The Great Northern States Health Care Initiative is a group of people from Minnesota and Wisconsin who have come together for the purpose of advocacy for a better health care system in our respective states and the nation. Our main objective is education of ourselves and others in our communities on the imperatives of a single payer health care system.
641-715-3900, Ext. 25790#
Thursday, December 31, 2015
Single payer more popular than Obamacare | Daytona Times
Wednesday, December 30, 2015
Tuesday, December 29, 2015
Monday, December 28, 2015
Deniial of Service Tip
Sunday, December 27, 2015
Saturday, December 26, 2015
Friday, December 25, 2015
Sanders on Single Payer
So I want to go over some facts with you and ask that you take action on this important issue:
Right now, because of the gains made under the Affordable Care Act, 17 million people have health care who did not before the law was passed. This is a good start, and something we should be proud of. But we can do better.
The truth is, it is a national disgrace that the United States is the only major country that does not guarantee health care to all people as a right. Today, 29 million of our sisters and brothers are without care. Not only are deductibles rising, but the cost of prescription drugs is skyrocketing as well. There is a major crisis in primary health care in the United States.
So I start my approach to health care from two very simple premises:
- Health care must be recognized as a right, not a privilege -- every man, woman and child in our country should be able to access quality care regardless of their income.
- We must create a national system to provide care for every single American in the most cost-effective way possible.
I expected to take some heat on these fundamental beliefs during a general election, but since it is already happening in the Democratic primary, I want to address some of the critiques made by Secretary Clinton and Rupert Murdoch's Wall Street Journaldirectly:
Under my plan, we will lower the cost of health care for the average family making $50,000 a year by nearly $5,000 a year. It is unfair to say simply how much more a program will cost without letting people know we are doing away with the cost of private insurance and that the middle class will be paying substantially less for health care under a single-payer system than Hillary Clinton's program. Attacking the cost of the plan without acknowledging the bottom-line savings is the way Republicans have attacked this idea for decades. Taking that approach in a Democratic Primary undermines the hard work of so many who have fought to guarantee health care as a right in this country, and it hurts our prospects for achieving that goal in the near future. I hope that it stops.
Let me also be clear that a Medicare-for-all, single-payer health care system will expand employment by lifting a major financial weight off of the businesses burdened by employee health expenses. And for the millions of Americans who are currently in jobs they don't like but must stay put because of health care access, they would be free to explore more productive opportunities as they desire.
So, what is stopping us from guaranteeing free, quality health care as a basic fundamental right for all Americans? I believe the answer ties into campaign finance reform.
The truth is, the insurance companies and the drug companies are bribing the United States Congress.
I want to make health care a right for every American. The health care industry doesn't like that very much, so they're flooding my opponents with cash. Fight back against those who want to stop a Medicare-for-all, single-payer system with a contribution to our campaign.
Now, I don't go around asking millionaires and billionaires for money. You know that. I don't think I'm going to get a whole lot of contributions from the health care and pharmaceutical industries. I don't like to kick a man when he is down, but when some bad actors have tried to contribute to our campaign, like the pharmaceutical CEO Martin Shkreli who jacked up the price of a life saving drug for AIDS patients, I donated his contribution to an AIDS clinic in Washington, D.C.
Secretary Clinton, on the other hand, has received millions of dollars from the health care and pharmaceutical industries, a number that is sure to rise as time goes on. Since 1998, there are no industries that have spent more money to influence legislators than these two. Billions of dollars! An absolutely obscene amount of money. And in this election cycle alone, Secretary Clinton has raised more money from the health care industry than did the top 3 Republicans -- combined.
Now, and let's not be naive about this, maybe they are dumb and don't know what they are going to get? But I don't think that's the case, and I don't believe you do either.
So, what can we do about it?
Changing the health care laws in this country in such a way that guarantees health care as a right and not a privilege will require nothing short of a political revolution. That's what this campaign is about and it is work we must continue long after I am elected the next President of the United States.
