President Obama: Address to Congress on Health Insurance Reform

The President delivers an address to a joint session of Congress, explaining just how he wants to bring peace of mind to Americans who have insurance, and affordable coverage to those who don’t. September 9, 2009. (Public Domain)

Why do we measure access to healthcare services? How can this information be used for improving care?

How do you certify a healthcare web application software?

Hi there,

I am just curious on the exact procedure to officially certify a web application software that will be used by clinical doctors and staff members.

From what I know preliminarily, it needs to go through the HIPAA certification. Is that correct?

Thanks!
Healthcare Problem Solver
Thanks, is HIPAA the only necessary certification?

More Small Business Health Insurance Basics In Texas

Because premiums, deductibles, copayments, and coinsurance levels for small business group health insurance policies in Texas can vary widely from plan to plan, it pays to shop around.

Have a good understanding of your employees’ healthcare needs before you start shopping. Do they require frequent medical care or do they rarely see the doctor? Are they more concerned about preventive checkups or coverage in case of emergency? Are prescription or maternity benefits important to them? This is an essential first step. You want to purchase a plan that offers the medical benefits your employees need, without a bunch of “extras” your employees won’t take advantage of. You’ll pay for these “extras” in the form of higher premiums.

When shopping for coverage, the Texas Department of Insurance recommends keeping these guidelines in mind:

- Be sure you understand the full extent of each plan’s coverage when comparing plans and rates. If you decide to go with a consumer choice health benefit plan over one with all the state-mandated benefits, the carrier or agent is required to explain in writing which coverages you don’t have.

- Plans with higher deductibles, copayments, and employee share of coinsurance generally will have lower premiums. Keep in mind, however, that your employees will also have to pay more out of pocket when they access services or benefits.

- Consider factors other than cost, such as a company’s financial strength and complaint record. These are indicators of the service you can expect. You can learn a company’s financial rating, as determined by an independent rating organization, by calling the Texas Department of Insurance (TDI) Consumer Help Line. You can also learn information about the frequency of consumer complaints filed against specific companies by calling the Consumer Help Line: 1-800-252-3439/463-5515 in Austin.

- Look into purchasing cooperatives. These are groups of small employers with similar health care needs who join together to negotiate discounted rates for shared plans. For a list of registered purchasing cooperatives in Texas, call the Consumer Help Line.

- Buy only from licensed insurance companies. Selling unlicensed coverage is illegal in Texas. If you buy from an unlicensed carrier, your employees’ claims could go unpaid and you could be held liable for the full amount of your employees’ claims and losses. Guaranty associations pay the claims of licensed carriers that become insolvent. You can learn whether a company is licensed by calling the Consumer Help Line.

- Understand that employee health coverage is different from workers’ compensation insurance, which covers only job-related injuries and illnesses. Although workers’ compensation insurance is not required in Texas, it protects you from high damage awards in the case of workplace accidents. Providing regular health coverage to your employees is not a legal alternative to providing workers’ compensation insurance.

Who Pays and How Much?

The law doesn’t require employers to contribute toward health benefit plan premiums. However, many carriers require employers to pay at least 50 percent of the plan’s premiums. Employers may choose to pay a higher percentage than the carrier requires.

The carrier must offer dependent coverage to all eligible employees. Generally, employers are not required to contribute toward the cost of dependent coverage. If the employer doesn’t contribute, employees may have to pay all of these costs themselves.

Premiums may increase at each renewal term, largely due to rising health care costs and possibly as a result of employee claims experience. Texas law caps small-employer rate increases due to health factors at 15 percent per year.

Insurers cannot require businesses to purchase additional lines of insurance, such as life insurance or disability insurance, as a condition of the sale of a health plan.

Employee Signup and Waiting Period

New employees must be given at least 31 days from their start date to enroll in a plan. After this time, they may be required to wait up to one year for the next “open enrollment period” to join. Carriers must offer a 31-day open enrollment period annually.

