Posts Tagged ‘health insurance’

Government Can’t Fix Healthcare

Why is the government so bad at healthcare? Why did Obamacare make it more expensive than it already was? Is there a solution? Former Member of Congress Bob McEwen explains.
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Script:

Why is the government so bad at healthcare? They’ve been at it for seventy-five years and still can’t get it right. It’s expensive. Access is spotty. It’s mired in bureaucracy. And it’s fraught with waste.
Obamacare was supposed to fix all this, but instead, like every other government healthcare program before it, it just made things worse.

Why?

Because the government is a third-party payer.

Let me explain.

Suppose you are going to buy something for yourself. You have two priorities: price and quality. You want the highest quality for the lowest possible price.

Say you’re buying a television. You have many options: the size of the screen, the quality of the image, the price. Only you know which one best suits your needs and your budget. And a lot of companies are competing for your business. You do your research; you make your choice.

This is called a first-party purchase – the person paying is the person using.

Now, let’s suppose that either the price or quality is not controlled by you; in this case, you are buying something for someone else. You care about the price because you are paying for it, but you are a little more flexible on the quality. A good example would be a wedding gift – say, a coffee maker.

You might think, by the time it breaks they’ll forget who gave it to them anyway…the cheaper one will be fine.

All of us have bought things for others we never would have bought for ourselves. We care about the price because we’re paying for it, but not so much about the quality because we’re not going to use it.

Or, suppose that we’re going to use something, but we’re not going to pay for it. Then we’re concerned about the quality because we’re consuming it, but the cost is not as important because we’re not paying for it. Any father who ever got roped into paying for an open bar at a wedding understands this program. Nobody ever orders the cheap stuff when it’s free.

These are called second-party purchases. The person paying is not the person using.

And now, for the coup de grace: when it is not your money paying for something, AND you don’t use it. Then you’re not concerned about either the price or the quality.

Suppose the boss gives you $150 to buy a door prize for the office party. In a store window, you see a six-foot tall stuffed frog marked $149.00 You think, Oh, that’s perfect – let’s buy it. The raffle winner is awarded the six-foot frog. Everyone laughs at the gag.

Now, this is called a third-party purchase – a purchase that is made with money that is not yours (therefore you don’t care about the cost) to buy something you’re not going to consume (therefore you don’t care about the quality).

Here’s the point: By definition, all government purchases are third-party purchases. The government spends other people’s money on things it won’t consume. It doesn’t care about the price or the quality. Thus, there will always be waste in government spending.

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Be the first to comment - What do you think?  Posted by admin - January 6, 2019 at 3:20 am

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US Healthcare System Explained

Ever wondered how the healthcare system in the USA worked? We explain everything in this video!

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Be the first to comment - What do you think?  Posted by admin - December 23, 2018 at 3:20 am

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The real reason American health care is so expensive

Hint: single-payer won’t fix America’s health care spending.

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Americans don’t drive up the price by consuming more health care. They don’t visit the doctor more than other developed countries:
http://international.commonwealthfund.org/stats/annual_physician_visits/

But the price we pay for that visit – for a procedure – it costs way more:
http://static1.squarespace.com/static/518a3cfee4b0a77d03a62c98/t/57d3ca9529687f1a257e9e26/1473497751062/2015+Comparative+Price+Report+09.09.16.pdf

The price you pay for the same procedure, at the same hospital, may vary enormously depending on what kind of health insurance you have in the US.

That’s because of bargaining power. Government programs, like Medicare and Medicaid, can ask for a lower price from health service providers because they have the numbers: the hospital has to comply or else risk losing the business of millions of Americans.

There are dozens of private health insurance providers in the United States and they each need to bargain for prices with hospitals and doctors. The numbers of people private insurances represent are much less than the government programs. That means a higher price when you go to the doctor or fill a prescription.

Uninsured individuals have the least bargaining power. Without any insurance, you will pay the highest price.