And because of the success we have enjoyed so far, I am more convinced today than ever before that universal quality health care as a right for all Americans will eventually become the law of the land.
It is the only way forward.
Thank you for standing with me on this important issue.
Gun Violence as a Public Health Issue
Thursday, December 24, 2015
Wednesday, December 23, 2015
High Deductibles and Narrow Networks: The Achilles Heel of the ACA'S Health Insurance | John Geyman
"It is time to replace it with a more accountable system with universal access, cost containment, lower administrative overhead, and a service-oriented culture--single-payer national health insurance (NHI)."
Tuesday, December 22, 2015
Monday, December 21, 2015
Sunday, December 20, 2015
Supporting single-payer, universal health care
"Many of the false arguments used against universal health care absolutely apply to our current system of relying on private insurance. Reliance on private insurance has proven to be bad for individuals, for business, for health-care providers, for the economy and our society. Still there are those who will claim socialized medicine is bad for our country. I suspect that if we could find the original sources of these claims, they would have very familiar-sounding names from the health insurance industry."
The Fate of Obamacare - The New York Times
Coment from PNHP:
Saturday, December 19, 2015
Friday, December 18, 2015
The Magical World of ACA Funding | THCB
"Revenue was to be generated (in large part) by a series of taxes on a variety of different sources. These taxes did not fare so well in the current budget."
The problem of Obamacare's large knowledge gap
"Not only do most uninsured Americans not know when the deadline is, but many may be mistaken in the belief that they can't afford coverage — apparently, many people with moderate incomes are unaware of available financial aid that can significantly cut the price of their monthly premiums. Separately, some of the uninsured don't know they could qualify for Medicaid, the government program for the poor, which would cost them little or no money."
Medicaid Privatization Gets Messy in Iowa - Bloomberg Business
"Nationally, the shift to Medicaid managed care hasn’t been proved to save money, and the approach has a mixed record on how patients fare.."
Thursday, December 17, 2015
Tuesday, December 15, 2015
The Experts Were Wrong About the Best Places for Better and Cheaper Health Care - The New York Times
Comment from Kip Sullivan: This morning's NY Times has a delicious article on the front page
debunking the ACA's theory of cost-containment, namely, overuse is
what's causing US health care costs to skyrocket, and the solution is to
push doctors into ACOs so they can bear insurance risk. In fact, the
paper provides evidence indicating that precisely BECAUSE the ACA
encourages consolidation of hospitals and clinics into ACOs, costs are
PNHP has been trying to communicate this fact to the
Health Care Financing Task Force: Overuse and the fee-for-service system
are not the problem, and cramming doctors into HMOs/ACOs so that they
can bear more insurance risk is not the solution. I hope task force
members read this article.
The article is based on a
soon-to-be-published paper by the National Bureau of Economic Research.
The paper shows that the overuse mavens who publish the Dartmouth Atlas
got it all wrong. They became very excited in the early 1990s about
Medicare data as computers made it possible to compare Medicare spending
region by region. By becoming obsessed with Medicare data and ignoring
data from the private sector, they convinced themselves of the wrong
solution. This is a great illustration of why drunks never find their
keys: They only look under the streetlight because that's where the
light is good.
Monday, December 14, 2015
Sunday, December 13, 2015
Saturday, December 12, 2015
Friday, December 11, 2015
Lone profitable ACA insurance co-op losing millions - Yahoo Finance
I'm guessing the devils in the political details. Killing the public option was a big deal for the insurance companies and this co-op ideas was a compromise. But, as with county based purchasing in MN, I assume the non-profit co-ops got short changed in terms of money and red tape requirements.
Wednesday, December 9, 2015
Tuesday, December 8, 2015
More Former Inmates Getting Medicaid Under Obamacare, Study Finds - US News
Getting coverage upon release needs to become a mandatory part of our criminal justice system. Mental health and chemical abuse are major contributing factors to criminal behavior and access to treatment is essential.
