costs

King v. Burwell: With Decision Imminent It’s Still Anybody’s Guess How Court Will Decide

As the Supreme Court decision on subsidies looms, many are wondering:  which way is the court leaning?  Most experts agree it’s way too close to a call.

Wondering where things stand as we wait for the high court to announce its decision?

Here’s a good, plain speaking synopsis of why it’s too close to call.  It was reported by Amy Howe at SCOTUS Blog back in March right after the case was argued before the Supreme Court:

What’s the best combination of cost and care? Picking the right DOC still trumps all.

Last week I wrote about improving healthcare literacy. It’s an important and worthy goal. However, I always juxtapose this with something a highly respected physician colleague and friend said to me a few years back.  It really resonated with me back then and still does today.

He said that the push for improving the public’s health literacy and increased consumerism is good. The more knowledgeable people can become about their healthcare the better.  However, he also cautioned that the expectations of predicted great gains in cost savings and improved system efficiency from increased consumer knowledge were a bit unrealistic. They needed to be tempered.  Healthcare is so dynamic and so complex that as a physician he had to really work hard to stay on top of best practices, new developments in medicine, the cost and outcome implications of various types of treatment, etc. His point was that if he, as an experienced physician with years of training and treating patients had to work so hard to stay on top of the latest developments and trends, then it is unrealistic to expect that consumers with day jobs and no medical training at all could understand the complexities of our healthcare system.

woman handshaking with doctor after checkup

We know from years of analyzing data and our experience that the most experienced doctors with good teams around them deliver the best possible outcomes – clinical, functional and financial.

So I think the best bet – whether it’s you, your family members, or your employees – is still to do your homework and choose the best and most experienced doctors around.

Last week’s post in case you missed it…

 Health Insurance Literacy: Too Complex For Some?

Big Pharma Companies Prescribe Higher Prices

An article about big pharma companies and their pricing policies show a trend toward sharply rising drug prices. It doesn’t seem likely that it will slow down any time soon. I warn you – there’s tons of details to consider when it comes to pharmaceutical drug costs. Here are some key takeaways:

  • Big Pharma is in a period of intense consolidation
  • The cost of brand-named drugs is soaring
  • Starting prices of new drugs are escalating
  • More concentration in a therapeutic area = higher prices
  • Generic drugs now make up 86% of all medicines used in the U.S. but that hasn’t reduced total spending on prescription drugs
  • The economics of prescription drugs are unique compared to other major markets
  • Turf wars between drug makers are driving costs higher
  • Rising prices of brand-named drugs is roughly equal to losses due to patent expirations

If you or your employees are concerned about the rising cost of drugs, stay tuned…you’ll see more about this hot topic from us.

To read the entire article, read Big Pharma’s Favorite Prescription: Higher Prices as seen on BusinessWeek.com

Where Are Our Healthcare Dollars Being Spent?

Quite often in the course of working with our clients on practical and innovative approaches to lower their healthcare costs or mitigate pending increases, we are asked two questions:

“Why is healthcare so expensive?” And “where is the money going?”

The first question is so hugely complicated there may not be enough bandwidth on the internet to analyze it and address it in writing. The second question was addressed in a recent study published by the Agency for Healthcare Research and Quality and related in easier to read fashion in a joint Kaiser Health News/Washington Post article.

While this is really big picture stuff, in answering the question on where the money is being spent, they present some interesting (perhaps only to analytical geeks like me) and startling facts worth taking a moment to contemplate:

  • In 2010, Americans spent @ $1.3 TRILLION on healthcare (This addresses direct payments for care provided during the year.  It jumps to $2.8 TRILLION when you include health care goods and services, public health activities, government administration, the net cost of health insurance, and investment related to health care).
  • 1% of the population accounted for 21% of the $1.3 TRILLION spent.
  • 5% accounted for 50% of all healthcare expenditures.  And, 10% are credited with 66% of the healthcare spend.
  • Contrast that with the 50% of the folks in the U.S. that accounted for less than 3% of the costs.

Our BBG world is micro and hyper-intensively focused on helping mid-size and small employers control costs and improve outcomes one employer at a time. We can’t even begin to suggest we know where the big picture solution lies. That’s for folks a lot smarter and better equipped. It does appear clear however, even to this lay person, that to put a dent in this ever growing cost curve, the lion’s share of the resources and efforts must laser focus on solving the 5% accounting for 50% cost equation…

For more on the study or the article, go here:

http://meps.ahrq.gov/mepsweb/data_files/publications/st421/stat421.shtml

And, here: www.kaiserhealthnews.org/stories/2013/october/08/one-percent-of-costliest-patients.aspx

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