Insurer, Mich. hospitals switch reimbursement plan

Michigan's largest health insurer and a dozen hospitals announced Monday they are starting to carry out a cost-saving deal designed to prevent unnecessary or overused tests and procedures, an attempt to put less emphasis on the traditional way providers are reimbursed for medical services.
AP Wire
Apr 30, 2013

Blue Cross Blue Shield of Michigan and Trinity Health-Michigan — one of the country's largest Catholic health care systems, which includes 12 hospitals around the state — said the dominant fee-for-service model is not working.

They do not plan to drop the traditional model by which providers are reimbursed for each service through agreements with insurers. But hospitals will be rewarded financially for saving money by better coordinating care, preventing re-hospitalizations and improving patients' outcomes.

"Ultimately, consumers will pay less in premiums. As costs go down, premiums go down," Sue Barkell, senior vice president for health care value at Blue Cross, said in a conference call with reporters.

Tuesday's announcement followed Trinity's May 2012 agreement to partner with Blue Cross on a "value-based" model to pay for hospital services. The fee-for-service model has been criticized for giving a financial incentive to doctors and hospitals to offer more treatments rather than focusing on improving patients' overall health.

Officials said it makes sense to change course before major components of the federal health care law take effect in 2014.

"It lines up with what the Affordable Care Act is trying to accomplish. ... We're trying to get out ahead and be a leader in this space," said Roger Spoelman, regional president and CEO of Mercy Health hospitals in West Michigan.

Trinity's hospitals under the Mercy moniker are located in Muskegon, Grand Rapids, Pontiac, Ann Arbor and elsewhere in the state.

Michigan has 134 community hospitals, and Blue Cross said it is hopeful others are willing to sign similar contracts. Blue Cross, which has 70 percent of the state's health insurance market, said fee-for-service reimbursements are a significant factor in the large growth in health care costs in the last decade.

The hospitals are receiving an unspecified amount of funding to improve infrastructure such as a registry system ensuring hospitals and doctors can access patient records.

The U.S. health care system squanders $750 billion a year — roughly 30 cents of every medical dollar — through unneeded care, byzantine paperwork, fraud and other waste, according to a report last year by the Institute of Medicine.

The study identified six major areas of waste: unnecessary services ($210 billion annually); inefficient delivery of care ($130 billion); excess administrative costs ($190 billion); inflated prices ($105 billion); prevention failures ($55 billion), and fraud ($75 billion). Adjusting for some overlap among the categories, the panel settled on an estimate of $750 billion.

Comments

Vladtheimp

The AP and the Tribune are proving why the old media is exsanguinating money - they don't recognize an opportunity when they see it (if they have been paid for this story, I apologize).

Kathleen Sebelius, Obama Queen of HHS announced on Friday she would pay public relations firm Weber Shandwick $8 million to promote Obamacare. Trinity Health-Michigan is receiving separate taxpayer dollars " to improve infrastructure such as a registry system." Blue Cross is obviously shelling out less money on behalf of its insureds, even though proponents of Obamacare had claimed that the evil insurers were not spending enough on their clients before Obamacare was passed.

And for running an uncritical story in support of Obamacare, the Trib didn't even get a lousy tee shirt. As a reward, I get even more of a loss of medical privacy, fewer tests, and fewer doctors.

Anyone wonder why the gubmint has to pay a public relations firm $8,000,000.00 of our tax dollars to convince us that Obamacare which they have been selling for over 3 years is REALLY good for us?

Lanivan

To answer your question: Because Republicans have been spending well over $8,000,000.00 of taxpayer money spewing disinformation, misinformation, falsehoods and lies about Obamacare for the sole noble and lofty ideal of making him look like a failure. And because poll after poll has shown that with education, along with citizens beginning to experience first hand the benefits of health care coverage, the popularity of the program and how it benefits all people grows.

