A New Name for the HPfHR Healthcare Reform Plan!

Our plan has a new name!

The Expanding Medical and Behavioral Resources with Access to Care for Everyone or:

EMBRACE Health Plan

Gil

The Massachusetts Way

The New York Times had an upbeat editorial today exalting the success of the Massachusetts healthcare program.

The number of uninsured has dropped — Massachusetts now has the lowest rate in the nation — and so have the number of those who turn to costly emergency rooms for routine care. And while the state has had to seek additional sources of revenue — mainly because of the program’s popularity — the gains in the first 21 months suggest that the plan could become a model for universal health coverage for other states or the nation.

What they don't directly state but is inferred is that the majority of the coverage is through Medicaid rather than private insurance. This, as most healthcare professionals understand, is not the same coverage as private insurance or even Medicare, and limits the services and providers that a patient can obtain.
What is not known as of yet and what the editorial also does not mention, is that there are no data on how much this plan has helped the health of the population it is covering and it's cost-effectiveness. Stay tuned...

Connecticut's new health plan has only 24 customers, 2 hospitals

W e previously discussed the Charter Oak health care plan (Connecticut's new initiative for "Universal Coverage"). At the time we had little information on what it was all about. This article appeared today in my local newspaper (The Danbury News-Times) about it. It seems that the plan is having some trouble getting traction...
Other than the high cost to the insurance companies and low reimbursements to providers, I wonder if there wasn't also a problem here of not properly informing the providers and the population about the details of the plan. Does anyone else (in Connecticut) feel under-informed?
Gil

Adddendum:
Today, August 6th, The Danbury News Times had an editorial about the plan.
Some highlights:

This state plan to provide insurance to uninsured adults includes a reimbursement rate so low that it will add to the financial problems that so many hospitals are facing.
"Philosophically, we believe in the importance of health care coverage for everyone," said Danbury Hospital spokesman Andrea Rynn. "Practically, though, Charter Oak relies on hospitals to provide services at rates which will not cover the cost of the care provided. "In recent weeks, Governor Rell has been issuing press release after press release announcing that thousands of Connecticut residents have been calling to inquire about Charter Oak.
The governor didn't mention that only 24 people have actually enrolled. Nor did she mention only two hospitals have agreed to join the program -- St. Mary's in Waterbury and the Hospital of St. Raphael in New Haven. Nor did she mention that physicians have been slow to join.
Nor did she mention that Commissioner Michael Starkowski of the Department of Social Services warned her office against starting Charter Oak before the program was ready.

And it concludes with:

Charter Oak was started with good intentions. But a solid program is needed, not just good intentions.

Gil

I recently had a conversation with Dr. JoAnn Manson about our healthcare plan and she had many insightful comments. One of the concerns that she brought up is how this plan might overload the primary care physician's practice. Now, the increase in volume of patients is something that we had anticipated with our plan and had thought that it would be an advantage for physicians.
As I looked over some of our prior discussions I came across the NY Times article back in April about the Massachusetts experience and then came across a blog entry from Alan Katz from that time. These were his thoughts:

What was apparently overlooked was how the influx of newly insureds into the system is straining the pressure on family doctors and other primary care physicians. As a result there’s waiting lists for some non-emergency treatment that stretches for months in some communities. The Times article recounts one physician in Amherst that is now scheduling physicals for early May — of 2009.
The problem is a serious one. By coming into the system, through subsidized coverage or not, residents of Massachusetts anticipated having access to basic health care services. Yet there’s just not enough primary care physicians to go around.
The United States will need 40 percent more primary care doctors by 2020, according to the American College of Physicians, to accommodate the aging population. It’s hard to see where they’re going to come from. The reasons are many. As the Times story reports, factors include reimbursement rates by Medicaid, and the attraction of a specialist’s practice among them. What’s ironic is that Massachusetts ranks significantly above the average in the per capita number of all doctors and primary care physicians.
Which does one little good if you need a doctor and can’t get one to see you. And none of this means attempts to achieve universal coverage should stop. It just underscores how tough a challenge it will be to make any reform package work.

Be that as it may, it seems to me that this may not be as big a problem as either the NY Times or David Katz think. Part of the reason that patients in the Massachusetts plan cannot get access to primary care physicians is that their newly acquired insurance is Medicaid which pays providers less than 20% of Medicare and even less than private insurance. This effectively bars a significant part of the population from access to private physicians. In other words, there is not enough incentive for the care providers in the Massachusetts plan to really allow for more access. This should not be the case in the HPfHR system (or a single payer system either) since everyone will have the same insurance (at least for Tier 1 services).
That's not to say that I don't believe that when the HPfHR system is first established there won't be an initial influx of newly insured patients flooding the available primary care offices. However, I do think that in the free market (and with some help from enhanced reimbursement from the "Board" and drastic reductions of the overhead associated with dealing with private insurance) primary care will become significantly more attractive. In addition, there is now a significant growth in the ranks of physician assistants and nurse practitioners that is already helping primary care services.
Please let me know your thoughts...
Gil

Doctors Urged Not to Screen Elderly Men for Prostate Cancer

I was reading this today on the NY Times Online edition and it just occurred to me that these are exactly the type of data that will be needed in the HPfHR healthcare system. These new recommendations will probably not only save money but may even reduce morbidity and improve longevity!
What a concept!!
Gil