Jeff Lemieux, SVP at the Center for Policy and Research at America's Health Insurance Plans (AHIP)
The slides Jeff used ar packed with data. It would be great if he actually pulled out the meaning from the slides. With these slides flying by it is just data without a lot of meaning.
Jeff talked about Managed Care 1.0, the backlash and the emergence of Managed Care 2.0
The backlash from Managed care in the late 1990's driven by:
High Deductible Plans:
Grew from 6M to 8M between Jan 2008 and Jan 2009.
Managed Care 3.0:
- More heavily regulated
- Innovation will go back to the Clinical area
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Jeff suggested the following areas of "Focue" (that wa sa typo in the title of his slide)
- Post discharge Transitions
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One example given was a patient taking 51 medications. This is not unusual.
Fee For Service Readmission rate across Medicare runs at 20%. No indication of Home or Physician visits for most of those re-admissions.
Managing the post-care transitions is a big area that is ripe for innovation and cost savings.
Medication Reconciliation
Fallon Community Health Plan send a pharmacist to the home 3 days are discharge to help patients with more than 10 prescriptions.
Cigna have nurses that contact Medicare Advantage patients within 24 hours of discharge.
Geisinger has a 90-day bundled payment to surgen and hospital for an episode of care. This avoids paying for re-admissins and gives surgeons and hospitals an incentive to improve re-admissions. This is all good for the patient.
Emblem Health - has an ER Frequent Flyer Program. By managing people with frequent admissions to the ER they reduce utilization by 8% in the targeted group.
Jeff Lemieux on Health Reform "The Democrats has a great opportunity to snatch defeat from the jaws of victory."
What will States do that differs from Federal?
"The States have no money to do anything right now."