Vladtheimp

Ve Haff Vays of Making you belief? How about sharing one or two of those polls. (I know - you're focusing on the Wash Post spin on the Kaiser poll of March 5-10, 2013 but ignoring the Kaiser poll of April 2013, where Obamacare has sunk to its lowest level of support and the dems are running from it like vampires from a Cross. http://townhall.com/tipsheet/guy... And since we're at it, a source for the $8,000,000 please. You can google Sebelius, Obamacare, Public Relations and see where the pr source is. The latest Kaiser poll indicates a majority of Americans approve of efforts to do away with this socialized medicine abortion.

Lanivan

Why don't you just come right out and admit it. I was right. Your link/poll explains clearly and succinctly that: people are confused about the law, they aren't even aware that it's law, and any overall awareness of key elements of the law they might have had has declined. This is a far cry from whatever gibberish that makes up your final sentence.

The $8,000,000.00 is an understated figure that represents the hundreds of millions the super-rich far-right creeps spent in ads, marketing, and propaganda spewing falsehoods about Obamacare in an attempt to get Romney elected - you know, the very same guy who implemented Romneycare, Obamacare's older sister, in Massachusetts.

Vladtheimp

Good sourcing - the vivid liberal imagination of Lanivan, as suspected.

Lanivan

Remember Medicare Part D? There was a tremendous amount of education that went along with that new program - brochures galore, 800#, etc. I distinctly recall reviewing the ins and outs with the older folks in my life at that time, and it was not easy. And this education targeted primarily just the geriatrics. It still goes on today. Think the tally thus far would be over $8,000,000.00?

As for my sourcing, remember your sourcing of Thomas Payne - common sense and rational thought.

Vladtheimp

Ah yes, you have no source but can't admit that you just made "stuff" up, so you fall back on your liberal common sense and rational thought. Sorry, that's not a source - that's an opinion, but why hold you to a stricter standard than that to which the mainstream media holds itself?

Lanivan

I know the disappointment you might be feeling - I too hold you to a higher standard that is often left lacking. But we must persevere! Think of it as exercise - all that raising and lowering of the bar!

For example, I have often mentioned the Heritage Foundation and their contribution to Obamacare in that they were the original creators of the concept (maybe they were a socialist group back then? Or our president wasn't of color back then?) You seem to lower the bar whenever mentioned. To the best of my knowledge, this is not made up:

Heritage Foundation - October 2, 1989: Assuring Affordable Health Care for All Americans (1.6 MB) , by Stuart M. Butler * "[N]either the federal government nor any state requires all households to protect themselves from the potentially catastrophic costs of a serious accident or illness. Under the Heritage plan, there would be such a requirement...

Society does feel a moral obligation to insure that its citizens do not suffer from the unavailability of health care. But on the other hand, each household has the obligation, to the extent it is able, to avoid placing demands on society by protecting itself...

A mandate on households certainly would force those with adequate means to obtain insurance protection."

And then, a few years later, just to drive the proposal home:

Mar. 5, 1992

Heritage Foundation The Heritage Consumer Choice Health Plan (10 MB) , by Stuart M. Butler "Step #2: Require all households to purchase at least a basic package of insurance, unless they are covered by Medicaid, Medicare, or other government health programs.

All Heads of households would be required by law to obtain at least a basic health plan specified by Congress...

The private insurance market would be reformed to make a standard basic package available to all at an acceptable price...

Employers would be required to make a payroll deduction each pay period, at the direction of the employee, and send the amount to the plan of the employee's choice."

Vladtheimp

Still waiting for the source of you statement that "To answer your question: Because Republicans have been spending well over $8,000,000.00 of taxpayer money spewing disinformation, misinformation, falsehoods and lies about Obamacare for the sole noble and lofty ideal of making him look like a failure."

That ole slight of hand just ain't workin for ya. Please just admit you made it up so we can get on with our lives.

Vladtheimp

1. Jim DeMint is head of Heritage, not Vlad - if an idea is a bad idea, whether it was germinated by Obama, Think Progress, or Heritage, it is a bad idea.

2. A history of the individual mandate,and how conservatives opposed and killed the Butler/Heritage plan can be found here http://www.forbes.com/sites/aroy... Particular attention should be given to the type of insurance "mandated" under the old plan.

