I took some time this weekend to scan some of the online videos that I have archived over the past few months, and I found one that I would like to share with everyone. I received this video through an email video subscription service from Healthcare Update News Service, an online news forum to which I have subscribed for the past year.
Take a few minutes to listen to Jamie Robinson, PhD, MPH, chair of the Division of Health Policy and Management School of Public Health, University of California. Dr. Robinson’s presentation was taped during the National Consumer-Driven Healthcare Summit where he was the keynote speaker. The program took place in September 2007.
Dr. Robinson’s presentation, A New Ownership Society in Health Care, discusses consumer-driven health care, the increasing role this is playing in today’s healthcare system, the challenges consumer-driven health care brings, and how it will expand in the future. If you take the time to listen to this presentation, which you can access here, I think you will be able to see the valuable role that the practice of case management will bring in assisting consumers as they make individual healthcare choices. Dr. Robinson discusses the history of the movement and makes some creative recommendations to support this system as this model to reform health care as a whole. It was interesting to hear the presentation and to better understand the challenges the consumer-driven healthcare discussion brings, how it is going to change the healthcare system that we know today, as well as the impact the medical management industry if we as professionals are willing to accept the challenge.
So take a few minutes from your day to watch this online video so you can learn about the trend of consumer-driven health care that is taking place, and the opportunities that the trend brings to the ever-expanding role of case managers. Once you have watched the presentation, you can begin to evaluate your skills to make sure you are ready for the challenge and position yourself to be part of the conversation. It promises to be an interesting time, so make sure you are informed!
Have a great week!
Anne Llewellyn, RN-BC, MS, BHSA, CCM, CRRN
Editor-in-Chief of Across My Desk, Case in Point magazine, and the Case Management Resource Guide
allewellyn@dorlandhealth.com
January 8th, 2008 at 3:48 pm
Sorry, but Jamie Robinson could not be more wrong about Consumer Driven Health Care. Here is how I wrote it up in my newsletter, “Consumer Power Report.” –
Mr. Robinson is an economics professor from UC Berkeley who has recently been named Editor-in-Chief of Health Affairs, replacing the recently retired John Iglehart. I expected great things from him ten years ago when his work first caught my attention. Unlike most academics, he seemed to be willing to plunge into the messy world of real insurance issues - risk pooling, pricing, benefit design, marketing. But more recently he has become an apologist for the health care establishment and hostile to the idea of consumer empowerment.
He was a peculiar choice to keynote a conference dedicated to consumer driven health care, and his talk made it clear that he scorns consumers and trusts only the elite. He thoroughly misunderstands what is happening in the market.
For instance, he repeats the charge leveled first by Jon Gable that people in CDHC plans are not given a choice of plan, but are being “herded” into them by full replacement policies. In fact, employers who offer HSAs and HRAs are far more likely to offer a choice of plan, than employers who provide HMO or PPO coverage. And some who have adopted full replacement strategies have been spooked by the critics who predict selection problems if people are given a choice.
He was wrong on a lot of other points as well. Here are some:
He says, “Contrary to CDHP rhetoric, consumers choose products with managed care networks.” Wrong. That is all the carriers offer, to date. Such networks will fade away with time.
He says, “Contrary to CDHP rhetoric no one likes FFS (fee-for-service),” and cites current experiments with pay-for-performance and “episode-based payment.” Wrong. It may be that Mr. Robinson doesn’t know anyone who likes FFS, but he’s hanging out with the wrong crowd. People like FFS because they understand it. These other approaches to payment all rely on bureaucratic interference and are at best unproven.
He says, “CDHP (has been) dis-intermediated,” that is, swallowed up by legacy companies. Wrong. Several of the original companies have been acquired, but the entrepreneurs are busier than ever. Too bad Mr. Robinson stopped paying attention.
He says, “Contrary to CDHP rhetoric, individual insurance market stagnates, uninsured rises rapidly.” Wrong. The individual market is dynamic. It is the small employer market that is collapsing.
He says, “Employers seek to continue some form of sponsorship, while limiting cost exposure.” Partially Wrong. Many employers have dropped coverage altogether, while many others are looking for ways to move to a defined contribution approach.
He says, “(There is) continued growth in public programs.” Wrong. Enrollment in public programs dropped faster that enrollment in private programs according to the latest Census Bureau numbers.
He says “CDHP ‘focused factories’ have not displaced incumbents (hospitals).” Wrong. Congress had to prop up the big hospitals with its moratorium on specialty hospitals. That it the only thing that slowed this trend.
He says, “CDHP vision of self-directed care has faded” to be replaced with population-based approaches. Wrong. Consumers are in fact taking control over their own health decisions. Witness the explosion in Internet information and patient support.
Mr. Robinson would replace Consumer Empowerment with “Managed Consumerism,” which is as much of an oxymoron as you will ever find in health policy. I won’t go into this in great detail, but one of the features would be income-based deductibles. Hmmmmmm. I asked from the audience, as he supports income-based deductibles, wouldn’t he also have to support income-based premiums, since the size of the deductible so closely determines the amount of the premium? He thought for a moment, and then responded, that yes, he would.
Alrighty, then. Here we go. All of the sudden we are in a Marxian world of “administered prices” - prices have no meaning, they are whatever the government says they should be. They convey no information and have nothing to do with underlying costs or demand for services. They are simply a penalty for consumption, based on nothing more than the ability to pay.
The right answer to my question, by the way, is “No. Don’t tamper with prices. If the poor need to be subsidized, do so directly with income assistance.”