This Could Be the Obamacare Outcome We've All Been Waiting For -- The Motley Fool
"In exchange for spending more money on
their members up front, it's possible that chronic and serious diseases
that are the primary expense culprit for insurance companies can be
caught before they become a serious issue. Thus, while health benefit
providers may be spending more now than they would like to, their
long-term outlook is also looking brighter presuming the current
generation of members is now going to be healthier than the last
generation given expanded access to medical care."
Needed: Domestic Disarmament, Not 'Gun Control' | Amitai Etzioni
This could be a major public health effort.
Monday, December 7, 2015
Sunday, December 6, 2015
Sunday, November 29, 2015
Saturday, November 28, 2015
Friday, November 27, 2015
Patrick Watson: Obamacare Collapsing Ahead of Schedule
Medicare for All single payer universal medical coverage for all
citizens is the only way we can save enough money to do what is right.
Profit should NOT be in our health care and insurance companies are an
experiment in health care that has failed miserably. I don't want
insurance execs making millions by denying me access to health care. I
don't want my coverage / access to health care dependent upon where I
work - it should not be job related. Hospitals should be put on a
budget and not have all that detailed billing for every little thing
they do or give you. Hospitals should be treated like public utilities
like electric companies in terms of what they can do and how much they
charge. Our country has the worst health care outcomes of all
developed nations and it has by far the most costly health care system
in the world. You can not change that by continuing to treat health
care as a commodity and me as a consumer. My local fire department and
police department and road and bridge department are not considered as
providing a commodity and I am not their consumer. Same needs to happen
for health care. And, I am not saying I want all my health care
providers to work for the government.
If you believe health care
should be denied to those you believe to be unworthy for whatever your
personal reasons may be, you are the problem. Our country needs to
change its view of health care to be considered as a right, not as a
Thursday, November 26, 2015
Wednesday, November 25, 2015
Monday, November 23, 2015
Fight Pharma Ripoffs
Sunday, November 22, 2015
Saturday, November 21, 2015
Medicare hopes bundled payments will lead to better care, lower costs
hope this is a move toward putting hospitals on a budget as how they get reimbursed.
Friday, November 20, 2015
Obamacare's Fate May Rest on Patience of Insurers Aetna, Anthem - Bloomberg Business
Yet another money based view. What this points out to me is just how consolidated the insurance companies have become and are becoming. We are close to a "for-profit" single payer system now. We need a Medicare for All system without the profit motive. Health care is a right, not a commodity. I am a patient, not a consumer shopping around.
Get ready for that TOO BIG TO FAIL crap applied to health insurance companies.
UnitedHealth Warning Creates Huge Spillover, With Big Implications Ahead - UnitedHealth Group (NYSE:UNH) - 24/7 Wall St.
We really need to get the for-profit insurance companies out of our health care. So much of the recent hype in the news has been about profits and shareholders and NOT about health care quality or access.
More on this: http://www.cnbc.com/2015/11/19/big-bad-day-for-obamacare-as-unitedhealth-considers-exit.html
Thursday, November 19, 2015
Many Say High Deductibles Make Their Health Law Insurance All but Useless - The New York Times
out of control. The anecdotes in the full article (link above)
demonstrate that many people find that their insurance is “all but
useless” simply because they cannot afford to pay the deductibles.
Anecdotes do not constitute a scientifically valid study, but they
certainly do tell us what is happening to individuals out in the real
affordable in order to maintain a viable market of private plans. They
do that by shifting costs to patients through ever higher deductibles.
This was inevitable through the reform model selected for the misnamed
Patent Protection and Affordable Care Act. Because of the large
deductibles, actual health care is not affordable for individuals with
modest incomes and thus patients do not have the protection that they
already spending on health care is enough to provide all essential
health care services for everyone. With a properly designed financing
system there is no need to erect financial barriers to care since cost
containment can be achieved through patient-friendly policies such as
those of a single payer national health program.
proper reform, “degradation of health insurance” will progress. People
will face greater financial hardship because of medical bills. People
will suffer more because of forgone health care. People will die.