3. It is interesting that you rely on a plan developed over 20 years ago to avoid providing the source for the figures you asserted, and you fail to note that Heritage does not support the plan of over 20 years ago. Before you attack, you might consider the shelf life of many Obama plans, objectives, promises, and core values and how they stack up to one plan from one conservative institution decades ago. Gay marriage is an example - You could say Heritage was evolving, but they didn't change their mind to garner votes.

Your race-baiting is despicable and unworthy of you, but I guess if you lie with dogs some fleas will jump from the Democrat Underground/Think Progress/Mother Jones racists onto you without you knowing.

Source for $8 please.

Lanivan

First things first. " Abby Goodnough of the New York Times explains why misinformation and fear of Obamacare is increasingly widespread. It's the money, stupid:

In all, about $235 million has been spent on ads attacking the law since its passage in March 2010, according to a recent survey by Kantar Media’s Campaign Media Analysis Group....Here in the suburbs of Philadelphia, which, according to the Campaign Media Analysis Group, is one of the top five media markets for ad spending against the health care law, it is apparent how such messaging is playing out. (The other top markets are Orlando, Fla.; Tampa, Fla.; Pittsburgh; and Denver, all in swing states.) In interviews with about two dozen residents who were mostly opposed to the law, certain worries, resentments and dark predictions about it came up time and again.

By contrast, only $69 million has been spent on pro-Obamacare ads...."

I have other links, but surely this will suffice, at least enough for you to get back on your feet and move on with your life.

Now, the Heritage Foundation. Let's focus, and not shift into anti-Obama modus operandi just yet. You have shown a strong reliance on the HF for your information, links, sources, props, and shiny objects on a regular basis (including a few days ago when you offered a Robert Rector/HF link). When an elite and influential conservative think tank created Obamacare, 18 powerful and influential Congressional repubs proposed and promoted the HF program back in the '90's, it was implemented successfully by one of their own - Romneycare in Massachusetts, and has become the cornerstone of anti-Obama sentiment, I'm absolutely in my rights to question why what was once the darling of the Republican party has now been the source of hundreds of thousands of dollars - much of it taxpayer money - spent on advertising, propaganda, legislative repeals, and a concerted effort to spread misinformation and disinformation.

But, as you point out, people have the right to change their minds. I'm sure that is the case for some.

But then there is the matter of the Republican political strategy to delegitimize and demean Obama based on a culture of racism. This could also explain why repubs are working so hard to destroy a program that is both one of their own making that was designed to address several major societal and fiscal problems, and a signature achievement of the Obama administration.

There is nothing despicable and unworthy of questioning alternative motives, which is what I'm pursuing. Discomfort with the pigmentation of our president is hardly a wild accusation. This particular president has had his citizenship, his religion, his loyalty, and his intelligence questioned repeatedly; he's been referred to in all manner of code words of stereotypical racial slurs by repubs at all levels, including one of Sarah Palin's more famous contributions - Obama's "shuckin' and jivin'". I am prepared to offer many links and sources if you don't take my word for it. For example, "My party is full of racists."

That is what retired Army Colonel Lawrence Wilkerson said on Friday, a Republican and former chief of staff to Colin Powell. He added, "My party, unfortunately, is the bastion of those people -- not all of them, but most of them -- who are still basing their positions on race. Let me just be candid: My party is full of racists, and the real reason a considerable portion of my party wants President Obama out of the White House has nothing to do with the content of his character, nothing to do with his competence as commander-in-chief and president, and everything to do with the color of his skin, and that's despicable."

My goal with this thread is not to go off on a tangent about racism in 2013 America (although I wouldn't be opposed if you chose to do so), but to offer a legitimate alternative motive for the 180 degree turnabout by congressional repubs regarding one of their signature achievements. I do want to make it absolutely clear I'm not pointing fingers at you or any one else in a personal or specific way, but my comments are meant to be taken in a general political sense only.

