There’s a fair amount of fear on display these days from some of the most powerful people and institutions on the planet. Trump's afraid of Nancy Pelosi. Billionaires at Davos are afraid of Ocasio-Cortez. Microsoft’s afraid of affordable housing and homeless advocates. And the health care status quo is afraid of losing its ability to charge whatever it wants for its products and services. If history is any indication, this high-powered group of scaredy-cats will ignore their opposers or attempt to appease them with small (in proportion to their total resources) gestures.

Just look at how they've responded so far.

Appease: Trump, unwilling to admit defeat to Nancy Pelosi, agrees to temporarily not get his way.

Ignore: Michael Dell, CEO of Dell Technologies and billionaire attendee at Davos, says voluntary philanthropy is a better solution to inequality than taxing the uber rich. (Like that's worked so far.) He also falsely claimed that increasing rich peoples’ taxes hurts economic growth. Bottom line: Mr. Dell thinks that he knows better than the government how to “fix” inequality.

Appease (with a catch): Microsoft, responds to years’ of criticism for exacerbating the affordable housing crisis in the city of Seattle, by creating a multi-hundred-million-dollar housing loan program, along with a much smaller grant to address homelessness. This is a loans-to-pay-for-future-loans program in lieu of higher taxes; with a much smaller grant program thrown in to make it appear more generous. (Where does this I know how to address housing policy issues better than government attitude come from?)

Appease (latch onto): Health insurers and hospitals, in an attempt to forestall Medicare For All, are rolling out small-scale programs to address social determinants of health—‘the circumstances in which people are born, grow, live, work, and age’ that affects their health status and leads to health inequality. (Marmot, Sir Michael, The Health Gap (The Challenge Of An Unequal World): Bloomsbury Press, 2015). By making a small financial commitment now against health care inequality, which was never a major concern of theirs, health insurers and hospitals, hope the public will ignore their ever-increasing, opaque prices and poor health outcomes, on the part of hospitals and doctors. Continue Reading...

Tags: health inequality, Social determinants of health, health care , Medicare For All

Stress, social isolation, and physical inactivity can affect high status, high-income individuals as well as lower income people. Research shows that where a person lives, their education level, their access to nutritious food, their access to health care, and their personal support system greatly impacts their health outcomes. Addressing these issues is key to improving health and to lowering health care costs. Using this research, federal and state regulators/payers (Medicare and Medicaid), community groups, doctors, hospitals, and health insurance companies have joined together to address the social and environmental factors that lead to poor health outcomes and high health care costs.

Employers that want to offer credible, research-driven wellness benefits should follow the lead of public payers and incorporate socioeconomic screenings and benefits into their wellness programs.

Workplace Wellness Programs—Entrenched and Evolving

According to the Kaiser Family Foundation, 49% (157,381,500) of Americans were covered by employer-sponsored health plans in 2016. In addition to their health insurance coverage, many of these individuals have access to an employer-sponsored wellness program. Despite the growing cynicism about the efficacy of workplace wellness programs, they don’t seem to be going away.

Wellness programs have expanded and evolved from weight loss clubs, health screenings, fitness challenges, and annual flu shots to onsite health clinics, fitness trackers, and financial counseling. So-called innovative wellness programs at top companies like Google, Motley Fool, and Zappos, provide nap rooms, Ping-Pong tables, massages, weekly recess, and other unique perks. But what started as common-sense promotion of healthy behaviors has turned into an unconnected, mix of wellness benefits without thought or impact. However, there may be a way for workplace wellness programs to redeem their legitimacy.

Getting Serious About Workplace Wellness Programs

If workplace wellness wants to return to its serious origins, it should look to the important work taking place in the public health care sector—screening for and addressing social determinants of health (SDOH). The Healthypeople.gov website defines social determinants of health as, “conditions in the environments in which people are born, live, work, learn, play, worship, and age that affect a wide range of health outcomes.” Specifically, SDOH includes factors such as income, education, food, environment, transportation, housing, and race and ethnicity.

Employers may think that confronting socioeconomic issues is an invasion of their employees' privacy, and that this work is best left to public policy experts. This is a legitimate concern; however, as the second largest payer of health care in the country, employers should not wait until government or some other group does the work for them. At a minimum, employers should become familiar with SDOH research, and incorporate socioeconomic screenings and benefits in their health plans and wellness programs.

Private health insurers can serve as a resource for employers that want to address socioeconomic issues through their benefits plans. Insurers (BCBS, UnitedHealthcare, Cigna, and Aetna) have experience creating tools and designing SDOH benefits for their Medicare and Medicaid enrollees. Some SDOH benefits employers should consider including in their health plan or wellness program include: Continue Reading...

Tags: workplace wellness, Social determinants of health

Oscar Health, founded, in 2012, originally set out to develop and sell tech products to established health insurance companies. When that plan did not work, Oscar Health’s founders took the millions of dollars raised from investors and started a health insurance company centered around its custom tech. Six years later, and with a recent $375 million investment from Google’s parent company, Alphabet, Oscar is doubling down on being an health insurance technology company. Or, are they a technology company that sells health insurance? And is Silicon Valley-style tech the missing component in health care reform?

Improving Services And Saving Lives

Oscar’s social media branding approach to health care and real-time data decision tools are a welcome contrast to the everything-but-the-kitchen-sink websites of other health insurers. A system that uses real-time prior authorization for surgeries is a huge improvement over faxing forms and waiting days or weeks for a response from the insurer before you can schedule an appointment. An insurance company that pays claims in real-time, while you’re still at the doctor’s office, is much better than waiting for a bill from the doctor and then waiting for the insurer to pay its portion before you know what you owe.

Innovative technology is good for the health care industry and the trash-talking bros at Oscar (these guys can't get through an interview without a negative comment about their competitors’ antiquated legacy systems) are producing tech that improves the health care experience and has the potential to save lives.

We know that the technology doctors and hospitals use to diagnose and treat patients can save lives, but so can having immediate access to real-time data. A recently reported story on Forbes Online about an Australian cancer patient, Mettaloka Halwala, illustrates how faxing forms can result in medical errors. In Mettaloka’s case, it was a death sentence. Less serious, but still frustrating, administrative errors occur in health care every day. Since 2014, Blue Shield in Los Angeles’s enrollment system, the one used for individual health plan purchasers, has been on the fritz. The enrollment system unexpectedly terminates policies of individuals whose premiums were paid. Customers spend hours on the phone trying to get their insurance coverage reinstated, all while skipping medical appointments and delaying prescription drug refills for days, weeks, and months. Blue Shield in LA’s continual system problems for the most basic of services is one of the worst examples of a major health care industry customer service failure due to inadequate technology.

Big Data, Innovative Tech, And The Human Condition

The rollout of the Affordable Care Act (aka Obamacare) had its technology challenges. But the Act achieved its primary purpose of providing affordable health insurance coverage to the millions of people without coverage. A glitch-free enrollment system, impervious to attack by political rivals, would have been a good start for Obamacare supporters and enrollees, but, what’s more important—affordable coverage or a streamlined health plan enrollment system? The guys at Oscar might think that they are providing both, but are they? Using data analytics, predictive modeling, and artificial intelligence may eventually lead to administrative savings in health care, but other factors can replace those costs. Continue Reading...

Tags: Oscar Health, obamacare, health care technology, Social determinants of health