Over the years as an HMO executive and later founding a disease management and Healthcare IT company, I have analyzed a lot of medical claims and quality data. One of the largest was an analysis of a State Medicaid program with about 675,000 beneficiary lives with two years of inpatient, outpatient and pharmacy claims. The pharmacy file alone contained about 15 million prescription fills.
More recently I became certified as a Professional by the Care Innovations Validation Institute and sit on their Advisory Board. This certification tested my ability to look at data and decide whether the outcomes reported were likely to be valid or not. As you look for vendors or consultants I would suggest you start with the Validation Institute. The following example is a good reason why.
Cruising around the web looking at various healthcare consulting firms and company websites I came across a company that is targeting employers and claims they have vetted and can bring in vendors to lower the costs for a company’s self funded health plan. Their website says they can identify, evaluate, oversee, manage and report on the vendors they propose.
On their home page is a chart used to show the savings an employer can expect to see by implementing their various cost saving approaches. Can you spot the flaw(s)?
Let’s start with the first and most glaring error and its on the first line. Continue reading
I recently interviewed Dan Munro on PopHealth Week and we discussed his book Casino Healthcare. We 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. Continue reading
Brian Klepper and I just published a piece entitled:
Employers, unions look to direct contracting for health system contracts
Some key points:
“Industry denials notwithstanding, reducing healthcare costs is fundamentally against nearly every healthcare organization’s perceived economic interests.”
“Florida’s Gov. Rick Scott, former CEO of Hospital Corporation of America, pointed out at a venture capital conference a few years ago, ‘What business wants to make half this year what they did last year? That’s why the healthcare industry won’t fix the healthcare industry.’ “
So purchasers beware. You can read the article by clicking the link to the story at Employee Benefit News:
And if you’d like to learn ways to lower your healthcare costs, contact Brian or me at Health Value Direct