Vladtheimp

I really do understand the unenviable position you are in. Having fully invested yourself in a charismatic progressive politician and believed his many promises, you find yourself supporting an empty shell, a virtual lame duck early in his second term, an incompetent poseur, but what are you to do?

Well, if I ever found myself in your position I would probably do the same - try to have everyone concentrate on a program proposed by a think tank decades ago, and long since abandoned, to deflect the real news about Obama, the Obama administration, and its signature program, Obamacare.

Forget that it was rammed through Congress using a combination of lies, deceit, bribes, and unlawful procedures. Forget it costs triple what it was sold as, that you cannot keep your own doctor, your own health plan; that it is not a tax; that virtually all of the criticisms of its critics are being proven true. Forget that Obama has made the economy worse, that the labor participation rate is the same as when the think tank first perceived its universal health plan; forget that any minimal gains in the labor market are due to temporary employment; forget the billions wasted on electric cars, windmills, algae, etc. given out to crony capitalists to solve the global warming farce that was manufactured by progressives; forget we are not supporting our traditional allies but have thrown in our lot with the "Arab Spring" and the Muslim Brotherhood; forget that Obama has added so much to the national debt that his Fed is limited to printing money at a rate never before seen to keep interest rates and inflation low (while benefiting the big banks and Wall Street, not Main Street); forget that the number of people on food stamps and welfare is larger than ever before in history; forget that once proud NASA's new mission is making Moslems feel good about themselves; forget the government's gun running and the people who have did from Fast and Furious; forget the coverup of the deaths of American heroes in Benghazi; forget that Gitmo would be closed his first year; forget he would cut the deficit in half by the end of his first term; forget the number of lobbyists working in the White House; forget that Obama took $750 million from Medicare and caused Medicare Advantage to disappear next year; forget unilaterally, and illegally deciding not to enforce our immigration laws; forget that and concentrate on the fact that once upon a time one conservative think tank promoted a program that had some elements of Obamacare, declare victory, and move on to the next challenge to try to convince people that Obama has not been a failure as our Chief Executive and Commander in Chief (and yes, he killed Bin Laden, no need to go off on that tangent).

As far as race, if the Grand Exalted Cyclops of the KKK was elected president, and adopted the same policies as Obama, I would level the same criticisms. And please don't forget the many racialist decisions Obama has made, from affirmative action appointments, to staffing, to the African-American dialect when it suits him, to "If I had a son" to "The police were stupid" and on and on. I'm sure his "Body Man" is proud, however.

Lanny, I truly admire your loyalty and perseverance; if I were dealt the hand that you have to play with respect to a hero of mine, I think I would be speechless as well as cardless. Carry on Oh Brave Warrier Queen - I salute you.

Lanivan

I'd like to start by saying how disappointed I am that you ignored my material regarding the money invested by detractors of Obamacare/Obama that is far in excess, by hundreds of thousands, to the measly 8 million the Obama administration has earmarked to help with implementation beginning 2014. Especially after all your prodding for sources. (Should I feel chumped?)

Although not surprised with your comments (should I call it a "stream of consciousness", or would that start to get too silly, even for us?), I was hoping for more of your unique insights into why the original Heritage Foundation proposal, which was so celebrated at the time, is now found lacking. As for your other highly subjective critiques regarding our president, am I to understand your disdain for our president is not based on race or visceral hatred, but strictly for his actions? I have come to see that conservatives seem to be always looking over their shoulders (only their right shoulder, sort of like nipping on the bottle of starboard) and finding fault in order to retell the party line, in zombie-like fashion, and advance their agenda, which these days has nothing to do with the health and welfare of the citizenry, but to block and tear down Obama.

This might be the side effect from the bitter pill that although repubs are capable of controlling at least one house of Congress, thanks to gerrymandering, etc, they are incapable of winning a general election.

But despite the momentary dizziness, breathlessness, and speechlessness I experienced while reading your epic "s-o-c", I am in awe of your ability to assume a ten in the hole when playing blackjack. The sounds of mutual respect, composed in the minor key.

