Health insurance premiums skyrocket as industry scrambles for answers.
Blue Cross announced recently that it lost 141 million dollars last year under the Obamacare Health Care exchanges.
The deficit in this category of insurance, under the Silver plan, was grossly underestimated as to cost and total claims by this population.
BCBS serves nearly 2/3 of the 231, 000 total people in TN seeking insurance through the exchanges.
BCBS because of this population’s over usage and a disproportionate share seeking care at inappropriate portals of entry have requested a 36 percent increase in premiums. Of course this will have to be decided upon by the state insurance regulatory body.
“We don’t have prior claim status information” is being used as an excuse for the premium increases.
“It’s a fairly new program.” Insurance officials keep spewing as a reason to further the conversation toward future increases and unanswered questions about overutilization, fraud and abuse.
I would venture to say that if you used the TennCare program as your template for prior claim data you may obtain a wealth of information on how this pool of patients will utilize their insurance options and their spending and use habits, to influence your bottom line.
The main problems lies in the main areas below with subsets stemming from these as generators of continued high costs and a resultant higher premium.
For the most part, from my observations, we are putting our dollars in the wrong places and not promoting proper access to care.
Let’s attempt to bridle this non frugal population that relies largely on LIP, Low Income Pools to fund or compensate inside a broken system. One can see that if you restrain and properly train this population in a complementary setting with adequate providers hospitals across the land will see a difference in their bottom line.
For so long hospitals, mainly ERs have promoted seeking care at their place, relying heavily on those LIPs or DSH, Disproportionate Share Hospital money to pick up the slack.
Now that federal money is being threatened to be taken away hospitals are now clamoring for a way to survive.
I think if we took a minute to look at our system based on the suggestions in the section below, a great impact could be made in our fight for healthcare dollars inside a dwindling reimbursement scenario.
We are currently seeing about 45,000 ER visits at an average cost of about $1300.00 for an ER visit. With 1.2 million uninsured in TN you can easily see the impact on our hospitals.
In one study at a hospital in Texas they showed that 6,000 patients to their ER had 10 or more visits. The breakdown for this population cost the hospital on average about $134,000.00 per person per year. If we dared look, I am convinced you would see similar numbers in every state in the US.
There is an irresponsible and overwhelming pattern of use among this population that must be broken.
Just as those who pay high premiums and even greater deductible and out of pocket expenses we must exercise frugality and promote accountability at all levels. On a large scale, this is not being done.
My assessment of where our healthcare dollars are being wasted that is resulting in these higher premiums.
There is a lack of education as to when and where resources are to be consumed appropriately.
There is a serious shortage of middle level providers in our state and across the US.
We also have a significant portion of providers that see reimbursement too low to continue seeing these patients, thus bouncing them to inappropriate care areas.
There are too many providers protecting their tales and over utilizing the resources available, a serious question arises here about tort reform.
There is very little oversight controlling and directing care and suggesting or providing the proper setting for that care defined.
Overusers and repeat offenders are posting record numbers visiting our ERs, our most costly entry point. Many are seeking drugs to fuel their habits. It is estimated that 4 to 8 percent of Medicaid/TennCare patients represent 21 to 28 percent of all ER visits.
Current federal law states our most expensive easiest access portal to healthcare, the ER, can be used regardless of your ability to pay and we must see you if you show up for any reason.
Over prescribing and fueling drug addiction is leading patients to enter the ER for their drug needs. Currently in conjunction with Joint Commission, a private entity, has joined with Big Pharma to prescribe via a completely subjective pain scale that encourages over prescribing and threatens fines if not followed.
We must issue Providers higher reimbursement and incentives to see Medicaid and exchange patients. In one study, 45 percent of Medicaid patients didn’t know who there Primary Care giver was.
In the same vein, primary providers need to reprimanded for referring everyone seen as underinsured or uninsured to go to the ER for care. Especially during office hours.
There needs to be after hour care clinics equipped with dental services to absorb a large portion of this population that uses the ER for primary or dental concerns after hours as well as for primary care issues.
Make the underinsured aware that if they seek care outside of a specified more costly portal of entry they will be asked to put some skin in the game, or foot a proportionate share of the cost at the door. We used to be able to do this and it was very effective.
Encourage after hour care seekers to pay a co pay at the door of an unauthorized care area.
Repeat offender, overutilizers and abusers must be limited in their visits. Place limits on use aside from emergencies and reward those that use restraint.
It’s a start, certainly not a complete plan but one that will definitely set a precedent for future utilization of resources.
I will contacting my reps soon. How about you.
I don’t know about you, I’m frankly tired of talking about these problems. It’s time we act.
Also, I will be releasing a book soon that elaborates more on these subjects and will even point you in a direction to make a difference.
It is in the We the People Books series called “Creating a Health Care Revolution.”
You can follow the book and the series to follow on Face Book called “We the People Books” like and follow if you desire.
Sources of info! Please visit these sights regularly.