Health insurance premiums skyrocket as industry scrambles for answers.

Health insurance premiums skyrocket as industry scrambles for answers.

06/01/15
1434 pm

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. 

And,

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. 
 
http://www.timesfreepress.com/news/local/story/2015/may/31/insurers-proposehefty-rate-increases/307112/

http://www.tennessean.com/story/money/industries/health-care/2015/05/15/health-insurance-rate-filing-requests-vary-insurer/27363437/

Common Core Estimated Costs per pupil for Bradley County and Tennessee

Common Core Estimated Costs: Per pupil in Bradley County and across Tennessee

When someone speaks of introducing a “national” standard to drive a curriculum for use in every state in the US to include a total change of that system, two quick thoughts come to mind. First, the indoctrination of our children and secondly, th cost to me or the state I live in to implement.

Trying to find out the cost of Common core has been like trying to pull a bad tooth from a sleeping bear. 

Just the thought of trying to get “cost figures” from our elected and non-elected reps has proven to be quite a daunting and elusive task.

I have posed the question via email to several folks locally and have either not gotten an answer, totally ignored my question or have offered that it’s paid for by federal grants, no strings attached.

If one of these are truly your answer you are either oblivious or are trying to hide the cost fearing the publics backlash of such an expensive and unproven program.

It is pretty safe to assume that when I meet high resistance or avoidance of a question, there is a pretty good reason for it. Someone is trying to hide the facts.

Either way our schools get nationalized, our kids indoctrinated while the taxpayer gets duped once again.

I had to do a little research, which has now become one of my favorite pastimes and I had to look no further than the NGO, Non Governmental Organization, (a term first used by the UN in 1945, by the way) The NCSL, National Conference of State Legislators, where every legislator is an honorary member and their level of involvement on committees from there is an additional choice.

Jessica Mathews, a historian and Pulitzer Prize winner, once said this about NGOs  in Foreign Affairs in 1997:  “For all their strengths, NGOs are special interests. The best of them … often suffer from tunnel vision, judging every public act by how it affects their particular interest”. Since NGOs do have to worry about policy trade-offs, the overall impact of their cause might bring more harm to society.

No time has been wasted, as several of  our local reps have taken to the task of implementing Common Core in our communities and working quitely behind the scenes, seemingly trying to not look at the cost factor.

Take Todd Gardenhire,  Delores Gresham, Kevin Brooks (also an ALEC education committee member), Harry Brooks, Stacey Campfield for instance. They are deeply involved in this NGO (NCSL) and no one has barely heard of this organization. Again, a big opportunity for them to affect state policy, but very little oversight or accountability. Sources below:

http://m.ncsl.org/state-federal-committees.aspx?tabs=855,22,629

http://m.ncsl.org/state-federal-committees.aspx?tabs=855,25,661

Let’s cut to the chase and begin to see what this will potentially cost our state and our community.

Since no one has offered to relinquish the “Golden Budget” on their own, I found a nugget on the NCSL website, a presentation by Patrick Murphy in 2011, presumably to NCSL committee members, perhaps updated numbers are out there but I couldn’t find them.

Click to access PatrickMurphyPPT.pdf

In this presentation he touched on many issues that may affect the Common Core cost outcome to include the unknown, retooling teacher programs, technology infrastructure, staff training, staff reductions, changes in leadership, future market costs, costs not adjusted per state, existing costs and factors with no control like inflation or individual community adjustment costs for data, assessment and software upgrades.

From what I can gather and he has lumped the cost into three different paths, the business as usual approach (the most costly), Bare bones(mostly online) and a mix of the two (lowest cost). 

These approaches will be determined by the school districts approach using the technology provided and what upgrades may be needed to their present environment and their desire to spend the extra cash this program demands. 

The business as usual seems to take the lesser demand on the present infrastructure, this seems to be the least path of resistance, requiring the least change, yet the most expensive up front. So, we will use the business as usual model to form our costs to implement Common Core in our community, Bradley County.

In summary the gross costs per pupil in all states using the business as usual model will be about 289 dollars per child and 2,000 per teacher, I am assuming per year.

Lets take the number of kids in Cleveland/Bradley County: roughly 15,100. Using the numbers provided by NCSL above that’s a high end, business as usual, around 4.4 million add in fixed costs of 4 million  provided by NCSL and that’s around 8.4million.

With 15 ,100 students in Bradley County and a 17-18 students per teacher ratio that equates to about 888 teachers or let’s round to 900. 900 times 2,000 per teacher head and we have an additional  1.8 million in cost.

Combined teacher and student cost is estimated to be about 10.2 million for Bradley County. 

Now factor in all the Bill Gates computer software, training, upgrades, system parts and things that go whizz and you safely have another 2  to 3 million and around 13.2 million seems to be the implementation costs for Common Core. 

Tennessee has about 1 million students and that could equate to billions, I’ll let you do the math.

I am sure there will be people alot smarter than me look at the “numbers” I have provided and come up with another number and dispute my numbers. But you know what? I haven’t seen anyone else even attempt to take a stab at it but I bet I’m not too far off. And from your vantage point that’s the easy route to take.

I, too would attempt to hide these costs. Our community or state does not have this type of surplus. 132 million over 10 years. I feel my taxes going up as I peck away at the keyboard.

Look at the provided presentation and look at the numbers. Come to your own conclusion.

My conclusion;  I believe we need to talk with our elected leaders, look at the decisions they are making and take the needed steps to protect our children from this horrible set of standards that will dictate the curriculum. Thus leaving our teachers with no option other than to be a pawn of the federal government inside our sovereign state.

Other sources of info:

http://m.ncsl.org/issues-research/educ/challenged-to-the-core.aspx

http://www.localschooldirectory.com/state-schools/TN

http://mobile.edweek.org/c.jsp?DISPATCHED=true&cid=25983841&item=http%3A%2F%2Fblogs.edweek.org%2Fedweek%2Fcurriculum%2F2013%2F04%2Fi_recent_heard_from_a.html