Insurance is without a doubt the best business on earth. Every month, insurance companies from many industries collect premiums from thousands of clients, relying on the statistical likelihood the companies themselves will collect more than they pay out. If the company has a poor year, they raise the premiums for the next year. It is a beautiful business model and a way to guarantee consistent profits year after year. Even ...

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What happens when the federal government and the states have split responsibilities for caring for Medicaid beneficiaries? Not much, other than casting blame on one another or on doctors for not providing the care. Buried on page 26 of the front section of a recent New York Times is a story about Medicaid patients not finding doctors or having to traveling long distances to find one. It says a federal inquiry finds ...

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Its time to talk trade offs in health care An advantage of being a foreigner, or a recent immigrant to be precise, is that it allows one to view events with a certain detachment. To analyze without the burden of love, hate or indifference for the Kennedys, the Clintons or the Bushes. To observe with both eyes open, rather than one eye looking at the events and the other looking ...

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The recent independence referendum in Scotland got me thinking. I must admit I was glued to the news over the last few days of campaigning. For those of you not following closely, it seemed as if the "no" camp had a comfortable lead right up until the last week when the opinion polls suddenly showed the "yes" camp pulling ahead. This rattled the establishment. The prospect of my country of ...

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Baseball fans like me take great joy in studying the way general managers assemble their rosters. The variations are fascinating. Some teams focus on pitching strength. Others go for speed or power-hitting. Each approach carries distinct advantages and disadvantages on the field. That same level of variation and strategic decision-making applies to health plans, as well. With the health care marketplaces reopening for enrollment on Nov. 15, anyone evaluating their coverage options should take ...

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We recently had a readmission -- a straightforward case, really.  Mr. Jones, a 64-year-old homeless veteran, intermittently took his diabetes medications and would often run out.  He had recently been discharged from our hospital (a VA hospital) after admission for hyperglycemia.  The discharging team had been meticulous in their care.  At the time of discharge, they had simplified his medication regimen, called him at his shelter to check in a few ...

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On September 28, 1864, the first meeting of the International Workingmen’s Association (IWA) was convened at St. Martin’s Hall, London.  Among the attendees was a relatively obscure German journalist by the name of Karl Marx.  Though Marx did not speak during the meeting, he soon began playing a crucial role in the life of the organization, in part because he was assigned the task of drafting its founding documents. The work ...

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Primary care is essential to building a higher-performing health care system that promotes personal well-being and saves consumers and taxpayers money. Research shows that more primary care physicians in a community means lower rates of mortality, better preventive care, and fewer hospitalizations and emergency room visits. Unfortunately, too many Americans lack easy access to primary care.  Approximately 50 million Americans live in areas, mostly rural, with too few primary care physicians. ...

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How to improve doctor administrator relations A colleague at a hospital-based health system recently told me about physician alignment initiatives his employer was introducing. These included co-management deals (where doctors get per patient incentives for on-time discharges, and high quality scores) and new salary models that adjusted based on various metrics. At the same time, he noted, his hospital was laying off clerks, leaving him spending hours on clerical tasks ...

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I have written a couple of pieces documenting the high percentage of physicians who refuse to take Medicaid patients, and some of the reasons for their refusal. One of my pieces prompted a physician to email me with his take on this matter. I am going to quote from that email, but take out identifying information to protect his anonymity. Here’s what he ...

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