Latest Blog Posts & Articles

The Relentless Rise of Healthcare Expenditures

The Relentless Rise of Healthcare Expenditures

Need I say more?

Posted in Uncategorized | Tagged

Turmoil in the Obamacare Exchanges

Photo Credit: Wall Street Journal

Photo Credit: Wall Street Journal

Here is a nice story from a NC news station explaining the turmoil in the exchanges, with Aetna pulling out of many markets. Worth a quick read.

North Carolina consumers buying broadly subsidized health insurance policies on the online marketplace created by the Affordable Care Act will have fewer options after a major insurer pulls out.

State Insurance Commissioner Wayne Goodwin said Tuesday that health insurer Aetna’s decision to drop out of the ACA marketplace came as his office was reviewing the company’s request to raise premiums by about 24 percent next year.

“I am shocked and disappointed that Aetna and its executives have chosen to abandon their Exchange members,” Goodwin said. “We at NCDOI were in the middle of reviewing Aetna’s rate requests for 2017. Never during the review did the company indicate any concern that the requested rates would not solve.

I am angered by the impact Aetna’s decision will have on Tar Heel families and our market,” he added.

The move leaves Blue Cross and Blue Shield of North Carolina alone in selling marketplace policies to residents of all 100 of the state’s counties. A company spokesman says a final decision on 2017 policies is pending. The state’s largest health insurer is seeking Goodwin’s approval to raise premium costs by an average of almost 19 percent.

Cigna plans to sell ACA policies in Raleigh.

“New marketplaces are messy. The health of people in the Obamacare exchanges is uncertain,” said Dr. Peter Ubel, a physician and professor at Duke University’s Fuqua School of Business. “But even though insurance companies are in the business of uncertainty, these new marketplaces bring more uncertainty than they can handle. When a brand new insurance market opens up, they don’t know who’s going to buy insurance and they don’t know how healthy or sick their customers are going to be, so they have to guess at the price. And so far, the people buying insurance through the exchanges are sicker than expected.”

North Carolina is just one of many states affected as Aetna said it will abandon Affordable Care Act insurance exchanges next year in more than two-thirds of the counties where it now sells the coverage, the latest in a string of defections by big insurers that will limit customer choice in many markets.
Dwindling insurer participation is becoming a concern, especially for rural markets, in part because competition is supposed to help control insurance price hikes, and many carriers have already announced plans to seek increases of around 10 percent or more for 2017.

“This is really going to be felt in Southern states and rural areas,” said Cynthia Cox, associate director of health reform and private insurance for the Kaiser Family Foundation, which studies health care issues.

Experts say it is too soon to determine how shrinking insurer participation will affect rates beyond next year, but fewer choices generally contribute to higher prices over time.

Aetna, the nation’s third-largest insurer, says it will limit its participation in the exchanges to four states in 2017, down from 15 this year. The announcement late Monday came several weeks after UnitedHealth and Humana also said they would cut their coverage plans for 2017 and after more than a dozen nonprofit insurance co-ops have shut down in the past couple of years.

“Time might fix this as more people buy insurance,” Ubel said. “But Aetna might have pulled out anyway to show their displeasure with the Obama Justice Department, which is in the process of blocking their merger with Humana. It’s not clear when the controversy over health care reform will end.”

Aetna covers about 838,000 people on the exchanges and has said it has been swamped with higher than expected costs, particularly from pricey specialty drugs. It will sell coverage on exchanges in 242 counties next year, down from 778. The Hartford, Connecticut-based insurer will sell on exchanges in Delaware, Iowa, Nebraska and Virginia next year.

The enrollment period for 2017 coverage starts Nov. 1.

Posted in Uncategorized

Could a Zika Epidemic Be the Key to a Trump Victory?

Platforms and popularity ratings; policies and debate performances; PAC funding and get-out-the-vote efforts – so many factors can make the difference in a close election. But uncontrollable world events can tip elections too. In fact, Donald Trump’s election chances may depend on something as seemingly random as a global epidemic.

Epidemics of contagious disease are frightening, and epidemic-related fear can shift people’s political attitudes. Did you know, for example, that the threat of infection makes people more likely to support physically attractive candidates? (Whether such a phenomenon would benefit Donald Trump depends, I guess, on whether you find the color orange attractive.)