You can choose to require your employees who enroll in a plan to wait up to 90 days before being eligible for benefits. During this period, the carrier may not charge you or the employee a premium.

Carriers may require participants to wait a certain amount of time before covering pre-existing medical conditions. In general, plans have different rules for pre-existing conditions. Plans using the open-enrollment requirement cannot make new members wait more than one year before covering their pre-existing conditions.

New enrollees who were covered in the year prior to joining a plan also receive credit toward the waiting period on a month-for-month basis. For example, an employee who was covered under creditable coverage for the entire year before joining a new plan would receive 12 months credit toward a one-year pre-existing condition wait — and would therefore experience no wait at all. For previous coverage to be considered creditable, there may not have been more than a 63-day break between the end of the previous coverage and the start of the new coverage.

A small business employer carrier cannot refuse to provide health coverage for employees on the grounds of employee illnesses or pre-existing conditions. Nor may carriers use health-related factors — such as employees’ prior claims experience or information on conditions arising from violent family situations — to decide whether to provide coverage.

How Small Employer Plan Premiums are Calculated

The rates for any given small employer plan are not solely determined by the benefits and deductibles of the plan itself. Certain objective “case characteristics,” along with any health status-related factors of employees, may also be components in determining the premium rate for the small employer group. Case characteristics consist of age, gender, group size, industry, and geography. Carriers can use some or all of these five objective criteria:

- Age of employees: Older people can reasonably be expected to have more expensive and more frequent health-related claims. Generally, the older your workforce, the more your plan will cost.

- Gender: Females generally incur higher medical costs than males at younger ages, particularly during childbearing years. The variance diminishes with age until medical costs for males begin to exceed those for females as they near ages 50 and 60. If you have a younger, proportionately more female workforce, or one that is older and proportionately more male, expect to pay higher premiums.

- Number of plan participants: Carriers often base rates on group size for two reasons. As size increases, administrative costs per insured decrease. Also, smaller groups tend to buy health coverage based on the targeted needs of participants, increasing the likelihood of claims for the benefits provided. As group size increases, this “custom-tailoring” becomes more difficult and premiums tend to decrease. However, the highest group size factor may not exceed the lowest group size factor by more than 20 percent.

- Industry: Some industries have higher medical claims costs than others because of working conditions and the prevalence of accidents. High employee turnover in some industries can also result in higher administrative costs for the carrier. However, the highest industry factor a carrier charges may not exceed the lowest factor by more than 15 percent.

- Geographic area: Health care costs vary by region due to differences in cost of living and medical practices, as well as the amount of medical competition in the area. Most plans vary rates by either county or ZIP code, using the employer’s business address to set rates.

The rating process for a small-employer group can be described as a two-step process. First, a carrier determines a premium rate based on case characteristics and plan design, without regard to health status-related factors. This produces the baseline price of the policy. Second, the carrier may adjust the rate to reflect health status-related factors of the group. This adjustment must apply uniformly to all members of the group and may not exceed 67 percent of the baseline price of the policy.

Group health insurance can be not affordable for many small businesses, not to mention an administrative headache. Another alternative to group health insurance plans is to offer individual health insurance options to your employees. By law, an employer is not allowed to contribute to these plans, or that would be treated as group insurance under Texas state law. But you can still help your employees become insured in a good plan and improve their health and well-being and also improve employee retention in the process. If you’re a small business owner who would like to offer affordable health insurance plans to your employees, but can’t afford group health insurance, you should consider offering your employees the revolutionary, comprehensive individual health insurance solutions created by companies specifically for young, healthy individuals.

Understanding COBRA Health Insurance

Learn how long the continuing coverage lasts—and what it might cost you. WHAT IS COBRA? The Consolidated Omnibus Budget Reconciliation Act is a federal law passed in 1986. It requires companies with 20 or more employees to continue offering health insurance at group rates to former employees and their family members after they’re no longer eligible for the group — because of job loss or divorce, for example. Some states have similar rules for companies with fewer than 20 employees. WHO …

Florida Health Insurance Plans: Get Guaranteed Health Benefits

Nowadays, getting yourself insured by health insurance coverage is a mandatory task and need of an hour. Getting the best health insurance deal for your family or for individual from the reliable agent is another one of the most important and arduous tasks. However, it is not mandatory that each and every company will provide you adequate and cost effective health insurance plans as per your needs and requirements. Only a professional and experienced company can help you in finding the best of health coverage and insurance policies which suits your budget and requirement.

