen is that employers, if they choose, can have different plans for employees that are catagorized as retired. Certainly, early retirees do not have the ability to coordinate benefits with Medicare so those plans may be more robust and more costly. Retirees that are Medicare eligible should have a plan that includes the proper benefit levels with the pricing of those plans to match.

Is there going to be any big rush for employers to re-introduce retiree benefits? No. With our workforce working longer and graying, retiree benefits are really a thing of the past. The real issue for the future is whether or not employers will be able to design benefit programs and encourage enrollment in those programs that are age/lifestyle based without the EEOC crying discrimination again? I hope so because that is where I think employers will see the most savings in the plans and employees will feel like they really have the correct benefits that meet thier needs. Another blog.

The Time For Mini-Medical Plans Is Now

The landscape of traditional employees is changing. Many of my clients are hiring part time employees due to the economy if they can. Other's are hiring employees on a 1099 basis so they can avoid some of the expenses associated with a traditional hire. With the labor pool changing, how do health insurance benefits fit in - or do they?

Individual health insurance is almost impossible for most people to secure, let alone afford. 1099 employees would not qualify under the definition of an eligible person for group health insurance and many plans exclude part time employees. Yet, employers need this base of employees and these employees need to stay healthy in order to work.

A new type of insurance coverage has been created in the marketplace. They have been available for several years now but until recently, lacked some key coverage elements to really make them worth looking at. They are referred to as limited medical plans - or mini-medical plans. Several carriers offer them with various underwriting guidelines but they work like this: Coverage includes doctors office visits, preventive care, pharmacy benefits, lab & xray and hospitalization. However, the plan limitations are lower than normal health insurance programs. They might include 8 office visits per year, 1 physical and hospital and surgical coverage of $100,000 per year. These programs are designed to keep people well. The premiums associated with these plans are far less that traditional health insurance coverage because the carrier exposure to claim is limited. Rates can be as low as $60 per month.

This type of program allows employers to offer something that is guaranteed issued - the carrier must accept all conditions and is affordable for employees. Also, the more employees a client can show that are covered under a group health program positively impacts workers compensation costs.

Many of my clients are considering plans like this for a variety of reasons. I don't suggest these plans as a replacement to the traditional full coverage plans but they definitely enhance an employee benefit program at a low cost for that group of employees that often finds themselves without.

Individual versus Group Health Underwriting

Healthnet has been in the news lately. Which insurance carrier has not? Anyhow it seems that Healthnet acted improperly and with malice (per the court) towards an insured that had been approved with and individual policy and then has her coverage terminated while undergoing cancer treatment. The judge in arbitration found for plaintiff - the insured - and awarded over $9 million dollars in penalties and fines.

Many of my clients have raised concerns this last week that this could happen to them. Because I have received more than one phone call, I thought I would try to put fears to rest in my blog.

First, if you are insured through an employer sponsored plan, it is group coverage, not individual coverage. The carrier cannot terminate you from that plan unless you have been terminated by your employer. Group insurance rules apply. The case in the media was around individual health insurance coverage that has very different underwriting rules.

Second, although HealthNet has been fined for this practice, all carriers that write individual health insurance have had underwriting practices under the microscope lately. Blue Cross recently recinded the practice of sending letters to doctors asking them to notify Blue Cross if patients covered under individual plans had illnesses or issues that might not have been disclosed in applications. What was not made public in this HealthNet case was the reason why this person had her coverage terminated? Was her application correctly filled out? Did she pay her premium? There are some unanswered questions in my mind as to what really happened here. However, we must rely on the court system and the judge hearing this case. He obviously had access to information that allowed him to rule in this way.

This entire issue clearly brings to light how challenging it is to find individual health insurance - even if you can pay for it! The underwriting rules have become so strict that if you have sneezed in the last month, forget it. I am not sure this problem will be legislated away. Finding health insurance and keeping it will continue to be a very important issue for everyone, especially with our ability to live longer than ever before.