Wednesday, July 18, 2012

Republicans and ineffective medicine: The saga continues

The love affair between Republicans and ineffective medicine grows ever more torrid.  Last week it was seeking to undermine the US Preventative Services Task Force, this week it's eliminating health services research.

These attacks on effectiveness research are bizarre.  Republicans claim to support market solutions to health care, but one of the biggest obstacles to that is that people have no idea what they are buying.  Are they buying a Cadillac treatment that delivers 100% satisfaction with no side effects or a 1979 Pinto that will blow up in their face?  When people can't tell the difference between shit and shinola there is no market and you can't have market solutions.   If Republicans are in any way serious about markets they should be advocating for more effectiveness research, not less.

So what explains the attraction?  Why do Republicans seek to protect treatment that doesn't work, like widespread PSA screening?  It's almost like they're afraid of the paradigm of using evidence to guide decisions.  Probably because in the real world so much evidence goes against them...

Thursday, July 12, 2012

Providence Rate Filing

I'm normally sympathetic to insurers, but something about this filing rubs me wrong.  Maybe it's because someone thought it was important that everyone know that we're paying an extra 1.1% for women's preventative health services through the ACA, so important that they included it as a line item in the summary.

Or maybe it's because of this:

Instead of estimating an annual factor and blowing it out over 23 months I'm looking at the actual 23 month changes.  I'm comparing that to Providence's selected 7.2% annual factor, which compounds out to 14.3%.  Even against the worst point in 2011 the factor used in the proposed rates is almost double.  Putting it in comparative terms,

Monday, July 9, 2012

Why CCO's may not fail like HMO's

In response to @ChargerJeff, who asked why CCO's would fare any better than HMO's:

HMO's did succeed at cost control, which is a primary purpose of CCO's.  Where HMO's failed was in working cooperatively with doctors and patients, CCO's if they are to last will have to do better.

Reasons to think they will:
  • We already have managed care, particularly in OHP.  The distance between where we are and where CCO's are going is shorter than the distance between indemnity plans and HMO's.
  • The distance between doctor patient interactions and financial authority is shorter, you're less likely to see the kinds of coverage conflicts for which HMO's were notorious. 
  • There is more cost awareness among providers now than there used to be.  Concepts like variation and evidence-based medicine are gaining growing acceptance, even if they are not entirely mainstream.
  • Maybe most important, providers have no choice.  CCO's are an attempt to control costs by empowering providers, if they fail the alternative is to control costs by disempowering providers and stripping them of authority over treatment.  Think about the ER restrictions that Washington considered (and that for-profit hospitals have implemented), or more direct interventions in provider pricing.

None of this is to say that CCO's are a sure thing, there's a reason the feds made their funding contingent on results.  But the cost of trying in my view is much smaller than the cost of doing nothing and hoping that a 40 year history of medical inflation will somehow reverse on its own.