Florida health insurance plans can be purchased at the most competitive prices by availing the professional and expertise insurance services of various companies of the Florida. These service providers are professionals and have expertise knowledge in evaluating various health care needs and requirements of customers. In order to provide complete health care solutions, these professionals offer entire gamut of health insurance plans ranging from dental to temporary or low to discounted health insurance. The pertinent and unique services provided by their companies for availing Florida Health Insurance plans are summarized below-

• By providing the quotes of various reputed insurance companies, these companies help in choosing the best Florida health insurance plans for an individual, families, business groups, etc.

• Once the plan is selected by a customer, now it is the company’s responsibility to complete the required formalities to get a customer insurance coverage.

• By calculating the approximate cost of the plan chosen by an individual, these companies will help in finding out whether the plan is cost-effective or not and able to serve the meaningful purpose.

• Because state government regulates the price of Florida health insurance plans therefore; all the health insurance plans are provided at the same rates that are being offered in the market by various other companies.

Depending upon a person’s health, age, and many other related factors, terms and conditions are decided in the various Florida health insurance plans. Although, from various insurance companies such as Celtic, Aetna, Florida health insurance plans can be availed, but the personalized services provided by these service providers are beyond comparison. You don’t have to repetitively visit the office and gather required information. All the information can be readily availed at the website and can be gained without any hustle and bustle.

The Pursuit of Jobs in Healthcare

Jobs in healthcare will become more plentiful in coming years as members of the “baby boomer” generation age. There will be an abundance of opportunities in healthcare careers, particularly in geriatrics, end-of-life care and hospice and nursing home work. In addition, the large number of severely injured and disabled veterans returning from occupation duty in Iraq is already creating an urgent demand for workers in all healthcare fields that will continue for decades to come.

If this kind of work interests you, you’ll need to prepare for healthcare careers with health care training and education. Online degrees are a convenient and economical way to start the training you’ll need in order to qualify for jobs in healthcare.

In addition to “hands-on” careers in healthcare in fields such as nursing, pathology, radiology and physical therapy, the U.S. Department of Labor anticipates a large number of openings for healthcare management jobs as well as healthcare administration jobs.

Healthcare administration is an area that will take on a great deal of importance in the coming years. If you saw Michael Moore’s movie “SiCKO,” you understand just how dysfunctional the present U.S. healthcare system is. The financial power of greedy insurance and pharmaceutical corporations and their undue influence over corrupt members of Congress presents considerable obstacles. However, there is growing rage among American citizens over this issue that may very well force changes at the state level.

Healthcare administrators are among those who see the problems firsthand and understand the issues; therefore, these people are in a position to help shape healthcare policy in the coming years as individual state governments begin the type of healthcare reform that most members of the U.S. Congress are unwilling to address.

Whether you choose an administrative or a hands-on career in healthcare, you’ll be able to complete your coursework at home, often at your own pace, by attending college online. Contrary to what you may have heard, online courses are similar to traditional classes at a brick-and-mortar university or college. You’ll hear lectures, read required texts, submit papers, take exams and even participate in class discussions. The only difference is that you’ll be using Internet technology such as podcasts and electronic bulletin boards for these interactions.

As you might imagine, training for healthcare careers in “hands-on” fields such as nursing, anesthesiology and pathology require some real-world clinical experience. Once you are at that stage, many schools can arrange for you to complete these requirements at a local hospital or other medical center near your home.

When pursuing an online degree, it is important to make sure that the school is properly accredited. Most online college websites provide this information; you can also learn more about accreditation by visiting the U.S. Department of Education website at http://www.ed.gov.