For more health care policy content, check out The Impact, a podcast about the human consequences of policy-making.
https://itunes.apple.com/us/podcast/the-impact/id1294325824?mt=2

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Be the first to comment - What do you think?  Posted by admin - November 4, 2018 at 3:20 am

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The Economics of Healthcare: Crash Course Econ #29

Why is health care so expensive? Once again, there are a lot of factors in play. Jacob and Adriene look at the many reasons that health care in the US is so expensive, and what exactly we get for all that money. Spoiler alert: countries that spend less and get better results are not that uncommon.

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Be the first to comment - What do you think?  Posted by admin - October 31, 2018 at 3:21 am

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Early Retirement Preparing – Information Relating to Coverage

Early Retirement Preparing – Information Relating to Coverage

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There are numerous matters to be contemplating when you want to plan a future for the time when you will be retiring thus, you must be contemplating your options ahead of time so that you preserve time and revenue by creating a decision the moment and for all. As a result, you must star contemplating no matter whether you will will need insurance designs in your retirement thoughts. Also, this matters relies upon on the age that you have in the present and the age you will be getting when you will be retired. As a result, based on your age, you could or not be eligible in the Medicaid, which will depart you a little bit in the open due to the fact you will will need to address you then and you must keep health insurance afterwards.

Also, if the partner will intend to perform for quite a few additional yrs right after you, then you must incorporate you to his coverage for the health insurance. You will spend more compact quantities of revenue if you regulate to do so and then, you will be to preserve further revenue due to the fact you will not will need to be spending for quality insurance or other expenses that occur with particular person health insurance.

The address for the dental insurance is also a different crucial detail you will need to have included even right after you will retire. The quality for dental insurances could impede you from obtaining just one and then, the costs can come to be too high for you to find the money for them. The detail to do would be to have a look for on-line for all the aspects related with this and evaluate no matter whether it is worth in your situation to go for an particular person insurance or…

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Be the first to comment - What do you think?  Posted by admin - December 19, 2017 at 9:37 pm

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How Small Term Health care Insurance coverage Can Assistance You

How Small Term Health care Insurance coverage Can Assistance You

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Keeping shorter expression overall health insurance plan is genuinely a superb way of sustaining the overall health insurance plan needed especially when an person is in the stage &#39tween traces of get the job done. To make clear, when an individual exits his line of get the job done, he also pieces from the professional medical insurance plan that is entitled to him considering that he would not very own a further overall health insurance plan right until this kind of time she finds a distinct position. This type of insurance plan is certainly synonymous to standard overall health insurance plan apart from the prospect the guidelines are much less costly. This type of professional medical insurance plan is fantastic for individuals who can acquire shorter-expression insurances when they are at their earlier phases of self employment. Fresh school graduates may perhaps also choose reward of this form of professional medical protection as they will probably maintain their whole time line of get the job done soon.

A outstanding benefit of a non permanent protection is the amount or inexpensiveness in equivalence to a normal overall health insurance plan. Aside from a incredibly lower-priced price tag, it even so caters superb protection. Occidentally, it expenses only half as much as the prevalent insurance plan guidelines and this kind of shorter expression insurance plan guidelines are proffered by numerous insurance plan providers which also source the traditionalistic programs.

Momentary protection instantly renders insurance plan protection and pre-current situations normally do not have any problems apart from for an exception of a specific affliction. Most of the time, non permanent insurance plan does not insure being pregnant or childbirth and this sort of insurance plan…

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Be the first to comment - What do you think?  Posted by admin - December 16, 2017 at 8:06 pm

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Collective Health Introduces a New Model for Employer Health Insurance | Business Wire

Collective Health Introduces a New Model for Employer Health Insurance | Business Wire

SAN MATEO, Calif.–(BUSINESS WIRE)–Launching today, Collective Health introduces a new solution for

employer-sponsored health insurance. Collective Health provides

companies with a simple solution to sponsor health care on their terms

by extending the benefits of self-insurance to companies of all sizes,

without the complexity or expense that is traditionally associated with

the self-insurance process. The company has raised a series A venture

investment led by Founders Fund with participation from Formation 8, the

Social+Capital Partnership, and prominent angel investors including

Scott Banister, Max Levchin, Jeremy Stoppelman and Amr Awadallah.

