NCQA-BBQ: It is to laugh

So, got this in email the other day:

"A new ratings system created by the National Committee for Quality Assurance (NCQA) provides consumers with a more accurate picture of how health insurance plans perform in key quality areas."

That's (mildly) interesting, but what were those "key" areas?

Oh:

"[C]linical quality, member satisfaction and NCQA Accreditation Survey" [emphasis added]

Are you kidding? One third of the metric is itself?

How does that work?

More importantly, though, is the self-delusion that consumers actually care about these kinds of things:

"Oh sure, Anthem has a terrific rate, $100 a month cheaper than Humana, but Humana ranks 3 spots higher on NCQA, so I'll go with them."

Said no one, ever.

It's similar to the experts who claim that folks inadvertently "leave money on the table" by not choosing a health insurance plan that offers cost-sharing in addition to premium subsidies. There's a reason, and it's not ignorance of the program.

It's human nature.

Wellness vs Privacy

Are you kidding me?

"Houston required employees to tell an online wellness company about their disease history, drug and seat belt use, blood pressure and other delicate information."

And the best part (for certain values of "best")?

"The company ... could pass the data to "third party vendors"

Oh goody!

Of course, employees could opt out, no problem.

Wait, what?

"[B]ut only if they paid an extra $300 a year for medical coverage."

So the vendor sells employee info, and employees that take a pass get dinged for $300?

Exit question: how much cash does each employee get for the re-selling of their private health info? Oh, they "save" $300 on insurance?

Seems legit.

68,000 and Counting

The miracle and wonderment of ICD-10 has been blogged on before, but now that day is upon us. At

midnight September 30 someone will flip a switch and ICD-9 coding will be no more and will be replaced by ICD-10.

Sounds so simple, doesn't it?

The updated system has about 68,000 codes, essentially an expanded dictionary to capture more of the details from a patient's chart.

How precise? Get nipped feeding a bird, and the codes can distinguish if it was a goose or a parrot. Have a bike accident with one of those horse-drawn tourist carriages? Yep, there's a code for that, too. - Post Bulletin

What color was the goose?

The government says this will make life better and improve quality of care.

When has anything turned out the way the government promised?



#ICD-10  #healthcare  #medicalinsuranceclaims

ICYMI: Kaiser Foundation Lies

The lying liars at the Kaiser Family Foundation want us to believe that:

"Since 2008, average family premiums have climbed a total of $4,865."

And this, while they "calculate that deductibles have risen more than six times faster than workers’ earnings since 2010."

Now, how do we know that they're telling fibs?

Well, who ya gonna believe, KFF or:

Kudos to us!

So, just received word that we've been selected as one of the best Men's Health blogs by Healthline (a comprehensive health information portal). Healthline's editors chose us "based on quality, frequency of updates and contribution to the community." The full list is available here.

We're honored to be #2 (out of 10 selected). Thanks, Healthline!

Yes, The New York Obamacare Co-op Pissed Away $340 Million

I posed a question for this answer to IB readers back a year ago. In fact, Mike and I both wrote posts about New Republic dating back to January of 2013. So what's happening now?

New Republic is the health insurance cooperative in New York. They boast having the largest enrollment of any of the government funded co-ops with over 150,000 members. However, it is being shut down by the State of New York and CMS. This should not come as a surprise. Especially knowing that in 2014 they had the lowest rates (by far) in several areas across the state and weren't allowed the premium increases they requested by the New York insurance regulators for 2015. They hemorrhaged $77.5 million dollars in 2014 and another $57.2 million was lost over the first six months of 2015. Ouch.

A little history is important. Before New Republic we had the Freelancers Union. They had their own insurance company - Freelancers Insurance Company (FIC) that was notorious for consumer complaints. Freelancers ended up terminating the entity when Obamacare became a reality. As FIC was winding down, the union was in the process of creating a new venture which they received $340 million in Obamacare grants to start up a health insurance co-op. Instead of associating it with Freelancers, union leadership created a new non-profit which became known as New Republic.

We've already seen other co-ops bite the dust so why should we care more about this one? One word:  relationships. The relationship concern here is between the Freelancers Union, New Republic, and the Obama administration. Freelancers was established in 2003 by Sara Horowitz. Ms. Horowitz is a longtime close friend of President Obama. Back when President Obama was in the Illinois state senate, he and Ms. Horowitz worked together to launch the George Soros-funded liberal think tank Demos. It should also be known that Ms. Horowitz is a Deputy Chair of the Federal Reserve of New York and has been reported to have close ties with U.S. Senator Kirsten Gillibrand.

Having friends in high places has netted Horowitz and the Freelancers Union a nice chunk of change. Some may suggest that these co-ops were funded in the same scope as Solyndra. In this case it is not even close. This goes well beyond the scope of Solyndra. This didn't hedge on success of a new technology or product. This allowed our federal government to give huge amounts of money that went directly to lining the pockets of those who aligned and aided a political interest.

As we untangle the web we can see one thing - it's good to be one of Obama's political cronies. And for 150,000 people in New York, sorry but, if you like your plan you definitely aren't keeping it.

#LIAM2015: What's it's *Really* All About

So, two decades ago, George bought a 20 year level term policy. Two months ago, the initial rate guarantee period ran out, and his premium shot up dramatically (as they are wont to do). A month or so ago, we met to discuss options, at which time he decided to "let it ride," at least for a while.

Three weeks ago, he died on the operating table from a stroke.

Yesterday, I met with his widow to finalize the death claim paperwork (it took several weeks for the official death certificates to be processed).

And in another week or so, I will deliver a check for $250,000 (plus interest) to her.

There is really nothing remarkable about this process; after all, everything went as it should (save for the delay on the death certificates, which was out of our control).

And yet...

And yet, there is everything remarkable about it: over the years, George paid in several thousand dollars in premiums, a mere fraction of what his widow will receive. When we met last month, he was considering applying for a new policy with lower premiums and, of course, a lower face amount.

But he let it ride.

And in a week or so, I will be the only person in his widow's life who will be giving her money.

It just doesn't get any better than that.