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Dawn Lipthrott, LCSW
Ethical Health Partnerships
1177 Louisiana Ave. #212
Winter Park, FL 32789
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Ethical
Challenges and Invitations to Health Insurance and Network Management
Companies
We invite you to accept this
challenge and invitation to co-create more ethical health partnerships
with both physicians and patients. Throughout the history of
your company and your industry, you have invested significant
time, energy and financial resources in assessing risks, costs,
and various factors that impact the cost of healthcare for your
company, and ultimately for all of us who pay health insurance
premiums. Therefore you are in a leadership position to address
those factors which are increasingly driving up health care costs,
and to do so in ways that address those problems at their roots
while helping patients and our physicians by reducing premiums
and increasing reimbursement regularly.
Challenge and Invitation:
Ethical Challenge 1 (addressing
the causes of increase in your costs):
1. Within 6 months publish
a plan to begin to address at least one of the following areas
which drive up health costs for all of us: chronic disease management
(especially diabetes), obesity, patient non-compliance (especially
medication-related), patient safety, pharmaceutical costs and
prevention of the most costly diseases. This would benefit nearly
all healthcare partners -- patients, insurance companies, physicians,
Medicare & Medicaid.
Ethical Challenge 2 (relationship
with physicians):
1. Within 6 months from the
date of this letter:
Create a committee of physicians and company executives to find
negotiation procedures and methods that will increase fairness
to physicians and patients, including areas of reimbursement
rates, claims and payment processes, physician authority for
treatment, other contractual issues and transparency of reimbursement
rates. Recent court orders have mandated some of this for major
companies, but all should take the intiative for ethical health
partnership.
To make the changes meaningful
and to encourage creative thinking, seek input from members,
providers, and the public through mailings and website. As part
of the input, create 2 small groups . . . 1 of physicians, 1
of patients, to LISTEN and take note of their needs and concerns
. . . and then develop your plan to address those concerns. Develop
a plan for addressing the issues, for implementation and a target
date for accomplishment of goals. Publish your goals and reports
of progress on your website. (Please notify us and we will provide
a link for your site.)
Ethical Challenge 3 (relationship
with patients):
1. Within 6 months from the
date of this letter:
Create a committee of patients, physicians and company executives
to find ways to reduce patient premiums. Continually increasing
premiums for patients is often the answer used in the past, but
a) only adds to the number of uninsured, which only increases
costs in the long run, and b) does not address preventable causes
of increasing costs.
Create a committee whose mission
is to design, within one year, a plan to address one of the top
3 drivers of health costs at the core and most effective level.
Use more creative thinking to address costs rather than the easiest,
which is to cut physician payment and/or increase patient premiums.
Develop a specific plan and target dates for implementation.
Post topics of discussion and plans on company website open to
the public for additional suggestions.
Although physician payment is
a significant part of the overall costs of healthcare (as is
insurance!), rate of physician reimbursement is not the primary
driver of healthcare costs. In fact, in 2003 it remained the
slowest growing category of spending in healthcare! ( Health
Affairs Tracking Health Care Costs: Trends Turn Downward in 2003
Strunk, B. And Gindburg, P. June 2004) Reimbursement levels
continue decreasing and this needs to be stopped to create more
ethical health partnership. Part of the physician cost percentage
is due to early detection of disease, and some is due to preventable
chronic conditions in patients. It is more about frequency of
service, rather than rates for service. Promoting prevention
could be a more effective way to hold costs. Decreasing reimbursement
impacts access to and quality of care.
c. Each year after, address at
least one of those factors that increasingly add to costs unnecessarily
(for example, preventable errors, pharmaceutical costs and increased
promotion, chronic conditions, obesity, patient failure to comply
with treatment or make lifestyle changes, etc.)
Studies indicate that defensive
medicine, rising hospital costs, errors, ncreasing pharmaceutical
expenditures, chronic disease, patient non-compliance and increasingly,
effects of obesity significantly drive increases in health costs
and thus, insurance expense. Another is increasing advances and
use of developing medical technology. Addressing these larger
contributors to health cost expense require more creative thinking,
planning and a commitment to address the cause, instead of focusing
on trying to pay for the resulting problem(s).
SOURCES
Trends and Indicators
in the Changing Health Care Marketplace, 2004 Update April 2004
Kaiser Family Foundation.
Health Affairs Tracking Health
Care Costs: Trends Turn Downward in 2003 Strunk, B. And Gindburg,
P. June 2004)
Causes of and Potential Solutions
to the High Cost of Health Care-- Chronic Conditions in the U.S.:
Implications for Service Delivery and Financing, Horvath, J.
2003. Agency for Healthcare Research and Quality, Rockville,
MD. http://www.ahrq.gov/news/ulp/hicosttele/sess2/horvathstxt.htm
To Err is Human, Institute
of Medicine (IOM) report, 1999 (on cost of errors).
Some of the areas you might
consider in your commitment to more ethical health partnership
are to:
* Reduce your administrative
cost per patient. Over the past 4 years, administrative costs
have doubled. (See Kaiser report and graph (Source: --------
Kaiser Permanente, 2005, page 11.)
Relationship with Physicians:
* Increase reimbursement and build in regular cost of living
increases for physician services
* Increase reimbursement for physicians with more experience
(perhaps by a series of brackets of 5 years)
* Find ways to provide prompt payment, reduce paperwork and time
in claims processing (both for physician and for company)
* Make reimbursement processes more transparent for both physicians
and patients.
Relationship with Patients:
* Provide patient education and incentives to control chronic
illnesses and conditions (like obesity) that significantly impact
healthcare costs. Reduce premiums for achieved goals created
in partnership with member's physician.
* Find ways to reduce and hold steady health insurance premium
rates in order to prevent more people from becoming uninsured
(which ultimately drives up health costs)
* Create other insurance plans that provide for catastrophic
coverage, that reduces 'frills' and increases patient responsibility
in a reasonable and fair way. For example, providing unlimited
drug benefits with little or no payment from patients, drives
up costs for all, even those who have or want basic coverage.
* Create fair and more affordable policies or risk pools for
individuals, especially for self-employed and very small businesses
that have only a few employees.
* Create a committee of patients, physicians, hospital administration,
and company representatives to think creatively about ways to
address the problem of the large number of insured and how to
prevent more people from becoming uninsured.
Ethical
Challenges Page
TAKE ACTION! JOIN US IN ISSUING THE
CALL TO ETHICAL HEALTH PARTNERSHIPS!
As always, I welcome
your constructive comments and suggestions about the material
on this website and how we can all be most effective in co-creating
the kind of healthcare system we all want. E-mail me at ideas@ethicalhealthpartnerships.org
© Dawn Lipthrott,
Ethical Health Partnerships, 2004 www.ethicalhealthpartnerships.org
(May be copied and distributed
as long as this identifying information is retained on copies.)
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