Donuts, Diabetes and Dialysis — Doing More With Less

December 15, 2010 Doug

This week we’ve chosen to share some extracts from James Calver’s talk in the UK, “Doing More with Less” — improving care and lowering costs. His comments reflect new developments in US health care that address some of the challenges faced both sides of the Atlantic. Too many donuts (and not enough disease prevention) are driving extraordinary current and future costs of care. New inexpensive monitoring tools and regimen adherence help diabetics and new developments in dialysis lower costs and improve patient care and experience. He illustrates with two related debilitating diseases, diabetes and renal failure and, more often than not, the cause, avoidable lifestyle factors.

By James Calver http://allexian.com/home

It is common knowledge that health care costs are increasing at a staggering rate in the US. Today, our health care expenses are nearly $3 trillion annually, 16% of GDP and projected to grow to 25% of GDP in the years ahead. The average family’s care costs $11,500 and this number has doubled in 5 years.

The increase in costs is driven by supply and demand factors. On the supply side, by 2020 we will have 40,000 fewer physicians. Medical technology costs outpace inflation nearly 5:1 and prescription drug spend on hypertension alone is $25 billion, a number that has doubled in ten years. On the demand side, 70% of our diseases are chronic and mostly lifestyle induced — too many donuts. Adding to the expanding waistline of health care expense is an aging population.

Several notable academics have written about the problem and the solution. Professor Clay Christensen from Harvard Business School; the originator of the term ‘disruptive technology’, writes in his new book. “…by transforming care delivery from integrated, centralized delivery points utilizing high cost interventions supported by highly skilled professionals to more disintegrated, de-centralized points leveraging lower cost interventions and supported by lower skilled professionals.” This means simply doing more with less in new, non-traditional ways and locations.

One of these new, non-traditional ways is more preventative care — 72% of chronic disease is preventable. Emergency room costs are some 80-100 times that of a wellness exam. Others include, personalized medicine tailored to the individuals needs and genome. Home care is cheaper and a better patient experience in many cases. New, lower cost treatments like Medco’s diabetic therapy management and education service. Levering inexpensive labor and technology can reduce costs dramatically.

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A Guide Through a Medical Wilderness

August 10, 2009October 16, 2009 Doug

As the government churns through health care reform, the media has realized that consumers can negotiate their health care with doctors and hospitals. The article indicates that it is best to choose an advocate with a successful track record in health care cost reduction. Medical Cost Advocate is a leader in health care cost reduction through expert negotiation.

New York Times

By WALECIA KONRAD

THESE days, dealing with medical bills and insurance claims makes April 15 look easy. The medical jargon and inscrutable coding on invoices and explanations of benefits are indecipherable for most lay people. Worse, seriously ill patients may simply be too sick or too broke to deal with the mountains of red tape. That can lead to unpaid medical debts and even bankruptcy.

It’s no wonder that a cottage industry has sprung up to fill this void. Known as medical billing advocates, these middlemen and women help patients deal with the paperwork and haggling often associated with medical costs.

In general, medical billing advocates help you find errors in your bills, negotiate with your insurer to appeal coverage denials, or negotiate lower fees with your medical care providers. Some advocates do all three tasks equally well. But others, because of their training or background, may specialize in one area or another.

Still others give the client the ammunition he or she needs to negotiate. That’s what happened to Susan Redstone, a freelance fashion stylist and author. When she broke her back in a horseback riding accident last summer, she held only a bare-bones insurance policy. So Ms. Redstone, who has since recovered, knew that she would be responsible for the bulk of her medical expenses.

Five months after the accident, just when she thought she had paid everything off, she got a bill for $16,000 from the helicopter ambulance service that ferried her from the remote location in Colorado where the accident occurred to a large medical facility 75 miles away. “I was completely taken by surprise to get this bill so long after the accident happened,” Ms. Redstone said. She consulted with Victoria Caras, a medical advocate in Aspen, Colo., who coached her on how best to approach the medical transportation company to lower her bill. With Ms. Caras’s advice, Ms. Redstone was able to negotiate a 25 percent discount in exchange for paying the bill in full. (more…)

Healing U.S. Health Care

January 22, 2009February 18, 2009 Doug

Health care reform is expected to be a top agenda item for the incoming Obama administration.

