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ACA Running Thread

CHDeac said:
The NEJM note above is a reasonable approach but lacks cost controls which is ultimately what we need to help create a stable market.

I'd add that we index provider comp for ACA plans to some % of Medicare to make coverage more affordable and also require providers to be in value based contracts with some risk component for these populations. In the same vein, I'd require selection of a Primary Care doc and also publish cost/quality metrics for primary care and create tiered primary care to drive people to the best, most effective primary care in the market.

Next week we will tackle big pharma!
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How are you determining the best, most effective primary care?
 
We have to trust him. After all, he said he'd eliminate the deficit in ten years and this year and next will only set records for the nation. He also said he'd make the "greatest trade deals versus the reality of exploding trade deficits.

Using his track record, his health plan premiums will only average quadruple the average mortgage payments.
 
Tobacco Road said:
How are you determining the best, most effective primary care?
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Total cost of care with quality metrics all controlled for risk profile of the population base. We have developed a set of algorithms and tested them and the results are meaningful. There are wide ranges in small geographic areas. Primary care influences / controls a significant portion of total spend and getting incentives aligned there are key.
 
Highland Deac said:
LOL. "Come up with a really good healthcare plan." That really inspires confidence!
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Why didn't any prior presidents just ask Congress to come up with a really good healthcare plan? This Trump guy gets it.
I mean for fucking real? After the Republicans bitched about ObamaCare for almost a decade now, they were just waiting to be (t)asked to come up with a really good alternative? What the hell have they been doing?
 
CHDeac said:
Total cost of care with quality metrics all controlled for risk profile of the population base. We have developed a set of algorithms and tested them and the results are meaningful. There are wide ranges in small geographic areas. Primary care influences / controls a significant portion of total spend and getting incentives aligned there are key.
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I'm probably asking a deeper question than is worthwhile at this point for this forum. I am a primary care and sports medicine physician. For my primary care patients, I crush the metrics. I am not under any illusion that I am so much better than my colleagues. I just happen to have a nice niche of educated, resourced and motivated patients. Doing sports medicine probably also biases my patient panel. Risk profile is pretty murky territory, so I am just a bit hesitant to rely too heavily on that. What you say sounds great at the superficial level. It comes down to whether that can accurately be evaluated in a meaningful and consistent way. I admit that I am skeptical that it can be done without unfair adverse repercussions (patients and physicians). The superficial answer that you have meaningful data is good enough for now (happy to discuss further if other have interest, though).

Obamacare imposed some changes for health insurance companies. What are your thoughts on how the health insurance industry influences cost. Any changes to make there? So far, you have noted primary care doctors and "Big Pharma".
 
Obama asked. Republicans just decided not to.
 
Republicans deserve every ounce of criticism for not coming up with their own solution to the healthcare crisis. They've had many opportunities, but came up empty every time.
 
I have a strong hunch that Trump's request for guys like Rick Scott to "come up with a really good healthcare plan" actually means "come up with some bullshit PR plan that we can sell to the rubes", so they can gut Obamacare and go back to the way things were prior to 2010, when something like 45 million Americans didn't have healthcare (even with Obamacare, it's still around 27 million or so). Modern Republicans are nothing if not reactionaries - back the future (circa 1955) might as well be their motto.
 
Of course, Trump wants Rick Scott to help decide healthcare. I'm shocked Trump hasn't taken El Chapo from super max to run the DEA. For those who don't remember, Rick Scott and his healthcare company were proven to be the biggest thieves and scammers in US healthcare history. In most other western countries, the CEO who orchestrated multi-billion fraud would have gone to jail for decades not to the governor's mansion and US Senate.

Trump is Mafioso POTUS. It's natural for him to hire a thief to come up with a healthcare plan.
 
Tobacco Road said:
I'm probably asking a deeper question than is worthwhile at this point for this forum. I am a primary care and sports medicine physician. For my primary care patients, I crush the metrics. I am not under any illusion that I am so much better than my colleagues. I just happen to have a nice niche of educated, resourced and motivated patients. Doing sports medicine probably also biases my patient panel. Risk profile is pretty murky territory, so I am just a bit hesitant to rely too heavily on that. What you say sounds great at the superficial level. It comes down to whether that can accurately be evaluated in a meaningful and consistent way. I admit that I am skeptical that it can be done without unfair adverse repercussions (patients and physicians). The superficial answer that you have meaningful data is good enough for now (happy to discuss further if other have interest, though).

Obamacare imposed some changes for health insurance companies. What are your thoughts on how the health insurance industry influences cost. Any changes to make there? So far, you have noted primary care doctors and "Big Pharma".
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There is a lot of science behind it recently. And even Medicare is dipping their toes in the water WRT the Macra changes and how they will decrease/increase reimbursement for traditional Medicare FFS. New advanced primary care groups are really pushing the envelope here such as Iora, Chen Med, City Block and Caremore. Its emerging but results are promising. CMS has also published multiple studies base don their own ACO work.

Id argue insurers can help control costs through several channels (not exhaustive)....

-Traditional mechanisms like medical policy, benefit design, fraud waste abuse, claims payment integrity programs, etc. These aren't sexy but are proven ways to control costs.

-Data analytics, like mentioned above. These programs have also been used to steer members to cheaper options for elective services.

-Advanced payment / value models which incent providers to deliver care and share in the savings they generate.

-Programs aimed at serving vulnerable populations. These include addressing social determinants like loneliness, transportation issues, food insecurity, etc.
 
Yep. That's their plan. "We've got this awesome thing, but the evil Democrats won't vote for it."
 
That’s a good summary of the Republican health care follies.
 
ConnorEl said:
Catherine Rampell: GOP’s ideal health-care system is Obamacare


Yep
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PhDeac said:
That’s a good summary of the Republican health care follies.
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In any case, Republicans have demagogued themselves into a corner, and they know it. The late Republican senator John McCain arguably saved the party from itself by killing the last legislative attempt at “repeal and replace”; now that Trump has foolishly revived this losing battle, Republicans will be forced to return to shouting “Free markets!” into the wind, as though that will somehow produce a real policy.
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They’d probably handle it like the NAFTA “overhaul” which was basically peel off the NAFTA logo and put a Trump sticker on. Repeal “Obamacare” and replace it with “Trumpcare” which is identical and costs the same but the key difference is this one isn’t filthy socialism and was a free market idea. Praise God for President Trump!
 
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