Consumer Directed Health Plan Survey

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Costs Hold Steady

[By Staff Reporters]

ho-journalAccording to Tracey Walker, Senior Editor of Healthcare Executive News on March 13, 2009, US employers expect healthcare cost increases to hold steady at 6%. Additionally, more plan to adopt consumer-directed health plans [CDHPs] in 2010, in an effort to control health cost increases.

Watson Wyatt – National Business Group Survey on Health

And, a survey by Watson Wyatt and the National Business Group on Health, found that:

  • Approximately half of companies now offer workers a CDHP, up from 47% in 2008, and another 8% are expected to adopt a CDHP by 2010.
  • CDHPs are helping employers control costs—companies with at least half of their workers enrolled in a CDHP have a two-year cost trend (4.6%) that is 25% lower than non-CDHP sponsors (6.1%).
  • Two-thirds of employers (67%) cite the poor health habits of their employees as a considerable challenge to managing their health costs.
  • While companies will be taking a close look at benefit offerings because of the recession, most do not plan major changes.
  • Nearly 30% of employers have revamped their healthcare strategy with another 30% planning to do so in 2009.

Assessment

The growth in CD-HPs has made it more important than ever for health plans to provide their members actionable information and pricing transparency to navigate the healthcare system. According to Dr. David Edward Marcinko;

“Members like our firm – and many others – are incented to be savvy consumers, but that’s a difficult task if not provided with the pricing and related information we need to make wise choices. And, to make matters even worse for lay patients; providers and hospitals are not often keen to supply information about same.”

But, there is some hope according to Hope Rachel Hetico; RN, MHA, CMP™ of www.MedicalBusinessAdvisors.com

“The overall transparency milieu today has definitely improved this last decade as we have participated in CDHPs for all our employees.” 

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Conclusion

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WellCare Medicare-Advantage Scandal

Company “Misled and Confused Medicare Beneficiaries”?

By Dr. David Edward Marcinko; FACFAS, MBA, CMP™dr-david-marcinko20

According to Jacob Goldstein, of the WSJ, on February 20, 2009, WellCare the publicly traded company that some folks “love-to-hate”, and manages health coverage for Medicare and Medicaid beneficiaries, is in trouble again. In a recent letter, the Feds ordered the company to stop enrolling new Medicare beneficiaries, effective March 7, 2009. The sanction will be in effect until the Centers for Medicare and Medicaid Services [CMS] is satisfied that the company has corrected the alleged deficiencies.

Letter from the Feds

Adjusted for enrollment, the rate of complaints about WellCare’s marketing of Medicare Advantage plans are three times the national average, the letter says. The letter goes on to allege that the company “misled and confused Medicare beneficiaries” and “engaged in unauthorized door-to-door solicitation.” CMS also accuses WellCare’s agents of “misleading beneficiaries and misrepresenting WellCare plans at sales events in December 2008″ and failing to “discover forged applications through its own monitoring systems.” Of course, the company said it would continue to work with independent third-parties to ensure that it is compliant with CMS.

Click here to read the letter.

Oh Regina – Say it Ain’t So!

Finally, and perhaps the most personally distasteful for me in this whole sordid affair is not the fact that WellCare allegedly tried to rip off old folks. It’s just that Dr. Regina Herzlinger, the Harvard Business School professor – mother of a physician herself and proponent of healthcare competition and Consumer Directed Health Care Plans [CDHCPs] and a WellCare BOD member – apparently sold $2.3 million worth of stock in Wellcare three months before the FBI arrived.

Assessmentbiz-book5

 I first became aware of Regina Herzlinger’s work while in business school [not HBS] in the early 1990s. I recall calling her office for advice and referencing her several times in both editions of my best-selling book, the Business of Medical Practice [Profit Maximizing Techniques for Savvy Doctors]. She even came to Piedmont Hospital, here in Atlanta, last year on a healthcare speaking tour promoted in the local newspapers. What a shame. All co-incidence; ask Regina? Link: www.MedicalBusinessAdvisors.com

Industry Indignation Index: 35

Full disclosure: I am the founder of www.CertifiedMedicalPlanner.com and a reformed insurance agent, registered investment advisor and Certified Financial Planner™

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Do you think WellCare “Misled and Confused Medicare Beneficiaries?” You may opine and decide.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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