Wednesday, May 25, 2011

Cliffs and Tsunamis

The patient was being prepped to be transferred to Hillcrest Hospital. It was at this point that the attorney, a senior citizen covered by a Medicare Advantage policy (Medicare Part C) objected. In pain, he had been rushed to Hillcrest. After some initial testing, he was packed up and delivered to Ahuja Medical Center, the new University Hospital facility. And now the administrators wanted to send him back to Hillcrest, part of the Cleveland Clinic system.

What medical condition would cause two of the most advanced hospital systems in the country to treat the patient like a hot potato? He had a tummy ache. Seriously. It wasn’t the medical condition. It was the insurance.

The attorney and his wife had purchased a Brand X Medicare Advantage contract. The company has a well-defined network of providers in its home market several counties from here. There was nothing wrong with the product. The Federal government certified and approved it. Our hospitals were unsure of the network, which meant that both hospitals were unable to determine that they would be properly paid.

Let’s stop and review this:
* Educated consumers evaluated their insurance choices.
* All of the products were government approved.
* Two of the largest, most successful, hospitals in the country reviewed the coverage.
* The insurer’s “Home” territory is less than 100 miles away.

The patient could have been treated by either hospital. There was no reason to transfer him. None.

Representative Paul Ryan would like to reform Medicare. The Democrats claim that he is trying to kill Medicare. Pictures of little old ladies being pushed off cliffs will be on your TV by this weekend. This is, of course, a gross exaggeration. Mr. Ryan would never push elderly people off a cliff. He would, however, lecture tsunami victims for their inability to out swim the wave.

Mr. Ryan introduced his Roadmap for America’s Future in 2008. he has had three years to refine it. He has had three years to learn how to explain it. He has failed on both counts. His Medicare plan does not involve vouchers. In truth, Representative Ryan appears to have borrowed the worst parts of the Medicare Advantage program, Medicare Part D (Rx), and the Charter School Voucher initiative, thrown all of these ingredients into a malfunctioning blender, and poured his concoction into a couple of broken martini glasses. Delicious.

I have read the Congressman’s website several times. I wanted to ask him a couple of questions, but his site only accepts emails from residents of his district. If he wants to be a national leader, he should be nationally accessible.

The current Medicare Advantage program allows senior citizens to acquire coverage online, by phone, by mail, or through a specially trained and licensed agent. There is no difference in price. The attorney went it alone. He was never in any real danger. He was always covered, but there had been better options. Representative Ryan’s plan is far more complicated and it doesn’t carry any guarantee of success. It is important to note that the attorney and his wife CHOSE the Medicare Advantage route. They could have stayed with traditional Medicare and purchased supplements. Mr. Ryan eliminates that choice.

The good news is that there are no cliffs involved. But Paul Ryan thinks that you better learn how to swim.


Saturday, May 14, 2011

Two Questions

The second most frequently asked question of an insurance agent is, “Why did my policy lapse?” The answer is because you didn’t pay the bill. The absolute winner, the question that I am asked at least once a day is, “Why did my rates go up?” There isn’t a simple answer to that question.

Some of the factors that may contribute to a premium increase for an employer are:
* Increased Utilization
* Aging Population
* More Mandated Benefits
* Medical Inflation
* New Insurance Taxes

That is not a complete list. There are more. But today’s post isn’t about price increases. It is about one of the ways to impact costs.

The May 2011 edition of Employee Benefit Adviser, which is not nearly as boring as it sounds, included an article about two employers enjoying 0% renewals this year. We are going to look, briefly, at J. J. Keller & Associates, Inc. of Neenah, Wisconsin.

J. J. Keller & Associates, Inc. is a privately held company with about 1,100 employees. Keller helps companies navigate through the minefields of government regulations. The company enjoys a stable workplace environment. 60% of the employees are over age 40 and the majority have worked for the company for five years or more.