Author:	Toni Johnson

Health experts agree the U.S. health care system needs an overhaul, as a way of shoring up the economy and U.S. competitiveness. But a battle is brewing over the president-elect’s designs for a public-sponsored insurance plan. Check out this article by Council of Foreign Relations Staff Writer, Toni Johnson

With the onset of the global economic crisis, some experts feared health reform would be knocked off the incoming administration’s agenda, but instead interest has intensified. “Many people say the government cannot afford a big investment in health care,” writes Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology. “But this represents a false choice, because health care reform is good for our economy.” (NYT) President-elect Barack Obama agrees, noting in early December that health care “is part of the emergency,” and health care reform has to be woven into the overall economic recovery plan (Atlanta Journal-Constitution). The stimulus proposal currently being discussed includes government aid for health care (NYTimes) costs to employers, workers, and states.

Health care reform discussions focus largely on improving access and lowering costs. Obama’s health care plan would create a public-sponsored insurance plan similar to the one provided by the government to members of Congress. It targets individual buyers and small businesses, two segments that have had trouble affording private insurance. Nearly 16 percent of the U.S. population has no health coverage. Insurance companies have balked at the public insurance plan, saying it would underpay doctors like other government health plans and shift costs to private insurers (NYT). Instead, the insurance industry wants the government to mandate that everyone must have health insurance in exchange for a pledge not to refuse coverage regardless of health status. Obama’s plan would mandate the industry cover everyone without requiring that everyone obtain insurance. That could allow some people to wait until they are sick before buying, the industry argues.

The value of rationalizing the U.S. health care sector has been accepted for some time as an important step in keeping U.S. industry competitive, as this Backgrounder explains. C. Fred Bergsten, director of the Peterson Institute for International Economics, and Raymond C. Offenheiser, president of the charity Oxfam America, say universal health care can provide U.S. workers with a safety net against the impact of trade deals (Miami Herald). Princeton economist Ewe Rheinhardt says the health care sector will soon be the largest in the U.S. economy, making it a good taxpayer investment (NPR). He and others say that past efforts to pump federal stimulus money into public works projects – dams, roads, bridges – often wound up missing the crisis, as the projects (and stimulus) get caught up in local planning and bidding battles. But shifting to health care investment, writes BusinessWeek columnist Chris Farrell, feeds a sector of the economy already growing, and would relieve a major source of economic insecurity “for anyone handed a pink slip during the recession.”

A November 2008 Kaiser Foundation report notes that access to employer-sponsored health insurance has been on the decline (PDF) among low-income workers. Meanwhile, the fiscal crisis is reducing the number of people who can pay (BusinessWeek) their doctor’s bills and insurance premiums. Even if the widely acknowledged systemic problems are left aside, these problems will worsen during a recession. The situation could push more people into government health care programs such as Medicaid. President-elect Obama’s economic stimulus proposal would allow laid-off workers without insurance to apply for Medicad for the first time. The Democratic victory in November has ignited a debate to what extent U.S. health care will become a government-run program. Pete DuPont, a billionaire former Republican presidential hopeful, warns of a coming “Europeanizing” of American health care (WSJ). But analysts suggest the European-style “single-payer” system is now virtually off the table (LAT).

Obama’s health plan hopes to tackle rising costs by allowing importation of cheap medicines from developed countries and increase access to new generic drugs as a means to lower costs. This would cut into drug company profits, however, and will be certain to meet opposition. And as this CFR Backgrounder points out, some experts also worry importing more drugs from other countries will challenge the already taxed Food and Drug Administration, the agency charged with drug safety. Expanding the number of people covered also presents another challenge: The United States has a shortage of doctors (NYT) and other medical professionals.