Tuesday, November 29, 2011

Payer-Provider Lines Blur -- Another Trend in Health Care

Have you noticed that the line between payers and providers is becoming blurred? More insurance companies now own groups of providers. There are numerous examples, but I’ve been paying particular attention to UnitedHealthcare’s launch of hi HealthInnovations -- a fully owned subsidiary that is providing steeply discounted hearing aids to some of its’ Medicare members as well as offering direct to consumer sales. Other examples include Humana’s purchase of Concentra, a Texas-based provider of stand-alone medical centers. Wellpoint recently acquired CareMore, a health plan operator that owns a number of clinics in the Los Angeles area. CIGNA controls a Phoenix medical group. There are flip side examples too, Partners HealthCare System Inc, a large hospital and physicians network in Massachusetts, acquired Neighborhood Health Plan, a Boston-based nonprofit insurer with 240,000 members. I found this article on the topic particularly interesting, Managed Care Enters The Exam Room As Insurers Buy Doctor Groups.  

Why the shift? Healthcare reform is minimizing profits, so insurance companies are diversifying. The Affordable Care Act limits the portion of premium dollars that can go towards administrative costs and profits. This year, a provision requiring insurance companies to spend 80 to 85 percent of premium dollars on medical care and health care quality improvement, rather than on administrative costs went into effect. In 2012, insurance companies will be required to provide a rebate to their customers if their profits exceed the mandated percentage.

Insurers are also under constant pressure from employers and other customers to minimize premium increases. If the insurance companies own the provider groups, they have more control over the costs. When I attended the United Healthcare’s Customer Forum last June, they mentioned that they were introducing a HMO in Florida at the request of some of the employers they work with. The thinking seemed to be that these employers would prefer to provide a limited HMO benefit to their employees than no benefit at all. Actually owning the provider groups doesn’t seem like such a huge leap from a HMO. Look at Kaiser as another example. And, isn’t that what is happening with the trend toward ACOs, Accountable Care Organizations. Some are being initiated by large physician groups, some by hospital systems, and others by health insurance companies. Humana, United Healthcare, and Cigna have all announced plans to form their own ACOs.

What impact will this have? Time will tell. Insurance companies controlling the providers might drive costs down, but ACOs could push costs up. As hospitals join forces with physicians and gain market share, they may have more leverage in negotiations with insurers. Benefits may become available to more people through delivery models like United's hi Healthinnovations, but consumer may have fewer choices of providers and durable medical suppliers. Americans typically place a high value on choice, but with 50 million people uninsured (16.3 percent of Americans) something has to give. Especially when you consider the fact that the percentage of people covered by employer-based health insurance has declined while the number of people covered by Medicare and Medicaid has increased.

Monday, November 21, 2011

Thanksgiving Dinner the Volumetrics Way

I asked Ellen Slotkin, the nutritionist we are working with on our current weight loss program, for her advice for staying on track during Thanksgiving. We're using Volumetrics as the basis for our program.

As we head toward the Thanksgiving holiday, here are several things to keep in mind…

1. Give “THANKS” this holiday season.
T- Try. “Try” dishes by taking a small portion, rather than eating an entire serving. That way you get to experience all of your favorites, without excess calories.
H- eat Half. The easiest way to “have your cake and eat it too” during Thanksgiving is to select everything you would have normally chosen, but put only half the amount on your plate. Once you have eaten it- take a moment to ask yourself if you are truly hungry for a second helping. Try having a glass of water, tea, or low-calorie beverage before going back for seconds.
A- Activity. Plan a family walk after your Thanksgiving meal, or head to the mall for some black Friday shopping and park farther out in the parking lot than you normally would.
N- “No” is not an insult! Saying No to an offer of a high-fat, high-calorie dish is not an insult to the person who made (or purchased it.) If they truly care about you, your health should come first.
K- Keep it Simple. Control the amount of extras at your meal -- gravy on turkey, whipped cream on pie -- these calories can add up quickly, so limit your self to a small amount of each.
S- Slow Down. Prevent second and third helpings by slowing down your eating speed. Focus on conversation, put your fork down between bites, count the number of times you chew.

2. Substitute Smart.
  • Use fat-free cream of mushroom soup for casserole dishes.
  • Use fat-free chicken broth to baste turkey and make gravy.
  • Use sugar substitutes in place of sugar and/or fruit purees instead of oil in desserts.
  • Reduce oil and butter whenever possible.

3. Portion Control!
  • Turkey: One deck of playing cards
  • Starches: Two computer micePie: Two small slivers

Thursday, November 10, 2011

Build Your Immunity Arsenal for Travel

Our organization holds an annual convention for 10,000+ members the week before Thanksgiving. About 100 staff travel to host the convention. We usually fly and then wind-up working 14 hours a day in a convention center. Inevitably, some of us get sick. It's usually just a cold, but it's no fun. I asked Dave Foreman if he had some tips for staying healthy when you travel. Dave's a pharmacist and a Naturopathic Doctor. We partnered with Dave on a heart health initiative earlier this year. This is what Dave shared with me.

Whether or not it is cold/flu season or you just don’t want to get sick, here are a few tips to support yourself naturally.
Avoid Sugar - (this includes other “white” foods like pasta, bread, cake, etc. and honey) I like to say that sugar/refined foods make your immune cells stupid. I read years ago that 7 teaspoons of sugar will decrease your immune function by 50% for up to 8 hours.  While you immune cells aren’t functioning properly, bacteria and viruses can wreak havoc on your body. Stay ahead of the game and avoid those refined foods.
Wash your hands - Goodness knows what all you have on your hands. I like grapefruit seed extract as my hand sanitizer.  If you want something more traditional, there are a few great choices at your local health food store.
Supplement - I use a supplement daily (Host Defense) to support my immune system. By using a support supplement, I can use it daily for months on end. Other products I like are: Advanced Immune Support (MD Select), Immune Support Formula (Weil Nutritional Formulas) and Immuneactive (Futurebiotics). Consult with a store health enthusiast to find the right formula for you.
Pay me later: You know the old saying, “pay me now or pay me later”. What if it is too late and you are now getting sick? Look for products that boost or stimulate your immune system into action. In my family, we use Esberitox (Enzymatic Therapy). Other great products such as; Seasonal Support (MD Select), Umcka Cold and Flu (Nature’s Way), Immuboost Blend Sp-21 (Solaray) and Wellness Formula (Source Naturals) along with a bunch more I can’t list can be found in the immune support section of your local health food store.