Vladtheimp

The figures you cited from Kantar Media’s Campaign Media Analysis Group were from the year Obama was elected, not the year the law passed. They do not take into account the enormous "free" advertising Obamacare has received from a compliant mainstream media, including refusing to cover problems with Obamacare's implementation, it's negative impact on new employment and causing companies to shift employees to part time, the fact that it is a huge new tax, the fact that it is driving up the cost of insurance while the subsidies don't come close to covering the added costs, and biased and deceptive polling. The value of this free advertising is incalculable. Once the law passed, why spend money to advertise how good it is for us - do the democrats or republicans do that with other legislation?

Yes, my response was stream of consciousness (sauce for the gander) in that all of the damage Obama has done came off the top of my head - no teleprompter required - and I even left out the damage letting 30 million illiterate foreigners into the country under the proposed amnesty will do to American blue collar workers, and to the taxpayers who will have to eat their welfare. It has nothing to do with the color of Obama's skin - it has to do with the content of his governing philosophy.

I may assume a 10 in the hole, but that's better than going all in playing Texas Holdem based on hope and change.

Lanivan

On the off chance anyone is still reading this thread, I thought I'd quell some of the rumors you are spreading about Obamacare.

1. There is nothing about it that is a tax. The penalty clause is just that - and of course you of all people should know that the Supreme Court ruling proves that the mandate penalty is not a tax.

2. Just a short list of things that Obamacare accomplishs for US citizens:

* Forbidding pre-existing condition exclusion policies

* Forbidding annual and lifetime caps on benefits under health insurance policies

* Preventing recissions, which is the industry practice of accepting your premiums for years on end, but then cancelling your coverage as soon as you get sick

* Requiring insurance companies to spend at least 80% of your premiums on providing health care services, which has led to $1.3 billion in refunds to consumers

* Requiring health insurance companies justify rate increases of more than 10%.

* Closing the Medicare prescription drug coverage doughnut hole

* Eliminating co-pays for preventive care services

* Requiring insurance companies to cover under their parents’ policies adult children until they reach the age of 26

* Expanding health insurance coverage to 32 million more Americans through providing tax credits to make coverage more affordable for families earning under $88,000 per year and small businesses, and by expanding Medicaid

Health care reform shows that government can work to help people. That's probably why the GOP is scared of it, and has spent hundreds of millions of dollars to spread misinformation, disinformation, and alarmist falsehoods about it. Now it's time to turn over that river card and win the game.

Vladtheimp

Message to planet Progressive Uranus - the only reason Obamacare was upheld by the Supreme Court is that Chief Justice Roberts declared the Individual Mandate is a TAX, contrary to what Obama and the Dems sold it as. http://www.cbsnews.com/8301-5051...

And yes, I of all people do knows it because I read the arguments and the opinion, unlike some, apparently!

Wingmaster

Shhhnap!

Planet Uranus. ..OMG a reality rocket planted square on target.

Lanivan

Yes and no. The Supreme Court ruling declared the penalty as a tax for constitutional purposes, but it is not a direct tax. "A tax on going without health insurance does not fall within any recognized category of direct tax. The shared responsibility payment is thus not a direct tax...".

But I stand corrected. I should have split the hair finer, but when countering vague generalities, built of alarmist falsehoods on a quick sand of alternate motives, I allowed myself to omit the words "direct tax".

Surely you of all people should have known this.

Vladtheimp

Wriggle, wriggle, squirm and octopus like, send out a dark spray to obfuscate the fact that, unlike what you asserted, Obamacare imposes a huge tax on citizens, including those making less than $250,000, unlike the promises, characterizations, assertions of the boy President and the democrats. And, as I said, if Roberts had not characterized it as a tax, it would have been held unconstitutional, which is why so many of us are so disappointed with the position Roberts took. You need to get over it - Obama lied, citizens cried.

Lanivan

Oh, the allegories begin! And you so Captain Ahab-like with your obsessive pursuit of the evil Moby Dick (Obamacare to you).

Actually, The Roberts Court ruled exactly the way the overwhelming consensus of legal experts, both conservative, liberal, and centrist, believed was the correct decision - that Obamacare was clearly constitutional.