Health care spending, and health insurance premiums in particular, are

increasing at an unsustainable rate, with spending on health care

growing twice as fast as overall GDP1. With over ninety

percent of private health insurance paid for by employers, companies

have borne the brunt of these increasing costs and have until now been

held hostage to rapid and unpredictable increases in traditional health

insurance premiums2. Collective Health was created to offer

companies a better way to control and manage health care costs, while

offering superior health coverage uniquely tailored to the needs of

American workers.

“While insurance is supposed to be a risk-sharing business, health

insurance has increasingly become a middleman business ­ devised to

generate profit for the health insurers above all else. As a result,

there is a fundamental disconnect between the incentives of traditional

health insurance companies and people’s and organizations’ health

insurance needs,” said Ali Diab, co­founder and CEO of Collective

Health. “At Collective Health we have created a complete replacement for

employer-sponsored health insurance: a replacement that is focused on

people’s and organizations’ health and happiness, not on health insurer

profits.”

Collective Health’s cloud-based self-insurance platform extends the

benefits of self-insurance to businesses of all sizes, bringing

technological innovation and efficiency to an industry infamous for its

opaque business practices, antiquated technology and processes, and

unpredictable price increases. Additionally, Collective Health’s

solution is underscored by a user experience that is built from the

ground up for the people it was designed to serve – employees and their

dependents.

Delivered as a software-as-a-service (SaaS) solution with a flat-fee

pricing structure, Collective Health provides employers of all sizes

with a fully integrated health self-insurance platform – including

actuarial analysis, customized health plan design, legal and regulatory

compliance, plan funding, claims administration, health provider network

access and real­time data analytics – all in one seamless package.

Self-insurance provides true transparency into the real costs of health

care and substantial financial savings and cost control compared to

traditional health insurance, as evidence by the ninety-four percent of

large US employers that self-insure their employee health plans today3.

Yet, until today, self-insurance has not been a viable option for most

businesses due to the complexity and high fixed costs associated with

establishing a self-insured employer-sponsored health plan. Collective

Health makes self-insurance easier than buying a fully-insured health

plan, giving employers a clear path toward health insurance independence.

Through Collective Health, employers and employees have access to a

single, unified platform to view and manage their health care activities

and costs, direct access to real-time customer service, and health plan

features and descriptions that are presented in clear, unambiguous

language. Collective Health self-insured plans are optimized by

employers to meet the unique needs of their employees and can be

integrated with popular perks such as telemedicine, nutrition programs,

gym memberships, free rides to doctors’ appointments and more.

“Fundamental reform is long overdue in the health insurance industry,”

said Scott Nolan, Partner at Founders Fund. “Collective Health is

challenging the status quo of the entire private health insurance

industry, using technology to dramatically bring down costs for

employers of all sizes while providing higher quality care to employees

and their dependents.”

Collective Health was founded in late 2013 by Ali Diab, previously Vice

President of Product Management and Business Operations at AdMob,

acquired by Google in 2010, and by Dr. Rajaie Batniji, a physician and

political economist on faculty at Stanford University. The company is

headquartered in San Mateo, California. Collective Health is currently

enrolling companies for a January 1, 2015, health plan coverage start

date. For more information, please visit collectivehealth.com.

