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Opinion
One Man’s Opinion: Route to Lower Health Care Prices Still Mapped by Private Sector
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One Man’s Opinion: Route to Lower Health Care Prices Still Mapped by Private Sector

One Man’s Opinion: Route to Lower Health Care Prices Still Mapped by Private Sector

One Man’s Opinion: Route to Lower Health Care Prices Still Mapped by Private Sector

No longer able to rely on traditional cost sharing techniques to manage costs, a growing number of employers are taking an activist role in shaking up how care is delivered and paid for," said Brain Marcotte, CEO of the National Business Group on Health, as reported by CNN.

Healthcare remains the only major economic sector and consumer of roughly 20 percent of the GDP, where the customer generally has no idea on costs, particularly on an insured procedure, medical appointment or prescription drug until AFTER they place the order or receive the service. 

Many employers, large and small, who want healthy employees and want to provide benefits have found the current service and funding model to be irreparably broken, and an increasing number of larger companies are employing direct service plans, ranging from onsite medical clinics to incentivizing wellness and Health Saving Account options (HSA), which are particularly popular among younger/healthier employees. 

In an odd twist of irony, well over 24,000 GM salaried employees across southeast Michigan will next year be able to select such a less expensive service delivery model (with significantly lower premiums) with care provided exclusively by the Henry Ford Healthcare System. Ford Healthcare will provide all medical services, surgeries, and E.R. visits, as well as prescription and pharmaceutical products via its network of six hospitals, 3000 doctors and health care providers through GM's new "Connected Care" plan. GM's thousands of hourly workers and Union employees will continue to receive health care via a contracted benefits plan and more traditional service model. Connected Care will also provide wellness exams, chronic care monitoring and preventative screenings, in addition to prompt appointments with providers and virtual visit options delivered via telemedicine. 

Comcast, the nation's largest cable provider and owner of NBC networks as well as Universal Parks & Resorts, is turning its $169-billion behemoth ship as well as holding the annual increase in its health care costs to roughly 1 percent a year. Comcast spends roughly $1.3 billion a year on health care for its 225,000 employees and their families. But instead of charging their employees higher premiums, Comcast has instead selected a flat up front deductible expense (subtracted from payroll) of on average $250.00 per employee. That is an ANNUAL figure. 

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Healthcare Bill Crane

Instead of handing this massive headcount to any leading insurer, Comcast is directly contracting with a handful of highly specialized service providers. Comcast uses several technology start-ups, one of them called Accolade (in which Comcast is also an investor) providing employees with health care Navigators to help them understand, as well as guide them through the host of service and treatment options. The focus is on keeping the employee healthy, without requiring them to become expert at managing co-pays, deductibles, generic drug costs or nearly requiring a medical certification or training if a member of their family is chronically ill. 

Another Comcast system provider, Grand Rounds, is available for more complicated health care challenges, serving as both a check on costs and charges, and a referral network of skilled practitioners for more complex surgical and related treatment needs. Insurers hardly love this delivery model, which treats them like an expensive middle-man, providing little or no real value or return on investment. 

Some insurers are receiving that message and also responding in the marketplace. Following a raft of research which demonstrates that health care costs decline when a consumer’s basic social and well-being needs are met, WellCare Health Plans of Tampa, Florida opened a call center for customers needing assistance with housing, transportation and other social concerns...now being connected to community and social service organizations, in addition to health care providers. 

Kaiser Permanente in Oakland, California, is investing $200-million in projects to protect and preserve affordable housing in the Bay area, to revitalize challenged neighborhoods as well as improve overall community health. United Health Care has partnered with another start-up called Healthify to use software in pre-screening new insured clients to better assist them with identifying social service and community support groups in addition to better coordinated care among their network of service providers to help insure better patient outcomes. 

Our traditional health insurance/government hybrid service delivery model has long been in need of a check-up and some surgical upgrades. Unfortunately our state and federal government leadership typically lacks the courage or stomach for touching this proverbial 'third rail' of American politics...leaving the private sector once again to try and shine a light and lead the way. More power, and more innovation to them.