The Future of Public Health — NEJM
expectancy was 54. Today it is 79. Public health has played a much
greater role in realizing this gain than has clinical medicine. Although
most health funds are being directed to clinical services, public
health services will need support to continue and to expand the gains
that have been more important to society as a whole.
must remain responsive to the nation’s health needs. Recognizing that,
Congress included in the Affordable Care Act a $15 billion boost in
public health funding. However, that was reduced in 2012 legislation by
$6.25 billion, and then further reduced by sequestration. Public health
appropriations for 2015 are less than half of the $2 billion budgeted.
can these reductions be justified? The need for austerity? Not based on
the billions of dollars being fed into the coffers of the wealthiest
amongst us. Less need for government public health services? Not unless
we are willing to accept a surge in preventable disease epidemics and
injuries from public hazards. Can we justify these reductions based on
the ideological principle that the responsibility for health should be
shifted from the government to the individual? Even ideologues can
suffer or die from uncontrolled epidemics, from uncorrected public
hazards, or because of a lack of beneficial interventions that were not
public health actions, we would also benefit by adopting a
government-run health care financing system - a single payer national
health program. The failure to act makes our Congress one of the
greatest public health hazards that we face. Electing the right people
to Congress may be the most important single measure that we could take
to maintain and improve the health of our nation.
Tuesday, November 17, 2015
Assembly approves self-insurance oversight bill | State and Regional News | host.madison.com
Hard to believe this. Here's the email I sent to my Senator:
---------- Forwarded message ----------
you help me understand what this will really mean. I can't believe the
current leadership in the Legislature and the Governor want to take
business away from private insurance/HMO companies. Are they just going
to shift from buying "insurance" to paying those same companies to do
all the work?
self-insurance, the state would pay benefits directly instead of buying
insurance from 18 HMOs.", then why isn't it a good idea for WI to do so
for ALL publiclly funded health care programs?
Monday, November 16, 2015
Saturday, November 14, 2015
Saturday, November 7, 2015
Why You Might Be Choosing the Wrong Obamacare Plan | The Fiscal Times
$ up front for premiums versus $ later via tax subsidies....Maybe folks don't trust the government....maybe we need a simpler way to make it affordable.
Thursday, November 5, 2015
PNHP: This is why we need single-payer – Medicare for all
Open Enrollment - note from Grassroots North Shore in Milwaukee
Wednesday, November 4, 2015
The hidden risk of high-deductible health plans
"...they’re just skipping the care they need altogether"
Tuesday, November 3, 2015
Saturday, October 31, 2015
Friday, October 30, 2015
Thursday, October 29, 2015
Wednesday, October 28, 2015
Tuesday, October 27, 2015
Minnesota achieves the near impossible: 95 percent of residents insured
Don't give in to the political and profit motive pressures to go backwards. You will lead others in the right direction toward single payer if you continue to get better.
Saturday, October 24, 2015
Thursday, October 22, 2015
Tuesday, October 13, 2015
Friday, October 9, 2015
U.S. Health Care from a Global Perspective: Spending, Use of Services, Prices, and Health in 13 Countries - The Commonwealth Fund
still spend far more than any other nation on health care, partly
because of our very high prices, even though we are not using more
health care. Worse, in spite of our high levels of spending, our
population health remains relatively poor.
and on social care (retirement and disability benefits, employment
programs, and supportive housing) is about average (see Exhibit 8,
above). Considering that our health care spending is so high, it may be
that the comparatively low spending on social services is a significant
contributor to our poor population health.
system would do that. However, since we are a very wealthy nation, we
should be able to increase spending on social services as well. The
progressive taxes required to do that would also help to address our
crisis in income inequality."
