Contributors
As a health plan nationally recognized for excellence and innovation, Priority Health is working to influence health care reform.
Our experts include: Kim Horn, President and CEO Amy Chambers, Associate Vice President, Market Development Dave Bilardello, Executive Director, Commercial Products Jim Byrne, M.D., Chief Medical Officer John Fox, M.D., Associate Vice President, Medical Affairs Leon Lamoreaux, Vice President, Government Programs Rob Pocock, Associate Vice President, Communications Mark Zickel, Vice President, Sales and Client Services |
Join us in discussion as the country wrestles with the questions of health care reform – What? When? Why? How?
Rob Pocock, Associate Vice President, CommunicationsWhat should reform look like?September 10, 2009The final bill must:
We have an impressive track record of doing just that here at Priority Health. Our Medicare Advantage program was recently cited in a Johns Hopkins University study proving we save significant dollars and achieve better outcomes in several key measures. Data of this nature supports the notion that a government run health plan is not the answer. Health care reform must allow organizations like Priority Health to continue their mission of provide all people access to affordable and excellent health care. What did you think of the President's speech? Join the dialog!Submit your comment.Comments: The president's speech last night echoes Priority Health's mission of providing access to high quality, affordable health care. His comment that people without health insurance would like the same type of access and security that other members of our society have--including members of Congress--resonated strongly with me. How that can be done is the issue, an issue that he made clear needs to be resolved through reasoned debate. In a civil society, a reasoned and rational debate is of paramount importance in serving the public's interests. not special interests. I hope his speech will bring about a renewed committment to find a solution to our healthcare financing dilemma. More importanly, I hope it diminishes the vitriol that does not advance the public good, serve the public interest or reflect our forefathers committment to build a society based on mutual respect.
Rob Pocock, Associate Vice President, CommunicationsLooking at the tough issues
July 23, 2009
As the Priority Health Blog continues to evolve, we want to thank you for your feedback. Health care reform really is an emotional topic for people. And I can understand why many just aren't sure where to stand on the issue. I think the tough issues are only just beginning to surface. How are we going to pay for the $1.2 trillion estimated price tag? (An estimate just put out by the Congressional Budget Office.) Will a government-run health plan create greater competition, choice and cost less than private insurers? We need to keep our perspective during these times. Whatever the outcome of the health care reform debate - it will be just the beginning, not the end. Health care reform in the past (Medicare, Medicaid and HMOs) has not been universally embraced and have had both negative and positive consequences. Whatever happens today is just another chapter in a book that started nearly 50 years ago with the launch of Medicare. There are some important principles likely to be embedded in the final health care reform legislation. While the devil is in the details, the best plan will be one that features all of the following:
I would be interested to hear what you think is the most critical topic health care reform should tackle. Are the above-listed attributes the only areas that need to be addressed in a good plan? Join the dialog!Submit your comment.Comments:
Submitted 08/10/2009 01:16 p.m. by: anonymous
Frequently during the discussion related to health care reform the comment is made by White House officials that "if you are satisfied with your current health care you will be able to keep it". I am doubtful when I hear this because I think it will be difficult for current health care options to compete with a government sponsored plan. With Medicaid and Medicare the government dictates to providers ( hospitals, physicians etc) what they will be paid. Whereas a private plan negotiates reimbursement with providers. Providers usually expect private carriers to pay them more to compensate for what they are loosing from government payments. If a private health plan has to keep covering those losses how can they be competitive, how can we expect to keep our health plan we have now without having to pay unfair increases?
Submitted 07/30/2009 09:28 a.m. by: Laurie Joyce
From my point of view, healthy behaviour is essential to turning things around, and is the toughest challenge because it involves mindset...old habits die hard! Controlling costs by eliminating unnecessary labs and tests is equally important. Patients have to ask themselves, is this what I really need? What are my options? What alternative treatment is available? Just this week, a family member went to an ENT for ear pain. The specialist's office recommended hearing tests, and allergy testing and a follow up visit the next day!! That didn't allow time for the antibiotic they prescribed to work! Finally, it seems to me that there should be NO health insurance companies in the business FOR PROFIT! Wouldn't that eliminate at least most of the lobbying in Washington? As long as there are stockholders to satisfy, how can the patients be satisfied? 
Kim Horn, President and CEOWhen the White House callsJune 19, 2009Earlier this month, I was invited to meet with officials from the White House's Office of Health Reform in Washington, D.C. This was just days before President Obama's major health care speech in Wisconsin. I was one of only four leaders from health plans across the nation: Priority Health, Geisinger, Group Health Cooperative and Health Partners. We were pulled together by the Alliance of Community Health Plans to discuss Medicare. The White House was interested in "value-based purchasing" and "pay for performance." Our overall message was to use caution. All four plans gave specific examples of their successes in value-based purchasing. I spoke on two areas:
Our meeting lasted 90 minutes, 30 minutes longer than planned. Given the speed and determination of this administration to enact health reform, this amount of attention reflects the credibility of Alliance of Community Health Plans organizations and our message of providing affordable, excellent health care with an evidence-based approach. I would be interested in hearing your thoughts on this issue.
