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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

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  • Six months after making national headlines, Braxton Moral is set to graduate high school and get a degree from Harvard University -- and the accomplishments will be made days apart. Moral, 17, graduated from Ulysses High School in Ulysses, Kansas, on Sunday. He will graduate with a Bachelor of Liberal Arts degree in government from Harvard Extension School May 30, ABC News reported. He minored in English at the school. >> Read more trending news  “I’m relieved to have a little bit of a head start,” Moral told “Good Morning America.” “I thought it really broadened my horizons. It helped me understand new things and what I want to do (in life).” As part of Harvard Extension School, Moral has been going to college and K-12 since he was 11 years old. “My parents noticed I was bored in school and needed something to inspire growth, so they ended up finding the Extension School,” Moral told CNN. Moral’s parents knew that their son was intellectually gifted at a young age, and was noticed by one of his professors at Harvard, too. “Intellectually, he is extraordinary, but more than that, it is his discipline and endeavor which has enabled him to begin adult life with such startling success,” Kevin McGrath, an associate professor in south Asian studies who taught Moral at Harvard, told “GMA.” Related: Kansas teen graduating from high school, Harvard in same month Next, Moral hopes to go to Columbia University and study constitutional law. Moral has written about his experience in his book, “Harvard in the Heartland,” which will be released in September.
  • Officials with Eastern Virginia Medical School said Wednesday that a three-month investigation into how a racist photo appeared in Virginia Gov. Ralph Northam’s 1984 yearbook ended inconclusively. >> Read more trending news Officials launched an investigation into the photo, which showed a man posing in blackface next to a person in a Ku Klux Klan robe, after it surfaced Feb. 1. School administrators said they’d investigate the image’s origins and the broader campus culture in the 1980s as part of the probe. Update 10:55 am. EDT May 22: Attorney Ben Hatch, a partner at McGuireWoods, the law firm that conducted the independent probe, said investigators were unable to determine who was in the racist photo or how it got into the yearbook. “We could not conclusively determine the identity of either individual depicted in the that photograph,” Hatch said Wednesday at a news conference. “No individual that we interviewed has told us from personal knowledge that the governor is in that photo and no individual with knowledge has come forward to report to us that the governor is in that photograph.” Investigators interviewed 52 people over the course of their probe, including administrators, faculty, staff, current students and alumni at EVMS. On Wednesday, they shared details of the 36-page report developed from the probe. Hatch said investigators, hampered by the time since the yearbook was published, were unable to determine exactly how the photo got in the yearbook. He noted that several images were found in EVMS yearbooks between 1976 and 2013 -- when the school stopped publishing yearbooks -- that could be considered offensive to women, minorities and others. Original report: Officials including EVMS President Richard V. Homan and attorneys with the McGuireWoods law firm, which conducted the investigation, will hold a news conference at 10:30 a.m., according to the Richmond Times-Dispatch. >> Embattled Virginia Gov. Ralph Northam conducts business as usual, no plans to step aside Northam initially admitted to being one of the two people in the photo after it surfaced, but he later walked the statement back and said he was unaware of the photo before his staff showed it to him in February. He did, however, admit to wearing blackface to imitate Michael Jackson during a dance competition in the 1980s. “There were actions and behaviors in my past that were hurtful,” he said during a February news conference, according to WDBJ. “But like Virginia, I have also made significant progress in how I approach these issues.” >> Va. Gov. Ralph Northam says he plans to finish term with devotion to racial equity Eastern Virginia Medical School banned yearbooks in 2014, according to The Washington Post. The controversy surrounding Northam’s yearbook photo is one of several high-profile scandals that gripped the highest levels of Virginia state government earlier this year. Less than a week after the photo in Northam’s yearbook surfaced, state Attorney General Mark Herring admitted to wearing blackface to a party in the 1980s. Days after that, Lt. Gov. Justin Fairfax was accused by two women of sexual assault, allegations he denied.