Thursday, October 8, 2015
Risk Selection Threatens Quality Of Care For Certain Patients: Lessons From Europe’s Health Insurance Exchanges
Comment by Don McCanne
Affairs, looks at European nations that use variations of market
exchanges of private insurance plans (Belgium, Germany, Ireland,
Switzerland and, especially, the Netherlands) to see what lessons on
risk selection they may have for the United States. But are these the
right lessons for us?
the healthy, with their relatively low health care costs, while avoiding
insuring individuals with greater health care needs. Although the
Affordable Care Act prohibits insurers from refusing to cover
individuals anticipated to have higher health care costs, we are seeing
insurance innovations in gaming risk selection that substitute for
medical underwriting, which sometimes still prevents patients from
receiving the care that they should have.
costs of the wasteful administrative excesses in our health care
financing. In fact, some of these excesses are for the very purpose of
ensuring the business success of the private insurers. So what
efficiencies do the European systems that use marketplace exchanges of
private plans have that might help the United States avoid the
perversities of favorable risk selection on the part of the insurers?
administration), systems to collect yet more data (more administration),
introduction of risk-sharing strategies such as mandatory
community-rated reinsurance or risk sharing between the regulator and
the insurers (more administration), allowing insurers to charge their
enrollees, within a band or range of acceptable charges, risk-adjusted
health insurance premium rates (more administration), and balancing
trade-offs of quality-skimping selection, efficiency, and affordability
of the trade-offs involved, further compromises in quality and equity
would result. No matter what strategies are used, the private insurers
will always find a way around them. That is inherent in their
European nations should be looking for lessons from our neighbor to the
North: Canada and its single payer model of health care financing. We
would do well to do the same."
Obamacare mandated better mental health-care coverage. It hasn’t happened. - The Washington Post
"The Affordable Care Act has boosted the number of Americans with health insurance coverage but has not resolved the disparate way in which many insurers treat the costs of mental and physical health care, according to an April report released by the National Alliance on Mental Illness. "
Reimagining Health Care
Reimagining Health Care
A panel of speakers from Canada, the UK, and Germany
will share their experience with universal health care. The
current state of the US health care system will be
presented for comparison. The presentation will be
followed by small and large group discussion.
Saturday, November 21, 2015
9 to 11 a.m.
St. Joan of Arc Catholic Community
Join us - Be a part of the discussion
Be a part of the solution
4537 Third Avenue South, Minneapolis, MN 55419
Wednesday, October 7, 2015
The world’s best, and worst, places to die ranked - The Washington Post
This has much about how the U.S. ranks in health care for the rapidly increasing number of us older folks. Includes some good arguments for universal health care.
Tuesday, October 6, 2015
Monday, October 5, 2015
Sunday, October 4, 2015
More from Kip-Evidence DHS is peddling faith-based health policy
Oct. 4, 2015
The paper I'm referring to is by Jonathan Oberlander, an expert who teaches a the U of NC, and Miriam Laugeson, who teaches at Columbia. Oberlander is a prolific and highly respected writer. I don't know anything about Laugeson. The title of their paper is "Leap of faith -- Medicare's new physician payment system." http://www.nejm.org/doi/full/
Oberlander and Lauger essentially say two things: Other countries spend a lot less than we do on health care even though they rely on the fee-for-service method of payment and do not rely on ACOs etc; there is no evidence to support CMS's claims for ACOs, "medical homes," and similar entities designed to shift insurance risk onto clinics and hospitals. Congress and CMS have only faith in the rightness of their opinions.
The other document I want to call your attention to is a letter to the editor of NEJM that I co-authored with Ted Marmor, the professor at Yale who invited me to speak with him at the Yale conference on Medicare and Medicaid last November. The NEJM asst editor I'm dealing with told me recently this letter will appear in the Oct 15 edition of NEJM.