Join the dialog!Submit your comment.Comments:
Submitted 06/23/2009 11:20 a.m. by: anonymous
Chicago Suntimes Personal Finance Columnist outlines the difficult issues in this debate at this link. http://www.suntimes.com/business/currency/1633058,CST-FIN-savage22.savagearticle Full article linked above. Here are some highlights:
Submitted 06/24/09 1:23 p.m. by: anonymous
I have many friends who think the U.S. should adopt a health care system similar to the one in Canada. Sometimes it's hard to articulate the reason that's a bad idea without sounding like I'm just trying to protect my job at Priority Health. Has anyone else had success explaining this to people with no insurance background?
Submitted 07/17/09 3:31 p.m. by: Joe Dontz
There are multiple topics of discussion available to interface your friends and family regarding why a Canadian insurance system is not right for America. 1. Patient Care- The only reasonable way to dramatically cut costs in order to offer services to everyone is to ration care. People with urgent health needs come to the US for treatment, often at their own expense. We have some of the best care and technology in the world. Why would we want to ruin that by socializing medicine? For example, the US has about a 20% higher survival rate of colon cancer. This statistic is largely due to treatment being administered promptly, not after waiting on a list for possibly months or years. 2. Control- Who do you trust more, yourself, or the government providing services to you? I prefer to choose who I work for and pick the insurance that is right for me. I do not want a bureaucrat making medical decisions that should be up to me, and my doctor. There is an open market for insurance. The idea that you do not pay for your insurance, and that your employer does is a falsehood among most individuals. You are paying for your healthcare indirectly. Your base salary would be much larger if healthcare were not included. 3. Simple Economics- The money must come from somewhere. The idea that taxing the “rich” to pay for the benefit someone else does not compute. The numbers just do not add up. The estimate for a socialized system is approximately 1-1.5 TRILLION dollars over 10 years . Everyone will pay for socialized medicine through discrete methods like service fees or tax increases over time. When you are taxing someone more, you take away their buying power. That does not mean just for everyday products, it also means to hire people and create jobs. Removing money from the private sector and putting it into the public sector never results in growth of an economy, only the growth in government. I hope this helps.  As a former Canadian resident, I can tell you that there are a lot of misconceptions about Canadian health care. Consider these issues:
Submitted 06/24/09 2:28 p.m. by: Barry Nowak
Kim, Thanks for blogging! In answer to your first question, a recent white paper [from the IBM Institute for Business Value, copyright 2008, 318KB PDF] identifies eight changing value dimensions for health care (they call the change "moving from sick-care to health-care"). These dimensions are 'ability to continuously improve and innovate', 'cost/affordability', 'clinical quality and safety', 'service quality', 'access and choice', 'overall health status of population', 'equity', and, 'ability to active citizens to live healthier lives'. I think in terms of these dimensions non-profits bring value to Medicare by driving positive change in all of these areas. For Priority Health in particular I believe we provide a benefit in 'continuously improving and innovating', 'activating citizens to live healthier lives', and 'service quality'. I'd be interested in hearing how you believe we're going to change and grow as an organization over the next five years!  Priority Health has a strategic plan that outlines several key deliverables for success. We are deliberately trying to diversify as we grow into new communities, with a variety of funding options and services to better serve unique segments of the population. There is significant growth potential as we expand our reach throughout the state. In government programs, for instance, growth will come in several forms including territory expansion and new product offerings. What we have learned through government programs is that health plans deliver great value for both the patients and the government. We not only keep our administrative overhead low – we provide unmatched quality and service to patients. In fact, Priority Health has been especially successful at this initiative – having received the only 5-star quality rating from the Centers for Medicaid and Medicare services. We are well positioned to respond to health care reform, especially if the government creates a public health plan mirrored after Medicare.
Submitted 06/26/09 3:35 p.m. by: Marcia Bartlett
I agree with others that we need to use caution moving forward and not just put a band-aid in place for something that needs sutures; however, I believe that the success that we and other non-profits have demonstrated with the Medicare Advantage plan should be the basis for moving forward with health care reform. Different from straight Medicare, Medicare Advantage plans cover things like preventive care, which makes more sense in the long run. We also promote individual accountability and responsibility, as well as wellness. These are key components that need to be built into any revisions of current programs or developments of any new programs. The third leg of the triangle (other than health plans and patients) is providers. Most providers want, and strive, to provide good care; but those who don't need to be held accountable for just seeing patients and not promoting wellness, helping patients get better, helping them get preventive care, etc.
One question I was unsure about in relation to the potential for an insurance exchange is, how this would fit in with the current sales environment involving agents? Do you see agents being a part of the insurance exchange, people/employers working directly with health plans (eliminating agents) - how would this work?  Great question Marcia - It will be interesting to see how the insurance exchange will impact agents. Will it incorporate them into the process? Will it impact their overall client base? This is yet to be seen. We could look at the travel industry for a clue - as travel websites hosting links to cheap flights and vacation destinations were posted online, travel agents were definitely impacted. Yet, there are many travel agents still in existence because individuals like having personal interaction and having someone watching out for them, something the online tools don't provide. But unlike the travel industry, understanding health benefits and options can be very complex. Agents bring tremendous value to both employers and employees. Priority Health works closely with the agent community and that is one thing we don't see changing in the future.
Last modified
09/14/09
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I wasn't able to watch the speech live, but I found it on YouTube, so I can catch up tonight. Here's the link: http://www.youtube.com/watch?v=bQhmRhqQsAE