Consumers For Health Care Choices: Tony Miller, Pioneer in Benefit Design

Tony Miller co-founded Lemhi Ventures in 2006 to build the capital base and value added approach of forming and helping companies continue to advance the marketization of the healthcare industry. Additionally, Mr. Miller is part of the leadership team at Carol Corporation, a Lemhi Ventures Portfolio company. Mr. Miller serves on the Boards of VisionShare, and Carol Corporation. Prior to founding Lemhi Ventures, Mr. Miller was a co-founder and CEO of Definity Health, a national market leader in consumer-driven health benefit programs, which was sold to UnitedHealth Group in 2004.

Courteous and Efficient Self-Service: Methods for Increasing Patient Satisfaction

Stephanie Monette, Senior Systems Analyst, St. Mary’s Health Plans talks about increasing patient satisfaction at the Healthcare Communications Forum, hosted by Insight Forums.

One of the best ways to improve customer satisfaction in any field is to empower those customers to tend to their own needs to the greatest degree possible. Happily, embracing such a philosophy self-service benefits the service provider as well by reducing the load on the call center and thereby lowering costs.

St. Mary’s Health Plan has achieved this twin outcome by deftly applying Web technology to its patient interactions. Members have online access to eligibility requirements, referrals and authorizations, claims status, and much more, and satisfaction rates have increased as a result.
This session will detail how St. Mary’s came to implement its self-service program, the business and technology challenges it faced when doing so, and the benefits it realized as a result.

Stephanie Monette

Stephanie Monette
Senior Systems Analyst, St. Mary’s Health Plans

Stephanie Monette has been in the healthcare industry with Saint Mary’s for 15 years. In that time, she has held many positions in several departments: claims, provider relations, member services, and client services. Now Senior Systems Analyst, she participated in the implementation of Healthx for Saint Mary’s online enrollment, and member, provider, and employer services.

Ms. Monette is now the superuser and trainer, and is responsible for the activities related to system support, maintenance, development, utilization, and enhancement of Saint Mary’s Health Plans computer databases. She is very active in the Northern Nevada Association of Health Underwriters and has held the positions of Secretary, Awards chair, State Secretary, and currently, local President.

Michael Moore on California’s Single Payer Proposal

Daniel Carlat, a professor at Tufts Medical School, and editor in chief of The Carlat Psychiatry Report, wrote a telling op-ed in the New York Times a few weeks ago.

In it, he argues that pharmaceutical involvement in doctors’ continuing medical education is having dangerous side effects for the very simple reason that the dangerous side effects of various drugs rarely make it onto contemporary curriculums.

Most states require that doctors obtain a minimum number of credit hours of continuing medical education each year to maintain their medical licenses. Not so long ago, most of these courses were produced and paid for by universities and medical associations. But this has changed drastically over the past decade.

According to the most recent data available from the national organization in charge of accrediting the courses, drug-industry financing of continuing medical education has nearly quadrupled since 1998, from $302 million to $1.12 billion. Half of all continuing medical education courses in the United States are now paid for by drug companies, up from a third a decade ago. Because pharmaceutical companies now set much of the agenda for what doctors learn about drugs, crucial information about potential drug dangers is played down, to the detriment of patient care.

On the face of it, this seems to be a conflict of interest, and a precursor to bad medicine. Carlat mentions as much, writing how Merck promoted Vioxx through various CME programs, just as GlaxoSmithKline promoted the now-troubled Avandia while downplaying both the drug’s side effects on the increased levels of lipids associated with heart disease, and a competitor’s drug (Takeda Pharmaceuticals’ Actos) that actually improves lipid levels.

While the Accreditation Council for Continuing Medical Education prohibits pharmaceutical companies from directly paying doctors to teach CME courses, the industry’s not so very hidden secret is that they simply pay a third party, who, in turn, pay the doctors.

Carlat’s idea to close this loophole is relatively straightforward:

The solution could hardly be simpler: any continuing medical education that is paid for by the drug industry should not be accredited. Drug companies could still pay for any educational event, article or pamphlet they choose, but their courses and materials would no longer bear the imprimatur and implied credibility of accreditation.

Doctors, in turn, would be encouraged to seek medical education from sources that are not financed by drug companies. A renewed commitment to unbiased education would allow doctors to learn about drug risks sooner. This would be good for doctors, and even better for their patients.

Sounds reasonable, and the guidelines for commercial support of CME are being reviewed after a report released by the Senate Finance Committee drew attention to the problem.

We’re cautiously optimistic as we await the results.

Michael Cervieri is ScribeMedia.Org’s Executive Producer and host of the HealthDot Pharma Report.

A Bank Teller’s Blank Stare and Other HSA Learnings

Just for fun, I went into the Citibank branch closest to my office. I asked the teller “Can I open a Health Savings Account, or an HSA, with Citibank?” The look on her face, and the teller next to her, was priceless. It was an American Express moment.

While one teller could not move past the permanently perplexed look (she was a deer in headlights), at least the other one, Vicki, realized she knew how to figure out the answer. She went to her computer console and did a search. Lots of scrolling later, she found…CitiBank Health Savings Account!! They do offer one. Now only if their employees knew this. She read the description out loud to me, and herself. It was the first time she ever heard of it.

As an aside, we then talked about her insurance coverage as a CitiBank employee. She has a PPO. She pays $80 per month. She believes this is the total cost of her insurance, that CitiBank does not make any contribution. Maybe I’m wrong, but I’m assuming her total insurance coverage is not $960 per year.

My message to banks and insurance companies. You really stink at explaining HSAs to people. Your own employees don’t even know what they are. Don’t get me started on…too late, you just did…

I’m going to link today’s bank experience to yesterday’s experience with our broker and prospective HSA provider, Empire Blue Cross Blue Shields. First of all, our broker had never sold an HSA before. And he wasn’t very happy we even wanted to go that route. After many Indian sunburns, we finally got him to submit a few plans for our review. None were all that good. A conversation with Roy Ramthun, President Bushes former health policy advisor, helped me understand why. New York is not a very HSA friendly state. And insurance companies don’t have a lot of incentive to provide competitive plans. And brokers don’t have incentive to sell a plan that offers them less commission.

As any good intentioned company would do, we asked our broker if he could come in and explain HSAs to employees. We had decided that we would offer people a choice – our regular old Aetna plan, which, surprise surprise, had gone up 30% in price since last year (while every other product and service in the economy except for gas FELL IN PRICE) or an Empire HSA.

Since he never sold an HSA before, he tried to get the Empire point person to come in with him. She was generally hard to get a hold of. But finally, a meeting was set. “We can come in tomorrow”, they said. So much for advanced warning, but we take what we can get.

So when they showed up, she brought someone with her who was more knowledgeable about HSAs than she was…cause she didn’t know squat. I probably know more about HSAs than her.

Generally, the meeting was helpful. But it was more guided by our knowledgeable questions than their ability to put on a great presentation. What I mean is that if we had not asked the questions we asked, I don’t believe they would have done a great job conveying the information that I believe any company, and its employees (the entire staff attended the session), would need answered to make informed decisions about whether an HSA is right for the company, or the individual employee.

What is your company experience? Do you have the support you need to educate employees about HSAs or other options? Are your brokers and agents well informed? If you are a broker, have employers been asking about HSAs?