The letter is very short (you only get 175 words). It criticizes the authors of a paper published in the June 18, 2015 edition of NEJM by David Blumenthal, currently the head of the Commonwealth Fund and formerly a member of the Obama administration, and two colleagues. This paper appeared in the June 18 NEJM. It purported to assess the progress of the ACA five years after its enactment.http://www.nejm.org/
They claimed that one of CMS's ACO programs (the Medicare Shared Savings Program (MSSP)) cut Medicare costs and one of CMS's three "home" programs cut Medicare costs. Neither statement was true. And here's the crazy thing: The two studies Blumenthal et al. cited proved them wrong. I don't know what to call the error Blumenthal et al made. How do you make a false statement and then cite a paper that demonstrates you made a false statement? Was it a lie? Was it laziness? Was it seeing the world through hallucinations induced by HMO Kool-Aid?
Here's what happened. The two papers Blumenthal et al relied on highlighted the reduced claims costs Medicare enjoyed as a result of the MSSP and "home" programs, but downplayed the cost of the bonuses CMS paid out to ACOs and "homes" that succeeded in cutting Medicare's claims costs. The latter costs were right there in the reports for anyone to see who didn't rely on CMS's press releases about the reports. Unfortunately for Blumenthal and all ACO and home buffs, the cost of the bonuses CMS paid out were HIGHER than the reductions in claims costs, for a net increase in costs to CMS of both programs.
What you should find especially troubling about Blumenthal et al's mistake is that they chose what they thought was the best research proving their point that ACOs and homes save money. They didn't have the space to do a literature review, so they cited what they thought were two of the most credible and up to date reports. But they got both reports wrong. The reports disproved their thesis.
So, if someone as smart as Blumenthal et al. couldn't find any literature to support their claims, what are the odds that DHS staff are going to find anything supporting their obsession with "value based purchasing" and ACOs?
Letters to NEJM rarely have replies. NEJM hasn't told me Blumenthal et al. were given a chance to reply and did or did not write a response. I don't know how you respond to our letter other than to say, "Thank you for catching our error."
I did give Blumenthal two chances to explain his behavior to me before I approached Ted about writing NEJM. I sent him and his Commonwealth Fund colleague Stu Guterman the email below. Guterman replied but dodged the question I directed at Blumenthal as to why he misrepresented the papers he cited. I replied to both men again and noted Guterman had dodged my question to Blumenthal. Neither man answered.
Ted and I then wrote the editor at NEJM who managed the article by Blumenthal et al. and politely demanded she print a correction, with or without Blumenthal's permission. She replied she would allow us to write a letter to the editor even though the three-week deadline for letters (they have to arrive at NEJM within three weeks of the publication of the article being criticized). So that's what we did.
So what is the probability that anyone at DHS can produce evidence for ACOs and "value based purchasing" that Blumenthal et al. couldn't think of? Answer: Zero.
From: kiprs [mailto:firstname.lastname@example.org]
Sent: Friday, June 26, 2015 8:04 AM
To: Stuart Guterman; David Blumenthal
Subject: Two questions about ACO research
Dear Mr. Guterman and Dr. Blumenthal,
I'm writing you to call your attention to a defect in the ACO model, and to an inexplicable tendency among health policy analysts to report the gross savings allegedly achieved by ACOs rather than the net savings. I urge you and other Commonwealth Fund officers and staff to use your influence to correct these problems.
I have pasted in below two comments I posted recently on the blog of Physicians for a National Health Program on these issues.
The first comment opens with a statement you made, Mr. Guterman, to Modern Healthcare about how difficult it is to make sense of the findings reported by L&M Policy Research, and by Nyweide et al. in their paper in JAMA based on the L&M report, on the first two years of the Medicare Pioneer ACO program. If Modern Healthcare had called and asked for a comment about the final evaluation of the five-year Physician Group Practice Demonstration (an earlier test of the ACO concept), you would have been forced to make the same comment -- it's hard to know who did what to whom to save the grand total of three-tenths of a percent that the PGP demo saved Medicare (net of CMS's bonus payments).
