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2010 Potpourri XXXIII

By September 11, 2010Commentary

The KLAS research firm has issued a report examining the overall costs of implementing an EHR; not just the purchase, but the ongoing maintenance and upgrades.   KLAS looked at the experience of 146 organizations in general and with specific vendors.  Many purchasers experienced significant problems in getting full value from their systems and were concerned about cost overruns and practice flow interruptions.   (KLAS Report)

Mercer is the latest employee benefits consultant to release a survey relating to employer expectations about 2011 health costs.   (Mercer Survey) Mercer’s survey focused on whether employers will allow their grandfathered status to lapse and what measures they will take to keep health cost increases at an acceptable level.  Most employers are willing to lose grandfathered status because they want to shift more cost to employees and will end up in a better position if they do so.  Employers anticipate about a 10% increase in 2011 without taking cost-shifting steps.  Those steps will reduce the increase to about 6%.   In addition to cost-shifting, most firms say they are relying on wellness and care management programs to help limit the increases.  Generally more bad news for workers as they shoulder even more of their insurance costs.

One of the misleading attributes about the “uninsured” problem is that many of these people actually have access to insurance but chose not to enroll.  Medicaid is the prime example, in which millions of persons are eligible but don’t sign up, even though the program is basically free.  Health Affairs has a brief article by Secretary Sibelius in which she estimates that there are five million children eligible for Medicaid but not enrolled.  Sibelius paints this as mainly an issue of ignorance of eligibility.  The likelihood is that many of the parents of these children just don’t care.   In any event, if they were all enrolled, Medicaid costs at the state and federal level would be even more out-of-control than they are now.   (Medicaid Article)

Another study of pay-for-performance programs concludes that hospitals which serve large numbers of poor persons were able to improve quality as much as more well-off hospitals.  There had been concerns that one effect of such programs would be to make prosperous hospitals even more financially successful while penalizing hospitals serving low-income patients, which often have limited resources to apply to quality initiatives.  The authors examined several hundred hospitals participating in CMS’ quality incentives demonstration and found that while initially hospitals serving more poor patients had worse quality performance, they had more improvement over the course of the program and caught up to other hospitals after three years.  (Annals Article)

As most knowledgeable observers predicted, the health reform law is causing insurance premiums to go up.  The Wall Street Journal carried a story describing some of the increases and how they were related to some of the changes in coverage forced by the new law.  Insurers are saying the new provisions will add 3-9% to premiums.  Kathleen Sibelius, who has become the Administration’s main mouthpiece to bash insurers, warned them to stop blaming reform for the increases.  The Administration can try to squelch this all it wants but anyone who looks at the data knows that eliminating lifetime caps, making children eligible for coverage longer, etc. has a cost.  It is not the insurers’ fault that the Administration and Congress lied to the public about the cost impact of the law.   (WSJ Article)

Science published research on the impact of social networks on health behaviors.     (Science Article) This is fascinating research because it helps us understand why people are sometimes so resistant to changing unhealthy behaviors.   Using online communities as a research base, the authors found that dense, clustered networks were more effective at motivating people to change behavior than looser, larger ones, which previously had been theorized to be more efficient at spreading information and influencing action.

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