The dishonesty and unscrupulous nature of the campaign against this reform (just like with Social Security, Medicare, Civil Rights Act, etc) - especially when the 2014 elections are right around the corner - are not going to change the fact that the Roberts Court have ruled the ACA constitutional, and health care reform is moving forward.

In addition, this "Obama lied" thing is juvenile. You're getting confused with Bush/Cheney - lying the US into war that has cost the US over $2 Trillion (not to mention lives lost). Citizens did indeed cry over that, though.

But I recognize your efforts in support of the extreme conservative viewpoint, isolated and insulated from reality as it is. It reminds me of the words on a gravestone, "He done all he could".

Vladtheimp

There you go, making "stuff" up again - I assume you can provide a legitimate source for "Actually, The Roberts Court ruled exactly the way the overwhelming consensus of legal experts, both conservative, liberal, and centrist, believed was the correct decision - that Obamacare was clearly constitutional."

Your mention of the Civil Rights Act brought to mind: June 10, 1964
Senate Minority Leader Everett Dirksen (R-IL) criticizes Democrat filibuster against 1964 Civil Rights Act, calls on Democrats to stop opposing racial equality. The Civil Rights Act of 1964 was introduced and approved by a staggering majority of Republicans in the Senate. The Act was opposed by most southern Democrat senators, several of whom were proud segregationists—one of them being Al Gore Sr. Democrat President Lyndon B. Johnson relied on Illinois Senator Everett Dirksen, the Republican leader from Illinois, to get the Act passed."

For a thorough history of democrat opposition to virtually every Republican effort to ensure civil rights to African Americans, see http://www.black-and-right.com/t...

Obama is a serial liar, and if anything is juvenile it is putting one's hands over their eyes and ears and chanting Nah, Nah, Nah, so they can ignore that fact.

Lanivan

Barry Goldwater, Wm Buckley, Strom Thurmond, Jess Helms....all powerful Repubs who opposed the Civil Rights Act of 1964. Your account of history, as well as your link, doesn't seem to jibe with this one (aren't you surprised?)..
http://nymag.com/daily/intellige... So which is correct?

I am sorry you feel that way about Obama, but I understand. I thought Bush/Cheney and Romney were serial liars, and it was very upsetting to me, as well. I wonder: did you see their lies? Did it upset you, too?

Wingmaster

Are you a lawyer by any chance? You surely could play one with your creative dance with words! Wow. ..I am learning something but it is not what you hope and intend!

Wingmaster

Above is a Lan question.

Lanivan

No, that's Vlad's excuse. Don't you appreciate my use of your brill phrase "alternative motive"? Besides being useful, it's fun to type - and pronounce, for that matter.

Speaking of words, Vlad's use of "Uranus" and your picking right up on it brings back fond memories of my grade school years, when we used to run around the playground and say that to each other, giggling all the while.

Wingmaster

Your right Lan, I should stop having fun at your expense because it is allowing you to run away from the whole "tax" thing that Vlad pointed out.

I will accept your scolding of my sophomoric humor and will be sure to remember that at some future date an reuse in our discussions an attempts at humor.

Reality rocket, now you must admit that was original!

Lanivan

Ah Wing - I wasn't scolding - I just appreciate the reminder of childhood indulgences. Please don't be concerned that having fun at my expense is allowing me to distract from the "tax" thing....I'm more than willing to continue debating the "tax" thing, because I am right about it. Vlad is just a little irascible as his team keeps losing - bummer!

Reality rocket is awesome! (has a 'drone-like' quality) May I use that one too once in a while?

Wingmaster

Sure, go ahead but beware of VDI... Vlad Defense Initative. Works much the same as the SDI Strategic Defense Initative.

Lanivan

Vlad is indeed on the defensive a lot...however, his Tower of Power technique has been more educational to me as a strategy than as a weapon.

Wingmaster

Your a closet racist Lan! Why are you inserting it ever so slightly in the conversation? Not trying to hijack the thread or send us off chasing shiny objects but knock it off with the race thing already! Jeez!

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