But consider another phenomenon – the threat of epidemics increases people’s intentions to vote for Republican candidates. That was what Alec Beall and colleagues found when they studied results from the 2014 midterm elections, which took place as the Ebola outbreak was reaching a peak. They tracked how often Americans searched Google for information on Ebola, and they pulled together polling data showing whether people intended to vote for Republicans or Democrats.

They found a spike in Republican popularity that followed in the week after the CDC announced the first case of Ebola in the US.

To read the rest of this article, please visit Forbes.


Posted in Uncategorized | Tagged

If You Don’t Have Employer Insurance, You Probably Have a High Deductible

Most people in the United States get health insurance either through their employer or through government programs like Medicare and Medicaid. But some people have to find other ways to get healthcare insurance, with an increasing number of people doing so through the Obamacare exchanges, or “marketplaces.” In fact, according to the Kaiser Family Foundation nearly 2/3 of people in this situation can thank the Affordable Care Act for their access to healthcare insurance:

If You Don’t Have Employer Insurance, You Probably Have a High Deductible 1

With increasing frequency, when people purchase health insurance through things like the exchanges, their purchasing plans have high deductibles:

If You Don’t Have Employer Insurance, You Probably Have a High Deductible 2

15 years ago, if I told you that a president came into office, instituted a marketplace for healthcare insurance, a marketplace that caused an increasing percentage of Americans to end up in high deductible “consumer directed health plans” – you’d have told me that must have been a Republican president. Go figure.

Posted in Uncategorized | Tagged ,

Your Physician Can’t See You Yet – She’s Busy Filling Out Paperwork!

Left to our own devices, most of us physicians try our best to provide high quality care to our patients. But almost none of us provide perfect care to all of our patients all of the time. In fact, many of us get so caught up in our busy clinic schedules we occasionally forget to, say, order mammograms for women overdue for such tests, or we don’t get around to weaning our aging patients from unnecessary and potentially harmful medications.

Because the quality of American medical care is often uneven, third-party payers – insurance companies and government programs like Medicare – increasingly measure clinician performance and reward or punish physicians who provide particularly high or low quality of care.

The result of all this quality measurement: gazillions of hours of clinic time spent documenting care rather than providing it.

According to one study, in fact, clinic staff spend more than 15 hours per week dealing with quality measures for every physician in the practice. In other words, a six-physician clinic group can expect 90 hours of staff time spent documenting quality performance. And it’s not just the staff that are left to do such documentation. Physicians spend precious time in such activities, too. The same study estimates that physicians spend almost 3 hours per week documenting the quality of their care. Here’s a picture of that finding:

Your Physician Can't See You Yet -- She's Busy Filling Out Paperwork 1

Is it any wonder why so many American physicians report being burned out by their jobs?

To read the rest of this article, please visit Forbes.

Posted in Uncategorized | Tagged , , ,

When It Comes to Healthcare, Republicans Have a Trust Problem

Here is some polling data, on a wide range of health and healthcare issues. It shows pretty consistently that Americans trust Democrats more than Republicans on these issues:

When It Comes to Healthcare, Republicans Have a Trust Problem

I think it’s time for Republicans to move beyond “repeal and replace” and start showing the American people that they have productive ideas about how to improve their health and healthcare.

Posted in Uncategorized | Tagged ,

How to Figure Out the Cost of Your Medical Care


Photo Credit: Cancer Therapy Advisor

Photo Credit: Cancer Therapy Advisor

Here is a link to an article from CBS News with some very practical advice on this thorny topic. I’m excited to say that some of our research on physician/patient communication was mentioned in the article. Enjoy it!

If you’re like most people, you’re paying more for your health care — and stressing about it, too. Average annual out-of-pocket costs for people in the workforce have increased almost 230 percent in the past decade, reports Kaiser Family Foundation.

Out-of-pocket costs are the main reason for the increase in underinsured Americans — people with medical bills that are more than they can afford. More than 30 million people are in that category, according to the Commonwealth Fund 2014 Biennial Health Insurance survey. Half of them reported problems with medical bills or debt, and 44 percent reported not getting the care they needed because of the expense.

No wonder 66 percent of consumers rank planning for out-of-pocket health care costs as the most challenging and stressful aspect of managing their health care, benefits firm Alegeus reported in a survey it released Wednesday.

Not only do consumers find paying for health care stressful, they also find it confusing. Nearly 60 percent of those surveyed said they found it difficult to understand the difference between benefit options, while 45 percent said the same about calculating what each option would cost, according to the report. “As we see a continued increase in premiums and deductibles, more of the health care cost burden is on consumers,” said Steve Auerbach, chief executive officer of Alegeus. “But they’re not prepared.”

