Health Insurance Rebates A 1 3 Billion Non Event

The Disease Management Care Blog has a lingering weakness for garden statuary. It thinks that nothing quite compliments phlox and snapdragons better than a weenie cherub or squatting amphibian.

The skeptical DMCB spouse disagrees. Tired of  kneeling trolls disturbing her caully laid mulch, she questions whether her husbands admiration for toadstools, rabbits or fairies projects the right level of curbside sophistication. 

Skepticism may also be a reaction of 16 million Americans who are about to discover a health insurance garden gnome rebate check in their mailbox.  According to The Hill, the commercial insurers that havent met the Affordable Care Acts 80 to 85 percent medical loss ratio rule will have to give back a total of $1.3 billion in premium rebates this summer. Whats more, the checks will have to be accompanied by a statement that theyre the result of Affordable Care Act.

The DMCB thinks this will turn out to be a non-event for four reasons:

1) What Does This Really Mean to an Individual?

When the DMCB does the math, $1.3 billion spread over 16 million eligible Americans works out to $81.25.  This article says the amount will be higher at $127.  While the DMCB thinks any free cash is always welcome, its inner behavioral economist doesnt think a check for around a hundred bucks is going to generate much buzz among health care consumers, especially among a population segment that can already afford to buy commercial insurance. 

2) Remember the Tax Rebate Checks of 2008?

Neither can the DMCB. But tracking polls at the time suggested they did little to capture Americas imagination or boost consumer confidence. That doesnt mean that Washington DC doesnt continue believe that giving something for nothing will generate gratitude and votes. All the better if its done just prior to a major election and humiliates health insurers.

3) Speaking of Which....

Why arent the health insurers pushing back by pointing out that the rebates pale next to the cost of the ACAs mandates and that a one-size-fits-all medical loss ratio rule is unfair to the individual insurance market? Could it have something to do with $1 trillion in new business or the threat of being resurrected as an anti-progressive bogeyman? The DMCB calculates that $1.3 billion will be viewed by consumers as the price of doing business with a hostile federal government. 

4) Plus, Is A Billion A Lot?  Really?

The DMCB looks forward to hearing our chattering politicians extol the rebate of "$1.3 billion." While that used to sound like a lot, our unending budget fiasco has since taught Americans that the term "billion" is now synonymous with a federal budget rounding error. Who can forget Harry Reids quote that the billions saved in passing tort orm was insignificant?

Next stop for the DMCB will be a bunch of solar powered lamps and a volleyball-sized mirrored gazing ball.  What the Administration has planned for our health insurers is another matter.

Choosing Wisely Unnecessary Testing and the Simplistic Use of Web 1 0 to Attempt Physician and Patient Behavior Change

The Model T

There are certain Disease Management Care Blog behaviors that the spouse finds.... objectionable.  She has verbally educated the DMCB about them and has left written notes about them.  Since these communications havent worked all that well, are there any other "channels" she could use? 

The DMCB spouse may be tempted to use the approach of the Choosing Wisely web-site. It provides lists of widely used medical tests and treatments that are typically unnecessary.  The lists (located here) were compiled as part of a joint physician and education project by organizations such as the American College of Cardiology (dont do stress tests in patients without cardiac symptoms) and the American College of Physicians (dont get back x-rays if the ache is non-specific). According to the press reports heralding the availability of this just opened web-site (for example), its purpose is to prompt patients and physicians "to work together" to not only make clinically wise choices, but save the U.S. health care system a lot of money.

The DMCB knows that the academic experts and organizations that developed these lists have been talking and writing about these wasteful tests and treatments for decades.  Waste has been the subject of infinite numbers of continuing education programs, grand rounds, published review articles, national meetings and guidelines.

Those approaches havent worked. 

So is the fix is to repackage the information and post it as simple text on a web page?

The DMCB cant say its impressed.  While the evidence underlying the clinical recommendations themselves is superb, there isnt any evidence that internet-based physician instruction is any better than traditional methods.  And if the purpose of the Choosing Widely web site is to prompt patient behavior change, the evidence that web-based education is better than print is pretty skinny there too. 

Its ironic that the intellectual rigor of the lists themselves wasnt matched by the same evidence-based approach to using the internet for this exercise in the first place.

Whats more, if these groups insisted on using the internet, the least they could have done was deploy a Web 2.0 approach.  The current Choosing Wisely site is so.... has been. 

That being said, there is some information that could be of use to the population health management service providers.  In contrast to the physician organizations, the DMCB is confident that theyll know how to package and present the information so that it can have a real impact.

The DMCB wishes Choosing Wisely good luck.  And in the meantime, it looks like the DMCB spouse will have to continue to rely on verbal and written feedback.... for now.