You hear whispers of it on the wind, legends of time where one person saw one doctor, who knew all of their past ailments, and truly cared about their health and well being. This standard has seemed to have fallen by the wayside in the recent years, among all the chaos and hubbub of the current United States healthcare system. Doctors now get paid per patient they see per day, so crammed waiting rooms, curt visits and impersonal service have become the norm, and we have gotten so used to it that we haven’t even considered an alternate way of doing things. But take of your goggles of disbelief, because a more personal, cozy model of health care is being buzzed about.

What is the Medical Home Model?

Three years ago, the healthcare guru’s over at IBM started looking at what they were doing to improve the quality of life for their employees and realizing they were overlooking a crucial component: healthcare. After realizing this crucial change that needed to be addressed, the director of healthcare transformation at IBM, Dr. Paul Grundy, helped found the Patient-Centered Primary Care Collaborative (PCPCC). This coalition of large employers, consumer organizations and medical providers developed the Medical Home model, and its combination of old school patient care combined with the latest in medical communication technology makes this unique and optimistic proposal for healthcare. Under the Medical Home proposition, one doctor would act as a coach for the team of specialists treating one patient, including things like preventative, holistic and wellness needs. More time is spent with the patients in person than you are probably getting from your doctor now, and the doctor is accessible on the phone and via e-mail in addition to extended office hours and coordination of care across the entire medical team.

Advanced Technology and Medical Care

The sharing of a patient’s health information via an EHR, or electronic health record, is an integral part of how the Medical Home model works. An EHR can help to reduce errors, eliminate duplicate tests, highlight drug interactions, improve overall quality of care and reduce costs. This interweb of information can allow a patient to access a web portal to schedule appointments and check their lab results, patient registries and e-prescriptions. With the click of a mouse, information about a patient’s health can be shared across a network of healthcare providers, and patients can always stay in the know about their treatment, doctor recommendations and medications by hopping online or picking up the phone. Instead of wasting precious free time that most of us don’t have, you would be able to utilize the tools readily available to you in the form of your phone and computer to stay in touch with your physician. Doctors would get extra money for being available for the patients in odd hours, and offices can get a little bit more money by implementing the technological changes necessary to upgrade the office. Phone and e-mail consultations would be reimbursed.

(more…)

Read the Fine Print

As I’ve mentioned in another blog, it would be a pretty amazing feat to make it into your golden years without having at least one “pre-existing medical condition.” The human body just can’t stay in peak condition until the end of one’s life, so having some medical baggage is perfectly normal for a senior. Since long term care insurance policies are designed with the elderly in mind, they are a little more lenient than other types of insurance plans when it comes to covering pre-existing medical conditions. This doesn’t mean that they welcome everyone with open arms. You need to be aware of this, and get very clear with insurance carriers about what their pre-existing medical condition clause it, get it in writing, and scrutinize every word.

(more…)

In the past few years, you couldn’t turn on the television without seeing an advertisement for some new kind of drug. Erectile dysfunction, blood pressure, allergies, and restless leg syndrome (yes that is real) are all some of the drugs you may have seen splashed boldly in front of you on the screen. If you have been paying close attention, or just spend hours glued to the television, you may have noticed that drug ads have become less and less frequent throughout 2008. What’s causing this ad-less phenomenon, and is just due to the struggling economy?

Drugs Are Denied More Than Approved

Many drug companies are getting many of their fancy new drugs approved by the FDA and other regulatory bodies, so there’s no point in spending money advertising a drug that no doctor is going to buy and prescribe. If drugs are making it past the rigorous approval process, they are often drugs that target smaller population groups, like a cholesterol drug. There is no sense on spending millions on advertising on a drug that won’t be treating millions of people. According to figures from TNS Media Intelligence, U.S. drug ad spending dropped 6% in the first eight months of 2008, to $3.2 billion. That comes after a 3% dip in the full-year 2007, which had a total of $5.3 billion. Ad spending had generally been upward previously, peaking at $5.4 billion in 2006.

A Change in Media

You may not have realized this, but most of the ad spending done by drug companies is in the form of print ads. I don’t read magazines much anymore but when I did, I would see a ton of different drugs being advertised, varying heavily from magazine to magazine and their target audience. As with so many things, the trend now is headed toward the online world. People want their information in an instant, and web advertising can provide that. While you can easily flip through a magazine and read a drug’s information there, it is so much easier for a consumer to have an ad pop up on their screen, click on it and then read all the information they ever wanted to know about a particular drug. It makes complete sense to funnel money into online advertising (but then again, I encourage everyone to get online, whether it’s for fund raising, communication or shopping). Drug giant AstraZeneca told Dow Jones Newswires that some 20% of its consumer marketing budget was for digital advertising this year, up from around 15% in 2007. 1/5 of a company’s marketing budget going toward making sure online consumers get the drug message? It seems smart to me on the part of the drug companies.

(more…)

The term “Medicaid issues” is rather vague, and you can let your fingers do the walking online if you are wanting to learn more about Medicaid plans. Medicare Advantage, however, is more specific. These are health insurance plans that are a part of the Medicare program, and they include things like:

• Medicare Health Maintenance Organization (HMOs)
• Preferred Provider Organizations (PPO)
• Private Fee-for-Service Plans
• Medicare Special Needs Plans

The interesting thing is that these plans do exist and are available under Medicare, so it is only my educated guess that Health Net was lobbying to reduce restrictions here as well, possibly opening the doors to more potential members and not barring people for health issues.

Considering that Medicare is intended to provide health care to our elderly population, trying to keep people from getting health coverage based on preexisting medical conditions is pretty absurd. You show me one 75 year old who has made it that far in life without bringing any medical baggage along with them and I’ll buy you a cookie.

(more…)

There are some health insurance companies where you feel like you are being taken advantage of at every single turn. Hidden charges show up on bills, you don’t have an easy time getting in to see your doctor, and you may spend upward of an hour trying to get the right person on the phone for customer service. This is not to say that health insurance companies exist simply to frustrate you: quite the opposite. Sometimes they just do not seem like they are doing all they can to best serve your interests as a consumer or customer. Health Net, one of America’s biggest health insurance companies serving over 6.7 million people across the country, has recently stepped up to the plate big time in the game of keeping people’s best interests (and health) at heart. In the third quarter of 2008, the insurer spent $670K lobbying with the federal government for a variety of different groups and lifting coverage restrictions.

(more…)

Yesterday, we looked at the types of health reform that Obama plans on instituting. Today, we’ll look at how these plans may be carried out.

If you were hoping Obama was going to charge in on his gallant steed and change the way health insurance operates in this country, you are probably mistaken. “The Obama plan is actually quite traditional,” says John Sheils, Senior Vice President of the Lewin Group, a health care policy research company. “It is very similar to the proposals made by other democratic candidates during the primaries.” This isn’t something to get down about, but realistic expectations should be held near and dear. Although there are some changes and extensions that Obama is hoping to make to the way things operate currently, what he drafts and what actually makes it through Congress are another story.

Bill Clinton and George Bush didn’t get bills passed simply due to lack in trying. Congressional support from the Democratic members, as well as their input, is going to be a crucial component of how the health care and insurance turns out for all of us, so that is what you will want to keep your eye on.

(more…)