What out-of-pocket health care costs are you likely to face? Here’s a brief rundown.

To read the rest of this article, please visit CBS News.

Posted in Uncategorized | Tagged

Ineffective Nudge?

Runners + Alligators Nudge

Posted in Uncategorized

Is The Golden Era of Pharmaceutical Profits Over?

For decades, the pharmaceutical industry has been highly profitable. The recipe for such profits has been pretty simple for most of the last half-century–discover a chemical or molecule that treats a common problem, like hypertension or diabetes or erectile dysfunction, and make billions of dollars while that product is still under patent protection. But of course, profits were never so simple. It takes billions of dollars to develop one new drug suitable for testing in humans and even then, the drug might turn out to be too toxic or to have too little benefit to make it on to the market. It might take a handful of such drugs before a company finally finds one that works, a single blockbuster that can hopefully make up for all that investment. But the cost of new drug development is rising, and the number of big wins is declining–with the number of common illnesses in need of interventions dwindling–so it is getting increasingly difficult to bring enough blockbusters to market to make up for all those drugs that go bust.

Are pharmaceutical profits passé?

Some economists would say that it’s about time for the industry to see a decline in profits. You see, economic theory holds that in competitive marketplaces, profits decline until no one makes any money. When pharmaceutical profits soar, more companies should enter into the business, thereby bringing more drugs to market at lower prices until profits dwindle enough to reduce the incentive for new companies to compete for pharmaceutical profits. By this reasoning, decades of soaring pharmaceutical profits were not a sign of a robust industry but, instead, were evidence of a broken market.

If that view is true, then you could argue that the industry is finally maturing. At least that’s the suggestion of a study in Health Affairs by Ernst Berndt and colleagues, who analyzed revenues for pharmaceutical products released since the early ’90s and found that the average lifetime sales of pharmaceutical drugs that make it to market appear to be declining:

Are Pharma Profits Passe 1

In the mid-90s, drugs that came to market brought in an average of $4 to $7 billion in sales. From 2000-2004, that number declined to around $5 billion. But between 2005 and 2009, that number didn’t even reach $3 billion. Now, an average of $3 billion of sales might still sound pretty good. But keep in mind that research costs are rising for the pharmaceutical industry. And the number of new drugs isn’t rising in parallel to these surging R&D costs.

To read the rest of this article, please visit Forbes.

Posted in Uncategorized

A Force More Powerful Than Anti-Vaxxers? Economics!

We have a vaccine crisis in the this country. Not just the one caused by anti-vaxxers like Jenny McCarthy, scaring Americans away from life-saving childhood vaccines with pseudo-scientific claims about autism. Instead I’m talking about a bigger crisis, one caused by a dangerously thin supply of vaccines. Wise parents who ignore the blatherings of people like McCarthy may soon arrive at their pediatricians’ offices prepared to vaccinate their children, only to find out there is no vaccine.

To protect supplies, we need to be sure we are paying well for the vaccines we receive.

That’s the conclusion of a study led by my friend and colleague David Ridley. Working with two graduate students, Ridley analyzed whether the likelihood of vaccine shortages was correlated with the price of the vaccine. You see, the majority of childhood vaccines in the U.S. are purchased by the federal government, as part of a Vaccines For Children Program created by congress to provide vaccines to low-income kids. In purchasing these vaccines, the government uses a “cost-plus-pricing” model.  This model establishes the marginal cost the manufacturers incur to produce a dose of vaccines and marks the final price up a titch, to give companies a small profit. This mark-up is pretty modest, however, especially for older vaccines. Such modest profits reduce manufacturers’ incentives to invest in vaccine production.

Shouldn’t a modest profit be enough to keep manufacturers in the market?

Unfortunately, it’s not enough of an incentive to avoid shortages. Vaccines can be complicated to manufacture. Inevitably, production lines get disrupted by contamination issues or other problems. If there were lots of excess production capacity, an occasional disruption wouldn’t matter. But many vaccines are manufactured by only one or two companies, and with very little excess capacity built into the system. Excess capacity, after all, is expensive to maintain. So when a production problem arises for an older, less expensive vaccine, often a shortage follows.

(To read the rest of this article, please visit Forbes.)

Posted in Uncategorized