Tag Archives: Healthcare Solutions

Making Cents of Your Health Insurance Dollar

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As President Obama continues to lobby the American people and Congress on Healthcare Reform, talk of change and what it means to average Americans travels from the board rooms of global corporations to the kitchen tables of homes across the country.

In quite a number of discussions, this quote sums up the feelings of many people I have talked to.  “Spare me the details – I just want to know what Healthcare Reform will mean to me.”  If this is how you feel, than this short video from CNN Money might help answer the question.  CNN Money video

One of the major components of the President’s plan is to require almost everyone to have some form of health insurance – tackling the current social and economic  burden of a population of approximately 47 million Americans who are uninsured.  This will add approximately 47 million Americans into the existing insurance pools of either government provided insurance, employer provided insurance or private insurance.  You can find the current breakdown by coverage class in my related post earlier this week.

That being they case, I thought it might be helpful to look at where our insurance dollars go.  To do  that, I referenced the bi- annual report on that information from the same industry report that was referenced by the Senate.  In January of 2008, Price Waterhouse Coopers published research on health insurance costs as commissioned by America’s Health Insurance Plans.  This link takes you to the full report. The Factors Fueling Rising Healthcare Costs 2008

The graphic above shows the break out of the pool of dollars that make up the  employer and private health insurance spend. Looking at the graphic, 13cents of each dollar goes to corporate profits, administration and sales and marketing support.  The other 87 cents goes towards the basics of helping us stay healthy, diagnosing illness or other medical conditions, and treatment.

So if we are going to lower healthcare cost, realistically, the focus will fall predominately in the area shaded in aqua – that 87%.  It is in these areas where we have the greatest opportunity to use American innovation to improve the healthcare process.  Information technology enhancements in the area of medical records management can help us reduce duplicate tests and better manage patient care.  New biotech diagnostics currently in development will allow us to detect and diagnose diseases earlier – thus greatly reducing the total cost of treatment by addressing small problems before they become big ones.   But technology and process improvement alone will never be the answer. 

We, the people, will also need to make some changes in our behaviors if we are ever to really get things under control.  Here are a few things each of us can do to put the health back into healthcare:

  1. Get a check up.  85% of Americans, who have health insurance, do not get an annual check up.  Yet studies by Medicare and Medicaid have shown that if we detect and diagnose chronic disease early we can avoid as much as 90% of the costs of treatment. And, chronic disease represents almost 70 percent of the medical services spend. 
  2. Take a walk.  It is estimated that approximately 31% of Americans are either clinically overweight or obese.  This condition has been directly correlated to a wide range of chronic conditions including Diabetes, Heart Disease, Stroke, Hypertension, some types of Cancer, Sleep Apnea, Osteoarthritis, and Gallbladder Disease.
  3. Ask questions and talk to your doctor.  Whether in your annual exam or during treatment, take an active part in the healthcare discussion.  Ask your doctor what you can do to be proactive about managing your health and your healthcare spend.  Very often a few extra minutes can leave you with good information, ideas, and in the case of treatment sometimes more cost effective alternatives.
  4. Understand what your healthcare plan has to offer.  If you have a bad health habit you want to break, many plans offer free services to help you.  Pull out that booklet they send you once a year and look.  You might be surprised at the resources you are paying for that you have never used.

President Obama may or may not get everything he wants out of Congress this year in the way of health care reform.  And even if he does, the some of the changes will take years.  But we can each start our own healthcare recovery plan today – if we choose to.

Thanks for stopping by. Stay Tuned…

Joan Koerber-Walker

Healthcare: A Perfect Problem with No Perfect Solution

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In the United States, we have two “perfect problems”: our Healthcare system and our Taxation system. What makes these problems perfect is their absolute complexity and an almost universal agreement that a problem exists.

The focus of this article is on healthcare.  I’ll leave taxation for another day – even though eventually our country will not be able to truly address one without the other.

