Casino Healthcare – An Interview with Dan Munro

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I recently interviewed Dan Munro on PopHealth Week and we discussed his book Casino Healthcare. dan-munro-picWe all know about the high costs and poorer outcomes associated with American Healthcare.  In Casino Healthcare Dan explains his view of how our system, one built with Selective Health Coverage is like a casino; or really three casino’s, the insurer casino, provider casino and pharmaceutical casino.

Dan explores each of these areas and explains how they work to maximize revenue through a system of complex transactions and systems.

As an example, on the Provider side Dan explains a little known group called the AMA/Relative Value Scale Update Committee  or “RUC” as its more affectionately known.  This private committee formed by the American Medical Association makes pricing recommendations in secret that are used to create the Medicare Fee Schedule. Medicare accepts near 90% of the RUC’s  recommendations which then become used as the basis of private insurers setting their prices.

The RUC is one of those areas where there is a clear underlying reason for pricing problems in our healthcare system. A number of examples of how pricing developed by the RUC leads to gross overpayments for the time and resources associated with various CPT codes have come to light. In fact a GAO report came out and  said “…the RUC’s process for developing relative value recommendations relies on the input of physicians who may have potential conflicts of interest with respect to the outcomes of CMS’s process.” Imagine that.

The Affordable Care Act or ObamaCare is discussed as a step in the right direction, but it’s also pointed out that the costs of healthcare were an area that was not addressed.  Recent results, have amply demonstrated that. While the ACA has increased the number of people with insurance, perhaps by 20 million, premium costs have risen rapidly and a number of insurers have dropped out.   It appears that the Casino got a hold of the ACA as well, but why would that be a surprise.  There are many examples of how the ACA was written to not only not deal with costs, but in fact created unintended consequences that incented companies to actually increase costs, such as the Medical Loss Ratio requirements.

Dan advocates for Universal Coverage, not necessarily a single payer system. Other countries such as Germany have this model where there are private and government insurance options within a universal coverage system. But even if Universal Coverage was put in place in the United States, unless something is done to wring out the excesses in the Healthcare Casino, we will continue to see costs go up.

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There are many other examples and issues cited in Casino Healthcare and it’s a very good read. You can listen to Dan’s interview on PopHealth Week here:

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PopHealth Week is produced by Health Innovation Media.

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The Florida Trail, 50 Years and Why these Trails are More Than Just a Walk in the Woods

Recently I took part in the Florida Trail Association (FTA) Annual Conference. The FTA develops, maintains, protects, and promotes a network of hiking trails throughout the state, including the unique Florida National Scenic Trail (FNST). This event celebrated the 50th Anniversary of the FTA’s founding.

A Brief History

The National Scenic Trails were authorized under the National Trails System Act of 1968 that began with the naming of the Appalachian Trail (AT) and Pacific Crest Trail (PCT) as the first National Scenic Trails. The AT was originally founded by Benton MacKaye and completed in 1937. It’s over 2,000 miles long. Earl Shaffer was the first person to do a complete single thru-hike of the AT  in 1948. Earl was a soldier returning from World War II who said he was going to “walk off the war”.  More on this and its relevance to current day later.

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Jim and Fred at the unveiling of the sign.

The Florida National Scenic Trail another of the eleven National Scenic Trails is about 1,300 miles long and has its own originator, Jim Kern. The weekend was a well-earned celebration of Jim’s vision to establish the Florida Trail 50 years ago.  Jim is also a co-founder of the American Hiking Society, and founder of Big City Mountaineers which takes under-served urban youth through wilderness mentoring expeditions.

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Upcoming Webinar: Why Health Literacy Matters to Your Business

October is Health Literacy Month, a time for organizations and individuals to promote the importance of understandable health information.

Please join me as I moderate a panel on  Why Health Literacy Matters to Your Business during a free webinar from EdLogics featuring top experts from across the country.

The panel includes:

  • Tommy G. Thompson, Former U.S. Secretary of Health and Human Services and former Governor of Wisconsin

Join us as we explore the strong connection between health literacy, health outcomes, and healthcare costs – and learn what you can do to make a difference.

Date: Wednesday, Oct 26, 2:30-3:45 pm EDT

Register Now

 

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Is Text Messaging being Overlooked as an Engagement Tool in Healthcare?

 

the-holy-grailImproving the consumer’s engagement in their health has become the holy grail; we’re all searching for it. It seems every week some company is coming out with a new app, system or program claiming they’ve developed an incredible engagement tool that will finally get people involved in their health. Most have stumbled.

Could it be that we are overlooking something because it’s just not cool and there are potential HIPAA concerns? That something is SMS text messaging. Think about it, everyone has a cell phone and text is typically unlimited and has become the new way to communicate.

It also turns out, there are some very good studies to support text messaging to be effective and much more likely to be read and responded to than an app, phone call or email. As for HIPAA, there are ways to use a “text first” approach and stay HIPAA compliant.  ken-saitow

Listen to this episode of PopHealth Week  with Ken Saitow of CareWire as he provides insights into text messaging, HIPAA compliance and use cases. He even touches upon seniors and Medicaid, both of whom respond well to text messaging.

 

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A Letter from Dr. Shetty and the Costs of Care

Sometimes we here in the United States, me included, when dealing with all the problems we face with our healthcare system need to step back and understand why we are really here. In the end, it is about the patient, the person needing help.

If I had my druthers I would do nothing but work in Medicaid.  After spending almost 20 years providing disease management services to Medicaid programs and running a Medicaid health plan, the joy of helping this population improve their health has always felt like the pinnacle of my work.

While much of what we have done and continue to do is laudable, there are many flaws with our healthcare system, we spend too much, get too little, and are constantly looking for new solutions to the unique problems the system we created, creates. It seems as if we harp on the negative, but is it really negative to harp on the waste, inefficiencies, fraud and abuse, to point out these wrongs in an effort to fix them?

Recently I received a copy of a letter written by Dr. Devi Shetty. He is a world-renowned heart surgeon, but more importantly he is a heart surgeon who says about healthcare:

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   “If the solution isn’t affordable, it’s not a solution,”

and

“For 92 per cent of people living on this planet, heart surgery is a distant dream,”

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