Keller’s commitment to Wellness includes:
* Company sponsored Weight Watchers at Work
* Smoking Cessation programs
* Fitness Challenges
* A Walking Trail available during breaks
* In-house Food Service
* Workout Facility
* In-house Wellness Center staffed by a Nurse Practitioner

You get the idea. They have made the complete and total commitment. J. J. Keller has everything in place for a successful program. Even the fact that it isn’t a publicly traded company helps. Does this mean that the health insurance rates are going to decrease? Are they saving money?

The article doesn’t answer either of those questions. My guess is NO on both counts.

Medical inflation, alone, is going to impact costs at close to 10% per year. Maybe more. The Patient Protection and Affordable Care Act is taking a toll, too. But the most important issue is that we are not discussing machine maintenance. We are talking about human employees, flesh and blood. We are going to get sick or injured. We are going to have claims.

A properly designed Wellness Program can mitigate the type and amount of claims by controlling behavior. Ongoing claims for diabetes, heart disease, stroke and cancer are budget killers. Many of these conditions are controllable through education, medication, and behavioral modification. The Keller program is designed to improve morale and awareness. From here, today, it appears to be working.

There are some local stars in the wellness universe. Kaiser Permanente is returning to its HMO roots. After a bit of soul-searching, the company realized that it was attempting to be all things to all people. Kaiser has recently declared that it will return to its core competency – an integrated medical practice whose mission is to keep people healthy. With a focus on Prevention, Kaiser hopes to reestablish itself as a unique option in the marketplace.

I recently met with Jamie Field of University Hospitals. Ms. Field has created an incredible wellness program for Northeast Ohio employers. She and her team will conduct Health Fairs, Wellness profiles, and Health Screenings at the worksite. The pricing tells the story. U.H. has made the decision to perform community outreach. For example, $20 per employee includes on-site health screenings for:
1. Blood Pressure
2. Blood Sugar
3. Cholesterol
4. BMI
5. Bone Density

Employees who fall outside of the normal range on any of the tests are given useful information designed to answer immediate questions and to spur productive steps towards help or control.

Will this lower the employer’s group health insurance rates? No, at least not anytime soon. But if the goal is to help someone before they have a stroke, heart attack, or other major claim, then a wellness program could be very useful. And yes, it could improve employee morale.

The purpose of group health insurance is to attract and retain good people. A wellness program, one designed to help and educate, could complement your efforts.

The results may be happier employees. You may have healthier employees. But the insurance will still lapse if you don’t pay and the rates may still go up. I'm hoping just a little.


Friday, May 6, 2011

Of Course It Is A Good Idea. I’m Not Paying.

One of the new benefits of the Patient Protection and Affordable Care Act (PPACA) is that dependent children, even if they are married, can be covered on the their parents’ policies until they reach the tender age of 26. Ohio upped the ante and made it 28. Employers are rejoicing.

A provision was built into the law that prevents an employer from passing any of the extra cost of insuring an adult child onto the parental employee. If the employer pays 75% of the cost of insuring a five year old girl, the employer must pay 75% of the cost of insuring a twenty-five year old woman. There is a huge difference in these risks. Neither the State of Ohio nor the US government is concerned.

The insurers are passing the additional cost to cover these adults, much like the other new benefits, to the policyholders. Individual (non-group) contracts are rising. Group policy premiums are climbing. Some employers are absorbing the difference. The recent hike in gas prices will quickly end such largesse.

I am seeing employers tackle this problem by raising their deductibles and co-payments in an effort to retain reasonable premiums. Other clients are asking their employees to pay a larger portion of their premiums. This would appear to be inevitable.

As the costs continue to mount, there are still those who want more. Can we include the spouses of the married children? Shouldn’t we include grandchildren? I’m reminded of my friend Jack who didn’t quit smoking. He simply quit buying!

There are no FREE benefits. There are no Free physicals. No Free colonoscopies. No Free coverage for dependent children. We are all paying for this, directly or indirectly. If this, any of this, makes sense as part of some greater public good, say so. It is time for our political leaders to publicly state their values. We need to be asked to support their choices with out money.

We’ve had subterfuge and deception. Let’s try something entirely different – honesty and transparency. I’m paying. Let me feel like I’m getting my money’s worth.