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News

  • Union County sheriff’s detectives were staking out an area Thursday near Wesley Chapel, North Carolina, when they saw two males leave a red vehicle. >> Read more trending news The suspicious people put on ski masks and hoodies and kicked in the front door of a residence. Detectives 'noticed they started putting on ski masks covering their faces putting hoodies on their heads, then they made their way toward the house and kicked the front door in,' said Tony Underwood with the Union County Sheriff’s Office. Patrol officers were called in and after a short time, the intruders left the house carrying a bag and got back into a vehicle where a driver was waiting. Authorities stopped the vehicle near Goldmine Road and Corporate Center Road. 'I heard sirens, and I saw a lot of Sheriff's Office deputies driving really fast down the street,' neighbor Shannon Skiscin said. Two of the suspects were taken into custody and the third fled on foot but was apprehended a short time later. Inside the vehicle, authorities found a 9 mm handgun, Taser, cellphones, ski masks and about 1,100 Xanax bars. The three suspects were Gabriel Alexander Oyuch, 20, of Matthews, Jaydan Burwell, 20, of Charlotte, and Michael Lamonte Byrd, 24, of Charlotte.  'I've never (sic) known nothing to happen,” neighbor Tammy Heath said. “I've fallen asleep with my door unlocked.' Detectives then executed a search warrant for the home and found marijuana, about 200 Xanax bars, Roxicodone and more than $2,400 in cash. The two people arrested in the home were Michael Joseph Tabbit, 18, of Wesley Chapel, and Jonathan Troy Sierski, 20, who lives at the house. Oyuch was charged with robbery with a dangerous weapon, conspiracy to commit a felony, felonious breaking and entering and possession with intent to sell and deliver a Schedule IV controlled substance.  Burwell was charged with robbery with a dangerous weapon, conspiracy to commit a felony, felonious breaking and entering, felony larceny and possession with intent to sell and deliver a Schedule IV controlled substance.  Byrd was charged with robbery with a dangerous weapon, conspiracy to commit a felony, felonious breaking and entering, felony larceny and possession with intent to sell and deliver a Schedule IV controlled substance.  Tabbit and Swierski also face numerous drug charges. “Outstanding police work,” Union County Sheriff Eddie Cathey said. “Deputies were in the right place at the right time to apprehend armed criminals who boldly entered an occupied residence in the middle of the afternoon. A situation like that could have ended much differently.”  The home invasion was not a random crime, authorities said.
  • Police are searching for a man accused of stealing a car from a Midtown high-rise condominium parking garage last week. The car was stolen from the Spire condos at 860 Peachtree Street on Feb. 5, Atlanta police said in a Friday news release.  The man slipped through the side of the parking gate and began pulling on car door handles and entering vehicles, the release said. The car that was stolen was a 2009 Honda Accord, which the victim said had been left unlocked with the key inside, the release said. A 9mm Glock handgun was also inside the vehicle when it was stolen. Anyone with information on the this incident is asked to contact CrimeStoppers at 404-577-8477 or online at www.StopCrimeATL.com. Tips can be sent anonymously and information that leads to an arrest and indictment in this investigation can earn tipsters up to $2,000. In other news:
  • One man was arrested after police in Florida said he allowed an underage girl to take the wheel during a trip to the store, according to the Brevard County Sheriff's Office. >> Read more trending news Officials said a vehicle was observed be driven into the opposite lane and into dirt off the side of the roadway Thursday in the area of North Tropical Trail at about 6:15 p.m. Police came in contact with the vehicle, where 62-year-old Mark Papczynski said he allowed the girl to drive to the store 'to get her a snack and himself another 18 pack of beer,' according to an arrest report. Papczynski admitted that letting the girl drive was dangerous. In a post-jail interview Papczynski said, 'I was brought up in the old school, where parents always taught their children the ways of life,' in regards to the incident. He also said that 'it wasn't like she was doing it for the first time.' He faces two charges of child neglect without great bodily harm and permitting an unauthorized person to drive, according to jail records.
