As I watched our friends in the Carolinas and the Florida Panhandle battle Hurricane Florence and Hurricane Michael, the parallels between these storms and our national health care problem was overwhelming. The storms had to travel all the way across the Atlantic, hit the perfect spot, then slow down, dump rain, and create enormous havoc. The Perfect Storm.
If I were going to design the worst possible health care analytics department in a health plan, TPA, or benefits consultancy, this is what I would do. First, I would go out and buy all the hardware and software licenses I needed, not to mention the database administrators and IT personnel necessary to support it. Why use the cloud? That's just a trend, right? And what about data security? The cloud can’t be nearly as secure as my data warehouse, right?
There has been so much hysteria about potential changes to the healthcare law that I feel compelled to attempt a level-headed view of things and suggest an idea. There are a lot of moving parts here, but I am going to stick to the pre-existing conditions portion as that one seems to get the most angst or at least the most television news coverage. The acronyms for the ACA and the ACHA are so close, let me simply call them Obamacare and Trumpcare for clarity. I heard Warren Buffett the[...]
I was listening to the news on the radio and heard a commercial from the AARP about proposed repeal and replace changes in the American Health Care Act that will allow health insurers to charge older Americans up to 5 times more than younger Americans for health insurance. The bill is referred to as the State Age Rating Flexibility Act of 2017. In the words of the AARP, this is an unfair age tax. I do not want to misrepresent the position of the AARP, an organization that helps millions[...]
I can still remember being little, losing a tooth and being amazed that a quarter (showing my age) found its' way under my pillow by the time I woke up. Of course, it is only something we believe for a few years before we realize mom or dad funded the quarter. Even reaching that realization and loss of innocence provides great value in that we learned that every benefit had to be funded somehow.
What is the price of offering insurance to folks with pre-existing conditions on the health exchanges and how do we solve the problem without putting in the mandatory insurance requirements under the Affordable Care Act regulations?To understand this you first need to understand that health insurance is simply a reflection of the claims cost plus administration and profit. Next you need to understand the distribution of medical expenses, which can fluctuate with populations, co-pays,[...]
Due to our presence in the Population Health Analytics space, I often get asked about what we should do about the Affordable Care Act ("ACA") and the declining choices at greatly escalating rates. As ACA open enrollment starts this week, I've been thinking a lot about this question, and I think it's timely to consider some solutions today. I look at a lot of data, so a couple of simple observations first. Health insurance isn't that complicated. Add up total claims on a population and[...]
It seems like the more I look at websites in the healthcare IT space, the more confused I get. I don't know how many times I have read a website and come away thinking "Okay. Sounds impressive, but what do you actually do?" In fact, I have gotten away from using the generic term “analytics”, because it can mean almost anything and therefore means nothing. I like the term "rules engine", but even that can be confusing at times. I am sure many people think that if you've seen one, you've seen[...]
One of the fun things about being in the healthcare analytics business is getting the chance to look at de-identified data from all over the country to see some of the things that tend to drive medical costs. The key to having any meaningful analysis is to take the thousands of diagnostic and procedure codes and organize those codes into a small enough set of groupers that allows for a meaningful analysis. We have over 6000 healthcare rules in our rules engine and none are more important[...]