1 National Health Expenditure Projections 2010-2020, Centers

for Medicare & Medicaid

2 2013 Employer Health Benefits Survey, Kaiser Family

Foundation

3 2013 Employer Health Benefits Survey, Kaiser Family

Foundation

Be the first to comment - What do you think?  Posted by admin - December 5, 2017 at 10:27 am

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Factors To Consider When Deciding Between HMO And PPO Health Care Plans

Factors To Consider When Deciding Between HMO And PPO Health Care Plans

Faced with ever-increasing medical costs, selecting the best health plan for you and your family requires informed decision-making on your part. There are two basic forms of employer sponsored health care plans: HMO & PPO. Both of them have distinct advantages and disadvantages that you must be aware of in order to be able to make the best decision possible.

Families without a health plan receive far less preventative health care and very often, they are not diagnosed with a disease until it reaches later, less treatable stages. Compounding the problem, individuals without a health insurance plan, even after diagnosis, receive less treatment. Studies have shown that approximately 18,000 people die each year from inadequate medical care. Studies also show that individuals without a health care plan are hospitalized 30-50% more often for avoidable conditions. With an average emergency room visit costing $3,300, the investment in a health insurance is clearly worthwhile.

Managed Health Care Benefits

Managed health care plans reduce medical costs to enrollees, allowing them to receive medical care that they might not otherwise be able to afford without a medical plan. Health insurance companies develop contracts with health care providers, promising to provide specific doctors and hospitals with more business through their health insurance. In return, doctors and hospitals agree to provide those services at a lower cost.

HMOs and PPOs are both managed health care plans that reduce the cost of medical treatment by combining contributions of enrollees and gaining the benefits of scale. There are other medical plan mechanisms put into place to reduce medical costs by encouraging such incentives as preventative care, enforcing limitations to coverage and increased beneficiary cost sharing. Each health care plan has advantages and disadvantages that must be considered. There are significant price, service, and flexibility differences between these two types of medical plans. Whichever medical plan you select, you will be able to receive more medical care for far less money than if you had no insurance at all.

HMOs Are An Inexpensive Option

HMOs, or Health Maintenance Organizations, are health plans characterized as cooperatives of doctors, hospitals, and other medical providers. HMOs such as Kaiser Permanente and Aetna are your least expensive and most restrictive health care plan. Under HMO policies, health insurance providers have agreed to provide their services at fixed prices and copayments are generally very low. Since health care providers receive less money for their services, they tend to see as many patients as possible.

There are many rules covering HMO medical plan services, the most important one being the requirement that your physician be a member of the HMO. If you need to see a specialist, you must see your primary physician for a referral. HMOs focus primarily upon preventative health care services such as immunizations and physicals. HMO doctors are paid on a per office visit basis.

PPOs Cost More And Provide More

PPOs, or Preferred Provider Organizations, are health care plans that have contracts with insurance companies to reduce medical expenses to enrollees. PPOs like Blue Cross Blue Shield are more expensive than HMOs, but you have much more freedom about who you see. Referrals are not needed to see a specialist, but your medical plan will require that you pay more to see a doctor that is not a member of the PPO medical plan.

Enrolling in a PPO provides you with more control over your health care plan as well as greater autonomy. Unlike HMOs, emergency room visits are generally covered under PPO medical plans. PPO doctors are paid on a retainer basis, thereby providing them with no incentive to unnecessarily prolong treatment.

One aspect of a managed health care plan is that treatments are reviewed by the insurer. In some cases, this can eliminate unnecessary procedures and overcharging, thereby saving both the insurer and enrollees’ time and money. Whichever coverage you select, you will provide your family with access to the benefits of regular, preventative care and early diagnosis of more serious conditions, increasing the likelihood of recovery. Eat right, stay fit, and enroll in a health care plan!

Be the first to comment - What do you think?  Posted by admin - at 4:21 am

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eHealth Appoints Ian Kalin as the Company’s Chief Data Officer | Business Wire

eHealth Appoints Ian Kalin as the Company’s Chief Data Officer | Business Wire

MOUNTAIN VIEW, Calif.–(BUSINESS WIRE)–eHealth, Inc. (NASDAQ: EHTH), announced today that Ian Kalin has joined

the organization in the role of chief data officer. Mr. Kalin brings

more than 15 years of experience modernizing highly complex, regulated

systems in the private and public sectors. Prior to eHealth, Mr. Kalin

was the first chief data officer for the U.S. Department of Commerce.

eHealth operates eHealth.com, the nation’s first and largest private

online health insurance exchange.