  • It was a busy day for Atlanta rapper 21 Savage Friday, starting with a pretaped appearance on “Good Morning America,” followed by being booked into a South Georgia jail on a felony theft by deception warrant. He was later released, according to the Liberty County Sheriff’s Office. >> Read more trending news The Friday legal matter is connected to a concert booking from 2016 for which a promoter paid the musician, whose real name is She’yaa Bin Abraham-Joseph, $17,000, TMZ reported. The rapper kept the money but did not perform, so the promoter filed paperwork to get a warrant issued for his arrest, according to TMZ’s report. “The warrant is from some years ago, and he went through the process and addressed the issue,” Liberty County Sheriff Steve Sikes told the Coastal Courier newspaper in Hinesville.
  • A Florida man said he was going through his morning routine when he walked out of his apartment bathroom and realized his Nest security camera was on. >> Read more trending news Adam King said he then heard a voice he did not recognize. 'The light came on and caught my attention, and I believe he said, 'No one wants to see that,'' King said. 'He had an accent, proceeded to do some shuffling of the microphone. When I left the bedroom, some music or audio of some (sort) came on.' King said someone was using a computer or cellphone to watch him through the Nest app. He said he walked into his living room to search for his cellphone or his iPad so he could turn off the camera, but he was unable to, because the other person had control of the app. 'I had no choice but to come right back inside and unplug the camera,' King said. Nest, which is owned by Google, provided WFTV with the following statement: 'Nest Security has not been breached or compromised. Customers may be vulnerable because their email addresses and passwords are freely available on the internet. If a website is compromised, it's possible for someone to gain access to user email addresses and passwords, and from there, gain access to any accounts that use the same login credentials.' Jason Cook, a Florida Department of Law Enforcement cybercrimes supervisor, said it is important to use a secured network. 'It's your thermostat. It's your home surveillance system, your washer and dryer, Wi-Fi, controlled outlet sometimes,' he said. 'They're all running through your network, and if your network isn't secured, all of that stuff is vulnerable.' Nest said that it encourages users to utilize its two-layer authentication process. King said he is unwilling to put his privacy at risk again. 'I don't want to put my camera back up on the wall in fear it could be hacked again,' he said. The company spokesman would not estimate how many customers have experienced similar issues.
  • Special counsel Robert Mueller’s office recommends that President Donald Trump’s former campaign chairman Paul Manafort serve a sentence of 19.5 to 24.5 years in prison after being convicted of eight financial crimes in Virginia. >> Read more trending news The sentencing memorandum also recommended a fine of up to $24 million. Though Mueller’s office did not recommend a precise sentence for Manafort, prosecutors said they agreed with a calculation by federal probation officials that his crimes deserve a punishment of between 19 and 24 years. They also lay out in great detail for U.S. District Judge T.S. Ellis III how they say Manafort’s greed drove him to disregard American law. “In the end, Manafort acted for more than a decade as if he were above the law, and deprived the federal government and various financial institutions of millions of dollars,” the prosecutors wrote. “The sentence here should reflect the seriousness of these crimes, and serve to both deter Manafort and others from engaging in such conduct.” Earlier this week, a federal judge ruled Manafort not only lied to Mueller’s team, he made false statements after agreeing to cooperate with the Special Counsel’s Office, according to court documents. >> MORE: Judge rules Paul Manafort intentionally lied after agreeing to cooperate The judge also found that Manafort lied in statements to investigators and the grand jury about finances related to a pro-Trump super PAC, that he lied about his communications with alleged Russian intelligence agent Konstantin Kilimnik and that he lied about information in another Justice Department investigation, among other false statements. Manafort’s attorneys have denied any wrongdoing. Officials said he’s turned over access to his electronic devices and email accounts as part of his cooperation. >> MORE: Paul Manafort appears in court after allegedly lying to investigators Last month, defense attorneys said Manafort has been kept in solitary confinement for his own safety. He’s had severe gout for several months of his incarceration, according to his attorneys, and it’s sometimes been severe enough to require that he use a wheelchair. The Associated Press contributed to this report.