  • After 79 years of marriage, an Illinois couple are still living a sweet life. >> Read more trending news  Curtis Peters and Virginia Gregory were married in Knoxville, Iowa, on May 18, 1940, according to Iowa marriage records on Ancestry.com. Curtis Peters is now 100, and Virginia Peters is 103, and they celebrated their anniversary last week.  Their hearts have melted ever since their marriage, and they share a Hershey’s chocolate bar daily, according to WQAD. “Chocolate keeps him going, and he keeps her going, they love each other very much,” the couple’s daughter, Susan Peters Cathoir, told the television station. The couple moved from Iowa to a nursing home in Illinois to be closer to Cathoir, the fourth of the Peters’ five children. Cathoir told “Today” there was always chocolate around the home when she was growing up. Cathoir said her parents even melted Hershey’s bars so the family could dip their ice cream into the chocolate. The couple even took the family on a bus trip from Iowa to Pennsylvania in the late 1950s to visit Hershey Park (now Hersheypark) to see how their favorite sweet was made, according to “Today.” The couple met while living in Cedar Falls, Iowa, where they attended the Iowa State Teachers College (now the University of Northern Iowa). After their marriage, Curtis Peters was a self-employed painter in Waterloo, while Virginia Peters was a teacher, WQAD reported. “It’s a long, long time, but they are good times,” Virginia Peters told the television station. The Peters’ children bring chocolate whenever they visit. 'I keep a pack in the freezer and go and give them one every day.” Cathoir told “Today.” I always leave chocolate in their drawer so in case I can't make it or I'm late, one of the (nurses) can make sure they still get it.” Cathoir said the Hershey’s bar keeps her father alive, “and he keeps her alive.” 'He shares it with her all the time — he shares everything with her and she with him,” Cathoir told “Today.” “Yes, and they are still madly in love, isn’t that great?” their nurse, Julie Derick, told WQAD. “They hold hands all the time.” The couple celebrated their 79th anniversary last weekend with family and friends, the television station reported. Chocolate was definitely on the menu.
  • A Tennessee man is accused of threatening police officers and rolling up a marijuana blunt in front of them. >> Read more trending news  Lemink Mitchell was arrested Tuesday in Memphis, WHBQ-TV reported. Memphis police said they were called to the home because Mitchell was threatening to kill his mom after she kicked him out. She wanted officers to get him out of the home, police said. When officers arrived, they said he threatened to kill them, too. Police said while they were talking to him, he started to cuss at them. “He don’t give a (expletive) that officers are right here. He is going to do what he want to do,” he told the police. He then rolled up some marijuana into a blunt before trying to escape, police said. Court records said multiple people came out of their houses while he was running away. After a short chase, Mitchell was arrested. Mitchell is facing multiple charges, including disorderly conduct and evading arrest.
  • A Virginia woman who recently died had some extreme, and illegal, final wishes. She wanted her dog Emma euthanized so the dog and the woman could be together forever. Workers at Chesterfield Animal Shelter were caring for Emma for two weeks as they tried to dissuade the executor of the woman’s estate from going through with the woman’s plans. The workers tried to get the person to sign over the ownership of the dog to the shelter so workers could find the shih tzu mix a new home, WWBT reported.  The person held firm and picked up the dog and then took it to a vet’s office, had it put down and then taken to a pet cremation business. The remains were put in an urn and returned to a representative of the woman’s estate. >> Read more trending news  WWBT did not say how the remains were handled after the pet’s cremation. But there was an issue. While it is technically legal to put down a healthy pet in Virginia, there is an ethical question surrounding it, so it could be difficult to find a veterinarian to put down an animal, according to WWBT.  But it is illegal in the commonwealth to bury an animal’s remains, whether it is a dog or any other animal, in a casket in a cemetery. But the law applies only to a commercial cemetery. Private and family-owned cemeteries can be an exception to the law, WWBT reported.