Can we agree that financing ACO experiments that tell us almost nothing about why ACOs saved or lost money is not a good use of taxpayer dollars? If so, I urge you to use your influence to induce ACO proponents (starting perhaps with your own board and Medpac) to demand that CMS and private promoters of ACOs define the mechanisms ACOs are supposed to use precisely enough to test them -- to operationalize them. That's not possible now given the extraordinarily vague, aspirational definition of "ACO."
The second comment I'm sending along addresses CMS's habit of reporting gross savings to Medicare and either ignoring the cost to CMS of its bonus payments to ACOs, the administrative costs associated with running the ACO programs, and the cost to ACOs of hiring the extra staff and buying equipment necessary to start and maintain an ACO, or burying them in a separate document. (The second comment also addresses another but less common problem -- simulating ACOs and reporting the results as if they were for a real program. If you care to comment on that issue, please do, but I'm more interested in the two issues I've described above.)
Dr. Blumenthal, your comment about the L&M/Nyweide et al. reports in your paper for NEJM, "The Affordable Care Act at 5 Years," illustrates the second problem -- the habit among analysts of repeating CMS's gross savings estimates and not calling readers' attention to the fact that the figures don't take account of CMS's costs, including the bonus payments they make to ACOs. In your NEJM paper, you cited CMS's claim that Pioneer ACOs have cut Medicare's costs by $385 million, but you neglected to tell readers that number was a gross number, not a net. According to a May report put out by CMS, the Pioneer program saved only two-tenths of a percent in 2012 and five-tenths in 2013 when CMS payments are taken into account (see page four here http://www.cms.gov/Research-
Similarly, CMS says the MSSP ACOs have RAISED Medicare costs (see the same document above), but you claimed in your NEJM paper savings of $700 million (with no citation).
I'd appreciate hearing any comments you have in response to this email, especially if you feel inclined to support the health policy community's current policy of defining ACOs so vaguely they can't be tested, and CMS's and the health policy community's emerging habit of pretending there are no costs to administering the ACO programs and, therefore, all savings are pure gravy.
Long but important comments by an expert - Kip Sullivan
True to form, DHS spoke in a language that sounds remarkably like English but actually isn't English when you ask yourself, What did I just hear? I will do my best to translate.
The presentation included 31 slides. It was entitled "Integrated Care Models and Value-based Purchasing in Minnesota." I know you understand what "in Minnesota" means. Let me translate the rest:
* "Integrated care" means medical care delivered by large corporations that own clinics, hospitals, pharmacies, and nursing homes. You see, providers can only communicate clearly with one another if they have the same corporate logo on their doors. Otherwise, communication is impossible. Email doesn't work, phones don't work, faxes don't work. If you don't have a corporate logo on your door, you provide "fragmented care" and, worse, "uncoordinated care."
"Value-based purchasing" is something insurers (public and private) do. "Value," as you know, is a combination of cost and quality. You might fear that letting DHS or BCBS define "value" is a recipe for disaster, but you'd be wrong, according to DHS. DHS knows we're on the brink of being able to measure not just cost per patient accurately, but the quality of care given to that patient as well. Moreover, DHS knows that some IT nerds somewhere are about to invent a computer program will that will combine an accurate score for cost with an accurate score for quality into a single "value" score. And then, DHS can rank all HMOs or all ACOs with a single value score, and award contracts on the basis of this score. Ditto for BCBS. It can rank all doctors and hospitals in the state and decide which ones to include in their ACO.
The first two-thirds of the Powerpoint slides are devoted to explaining ACOs that DHS has already set up within the Medicaid program. The first few slides use the phrase "integrated care model" (ICM) but gradually that label is displaced by the phrase "accountable care organization."