In his role, Mr. Kalin assumes leadership of all data operations for

eHealth, including unlocking new applications for eHealth’s data assets

and empowering customers with the information they need to navigate

important healthcare decisions.

“I’m very pleased to announce Ian’s appointment as chief data officer, a

role well served by his extraordinary record of data-driven

innovations,” said Scott Flanders, CEO of eHealth. “Ian’s leadership and

experience build on eHealth’s rich history of being a trusted provider

of health insurance information and discovering new ways to empower our

customers.”

As chief data officer, Mr. Kalin’s role is cross-functional and

enterprise-wide. In addition to leveraging business intelligence to

improve operations and optimize products, he oversees research into the

development of new data services to revolutionize the health care

industry. Mr. Kalin also manages the creation of a new data science

practice designed to equip eHealth’s industry-leading health insurance

specialists with today’s most powerful digital technologies. eHealth

job opportunities are posted now for this new data science team. Mr.

Kalin brings his experience working in heavily regulated data

environments to all these initiatives.

“I believe eHealth’s immense data resources can be used to create new,

innovative tools and efficiencies for consumers,” said Mr.

Kalin. “eHealth.com is an amazing, vast marketplace full of insurance

products with more than 15 years of data that we can use to help people

take control of their health care.”

A seasoned data tactician, Mr. Kalin comes to eHealth with a wealth of

experience from both the private and public sectors. As the U.S.

Department of Commerce’s first chief data officer he oversaw data

strategy and pioneered new products that transformed the way government

agencies accomplish their missions. As a former Presidential Innovation

Fellow, Mr. Kalin led the U.S. Energy Data Initiative, leveraging open

data to spur entrepreneurship, empower citizens and support economic

growth. He also acted as a consultant to Google and had leadership roles

in data and clean-tech start-ups. Mr. Kalin began his career in the U.S.

Navy, where he served as a counter-terrorism officer and a nuclear

engineer.

Mr. Kalin holds a bachelor’s degree in international politics from

Georgetown University and a master’s degree in engineering management

from Old Dominion University. He was also awarded the Robert Seamans

Fellowship from Harvard Kennedy School for leadership in technology and

public policy.

eHealth

eHealth, Inc. (NASDAQ: EHTH) owns eHealth.com, a

leading private online health insurance exchange where individuals,

families and small businesses can compare health insurance products from

leading insurers side by side and purchase and enroll in coverage

online. eHealth offers thousands of individual, family and small

business health plans underwritten by many of the nation’s leading

health insurance companies. eHealth (through its subsidiaries) is

licensed to sell health insurance in all 50 states and the District

of Columbia. eHealth also offers educational resources and powerful

online and pharmacy-based tools to help Medicare beneficiaries

navigate Medicare health insurance options, choose the right plan and

enroll in select plans online through Medicare.com (www.Medicare.com),

eHealthMedicare.com (www.eHealthMedicare.com)

and PlanPrescriber.com (www.PlanPrescriber.com).

Be the first to comment - What do you think?  Posted by admin - December 4, 2017 at 11:13 pm

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Clarabridge Transforms the Member Experience for Health Insurance Companies through New Customer Experience Management Solution | Business Wire

Clarabridge Transforms the Member Experience for Health Insurance Companies through New Customer Experience Management Solution | Business Wire

RESTON, Va.–(BUSINESS WIRE)–Clarabridge,

Inc., the leading provider of Customer

Experience Management (CEM) solutions for the world’s top brands,

today announced the first-ever full-service solution built specifically

for health insurance companies that will transform the way insurers

manage and improve their member experience. Clarabridge’s health

insurance solution—designed for rapid deployment and immediate

results—empowers insurers to listen to and convert the mountains of

feedback members are sharing across various channels into actionable

insights that increase member satisfaction and lead to dramatic

cost-savings.