[youtube=http://www.youtube.com/watch?v=HKOfXlB_3Wo]

Up until December of 2006, I did not think a lot about healthcare.  It was something I had, something I paid for, and with the exception of annual check ups for my family, something that I rarely had to use.  I knew it was a problem, but it was not necessarily mine. That changed December 21, 2006 when I became the CEO of the Arizona Small Business Association, and had to answer to and speak on behalf of our 3,000 business members and through them over 200,000 employees. 

The more I researched, surveyed, and listened; the bigger the problem became.  And I was just looking at one state, and within that, only one subset of the population, small business owners and their employees.  Yet both in our state and on a nationwide basis estimates from both the Federal government and independent agencies estimated that of the 45 million people plus who lacked health insurance, approximately 60% of them either owned or worked in a small business.   The constantly rising cost of health care was a burden these businesses were struggling to battle.  Others were starting to give up hope that anything could be done.

LOOKING AT THE NUMBERS:  HEALTH INSURANCE COVERAGE IN THE UNITED STATES

Source: Income, Poverty, and Health Insurance Coverage in the United States: 2007, p.69

hc-numbers-chtThe chart at right shows the estimated U.S. population (as of 2007) and the breakdown of the insured/uninsured and where the insurance comes from.

But as we all know, there have been some pretty significant economic factors since 2007 that probably shift these numbers upward in the areas of both government provided program and the uninsured due to the significant change in the unemployment rate (4.7% in June of 2007 vs. 9.7% in June 2009) and the continuing economic pressures on businesses of every size.

With a problem this large, it’s hard to have any impact.  Especially when it’s also highly complex and politically charged.  At the state level we had various mandates, imposed and proposed, that were continually driving the costs up.  A state provided program for small business had serious limitations and flaws not to to mention a serious deficit that threatened its sustainability.  The whole thing was a mess. 

I had learned a long time ago that it is almost impossible to tackle a really big complex problem – but that if you break it into little ones and tackle them one at a time, you can make headway.  So that is what we did.

First we framed the problem with a set of goals.  Our conditions for success were the following:

  1. It had to be available to any business of any size (even groups of 1) without limitation.
  2. It had to cover the entire state AND provide coverage for employees out of state.
  3. It had to provide the same level of quality care and service that was available to employees in a Fortune 500 company.
  4. Coverage had to be guaranteed issue with no pre-existing conditions limitations as long as there had been prior qualified coverage and pricing and eligibility would NOT be determined by health status of the employees.
  5. It had to be reasonably affordable and competitive.

The next step was to look at what resources we had to work with and to identify potential partners.  We reached out to corporate partners, legislators, the Governor’s office, and national organizations to see what was available, what we could work with or what we could change.  Through a combination of negotiations, partnerships, and collaborations, we were able to design a plan that met all five of our defined goals and launched it 10 months after we started the process.  To see the full details of the program, visit the ASBA website. 

Now, this program did not solve the national problem, but it did provide a solution/option for the community we served across the state of Arizona. AND, it did so without a single taxpayer dollar.  Best of all,  from 2007 to 2009 the gross increase in premium was a total of THREE percent while at the same time the program benefits were enhanced – not reduced.

So my question is this.  Perhaps, while they battle in Washington tackle the perfect problem of Healthcare Reform – and fight over every sacred cow.  Maybe, just maybe, individuals like you and me, in our little corners of the country can build viable solutions by breaking the problem down to smaller more manageable chunks and tackling them one at a time.  That way WE can solve the problem and THEY can keep on talking.

Thanks for stopping by.  Stay Tuned…

Joan Koerber-Walker

P.S. While I no longer serve as the CEO of the Arizona Small Business Association, my time there taught me something very important.  There is very little that can not be accomplished by American small business with a little hard work. collaboration, and ingenuity.  If we focus on the challenge, frame it properly and get down to work the results can be pretty incredible.