DHS warns us in slide 5 that we're never going to know what an ICM or an ACO actually does. Slide 5, entitled "MN approach to Medicaid ICM," says: "Define 'what' we want, rather than the 'how,'" and "Allow for local flexibility and innovation...." Slide 5 says what we "want" is "accountability for total cost of care," "robust quality measurement," and "models that drive rapidly toward increasing levels of integration."
See what I mean? The words are all words all have an obviously Anglo-Saxon origin, but when you stop and ask, What the hell did DHS just tell me, you realize you have no idea what they said.
The problem is that DHS won't state clearly what their end game is -- to identify the corporations they have in mind that will rule our system, and the tactics these corporations will use to control physician-patient decision-making. DHS's goal is to cram all Minnesotans into a few enormous insurance companies that will be nothing more than HMOs on steroids, but will be called ACOs. The Big Three insurers and a half-dozen dominant hospital-clinic chains (Allina, Mayo, Sanford, etc) will run these ACOs.
The Big Three and the hospital-clinic chains know precisely what DHS is up to. The rest of us don't. This is dog-whistle health policy. It's profoundly undemocratic.
Slides 24-28 describe DHS's attempt to determine how widespread ACOs are already in MN. This attempt was apparently conducted around the time MN received the SIM grant. I infer that from the title of slide 24, "SIM ACO baseline: What we hoped to learn." This note appears (after the name "Karen") at the bottom of the slide: "We wanted to learn about ACO and ACO-like practices in the health care delivery system and we wanted to know the strengths, weaknesses and barriers experienced by providers and payers, with the ultimate goal engaging our stakeholders in a broader discussion around statewide goals and SIM priorities."
The phrase "our stakeholders" appears to refer to insurance companies and hospitals. According to slide 26, DHS interviewed five insurance companies, five medical groups, and two community service workers for this "SIM ACO baseline" study.
Slide 27, entitled "ACOs are spreading," informs us that 40 percent of fully insured businesses (as opposed to self-insured) are "in ACOs," although there's no indication of whether the businesses know they're in an ACO. (I've never heard of an ACO definition which defines ACOs by the businesses that are "in" them. This is a definition peculiar to DHS.) We learn that about half of all providers (individual docs, clinics and hospitals) are in "organizations" that are in ACOs (note the convoluted progression from provider to organization to ACO).
Slide 28 informs us that, regrettably, the amount of insurance risk (presumably meaning risk borne by ACOs) is "low," defined as less than 10 percent of their revenues. But, and here's the good news, "many anticipate growth in % in next five years." You see, it won't be long before insurance companies have shifted all risk over to ACOs.
Not one of the slides in this presentation presents evidence that ACOs function as claimed -- that they reduce costs or improve quality. There is a good reason for that: Existing research shows ACOs either save no money or are raising costs, and that ACOs do improve their scores and the tiny handful of quality measures that are imposed on them, which of course tells us nothing about what happened to the patients whose care was not measured.
Not one of these slides discussed the evidence that "value based purchasing" harms poor people (because cost and quality cannot be measured accurately, that is, in a manner that measures only factors under physician or hospital control). This even though the entire task force has agreed they will examine every recommendation they make for its impact on health disparities.
Despite the evidence, and despite the threat that ACO mania will rapidly increase consolidation and worsen disparities and raise costs, the last slide, slide 31, recommends that we mash the ACO button even harder and spread ACOs across the land.
I have attached the slides that I have discussed here.
Posted by: kiprs <email@example.com>
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Healthcare-NOW! - 2015 Single-Payer Strategy Conference
This is a final reminder that today is the last day of early registration for the annual Single Payer Strategy Conference, coming up in Chicago on October 30 - November 1! Starting tomorrow, registration fees will go up from $75 to $85.
Over 700 single-payer activists will converege on Chicago to learn about the best organizing going on around the country, to assess our most important political opportunities and challenges, and to build a movement to WIN healthcare for all.