As enrollees continue to demand affordable, consumer-directed plans,

health insurance companies need to prioritize the member experience more

than ever before in order to thrive in this new era of consumer-focused

healthcare. For years, Clarabridge has helped its healthcare customers––UnitedHealth

Group, Blue

Cross Blue Shield of Michigan and Health

Care Service Corporation—enhance the member journey, resulting in

long-term benefits, including: lower churn rates, improved STAR ratings

and higher Net

Promoter Score (NPS).

Drawing from these experiences, Clarabridge has built the most

comprehensive industry-standard solution that provides insurers with the

tools to gain a complete understanding of member behavior and

satisfaction drivers. New features include:

  • More relevant, effective data: Connecting data from common

    sources of member feedback in the health insurance industry––grievance

    and appeals files, call recordings, social media, CAHPS survey data,

    ratings and reviews websites, etc.––enables insurers to capture what

    members are saying about their company across channels and identify

    frequently asked questions about specific interactions like billing

    and fees, so they can implement business initiatives that resolve

    those issues.

  • Faster insight discovery: New out-of-the-box healthcare

    category models—such as Insurance, Prescriptions and Medications, Call

    Center, Claims Experience and Provider models—automatically organize

    member feedback and detect fraud.

  • Enhanced sentiment listening: Understanding sentiment for

    common topics ensures providers easily uncover friction points across

    the member journey in order to more efficiently recognize how they

    should handle those processes like enrollment, claims and support to

    improve the member experience.

  • Interactive insight dashboards: Drill down from an executive

    view into specific lines of business and analyze member feedback down

    to an individual’s response. Segment data by attributes such as

    contract or policy number, plan type or location, so executives can

    identify the needs and healthcare concerns of specific demographics to

    help future enrollees with plan selection and education.

  • Improving call center optimization: Best-in-class

    speech-to-text translation capabilities evaluate contact center

    interactions, allowing executives to identify and fix the root cause

    of expensive cases through better self-service options and agent

    training, which reduces the volume and cost of member support.

  • Competitor benchmarking: Unprecedented ability for users to

    identify key trends and data metrics of their member journey and

    compare against those of their competitors, guaranteeing that

    insurers’ customer experience investments result in profits.

“The health insurance industry is rapidly evolving, and member demands

are ever-changing. Insurers now need to engage and attract

digitally-savvy enrollees across a variety of channels, while keeping

cost of service down,” said Julie Miller, VP of Product Marketing at

Clarabridge. “Clarabridge offers an all-inclusive solution for health

insurance companies that enables insurers to understand the member’s

voice and deliver a quality member experience across all touchpoints

affordably.”

“Clarabridge has been a great partner for us, helping us reduce member

pain points and ease friction across the member journey. The value that

Clarabridge brings to our customer experience program through text and

sentiment analyses really makes their solution an essential tool for

us,” said Paul Long, VP of Enterprise Customer Experience Strategy at

UnitedHealth Group.

Insurers can implement Clarabridge’s health insurance solution

themselves, or Clarabridge can provide CEM consulting experts with

health insurance knowledge to assist. For more information on

Clarabridge’s complete and cohesive solution for health insurance

companies and other industries, visit http://www.clarabridge.com/customers/industries/.

About Clarabridge

Clarabridge’s SaaS customer experience management solution helps

hundreds of the world’s leading brands put customer feedback to work.

Offering the most comprehensive solution for omni-source listening,

accurate customer and text analytics, and real-time, guided action is

why leading brands trust Clarabridge to power their CX programs and

drive a customer focused strategy. The result: better customer

experiences. For more information, visit www.clarabridge.com.

Be the first to comment - What do you think?  Posted by admin - November 29, 2017 at 12:28 pm

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