Healthcare sector in India

Sampling Research Pvt. Ltd. had conducted a research study on healthcare in India and the perspectives on Intellectual Property Rights in the Pharmaceutical sector. This study was done by conducting in depth interviews of highly placed people (ministers/ directors/ beneficiaries/ NGOs) across all strata of the healthcare system.

Not surprisingly most of the respondents rated healthcare in India at an average of a dismal 4 points on a scale of 1-10 (where 1 is lowest and 10 is highest). Many factors contribute to this sorry state of affairs. Those include:

Providing satisfactory healthcare needs of 1.2 billion people is not an easy task for any administration. There is a major divide between the rich and the poor in the country. Of late because of the many private hospitals that are equipped with the best infrastructure the urban rich get proper treatment and facilities. But unfortunately India is mostly rural than urban. Even the rural rich have to travel miles to avail these facilities. Medical professionals are concentrated in urban areas with no government policies to encourage doctors to go to rural areas. Some efforts are on by some state governments to force doctors to work in rural areas. In these areas there is a greater need for healthcare needs.

Lack of education gives rise to sanitation and hygiene problems. No reliable source of water supply and lack of infrastructure make people very prone to water borne diseases. Good government hospitals are overburdened by the high population densities in cities and cannot always provide quality healthcare required. AIIMS in Delhi is one such hospital. In addition there is a poor drug delivery system because of which medicines even when available do not reach the masses. In addition to that pharmaceutical companies are not spending enough in R&D to get the second and third generation drugs. One of the programmes by the government that failed is the Family Planning program due to cultural and social issues thus making the huge population a major challenge for the administration.

On a positive note over the years things have improved. Infant mortality has decreased, medical tourism has become more common and medicines have become more accessible. In case of medical tourism patients not only come to India from Asian countries but also from countries like UK where the waiting period for any surgery sometimes is several months. Successful healthcare programmes include the Polio drops/ DOT/ Immunization, the effects of which have to be measured.

The other issue studied was that of patenting of drugs

There was mixed response here. Most of the respondents felt that the government should understand the clauses first and should not patent anything and everything as that would restrict the availability of drugs in the market. Hence there should be enough clauses to help both the parties (the consumer and the manufacturer). Some respondents also were of the opinion that there was no harm in abusing patents to safeguard the people’s health. Inflow of FDI and innovation is not directly related to strong patenting at least there is no such evidence to back this. It was felt by many respondents that economic development will not be affected if government breaks patents for the benefit of the masses, many cited China’s example. Hence the middle path was most preferred with enough clauses so that monopolistic markets do not arise with the patent regime.

The drugs and pharmaceuticals sector has emerged as one of the top five sectors accounting for maximum foreign direct investment (FDI) inflow. India is increasingly becoming the darling of pharma MNCs, who are vying with each other to set up operations here. One of the main triggers for this growth is the change in the country’s patent laws. Japan’s fourth largest pharmaceutical company has big plans for India. The company has just set up its operations in India and has already rolled out two products into the domestic market, Aricept and Parit (being marketed by GlaxoSmithKline) — and both are doing “very well” according to newspaper reports. The advent of the product patent era and a positive outlook for the pharmaceutical sector as a manufacturing hub has resulted in a significant increase in foreign investment in the drugs and pharmaceuticals sector.

The sector has seen the maximum foreign direct investment (FDI) inflow amounting to $340m (Rs 1571.1 crore) in ‘04. Over the last 25 years, the Indian pharma companies have gained a firm footing in the market, their share of the domestic market having risen from barely 10 per cent in the early 1970s to over 80 per cent now. India has also emerged as a major supplier of drugs to the international markets, particularly over the past decade. A major factor that contributed to the rapid growth of the pharma industry is that through skilful innovations in production processes, the Indian companies could make cheap copies of patented drugs and sell them at very low prices compared to anywhere else in the world. However, this favourable business environment will now undergo a change to favour drug MNCs because of their size and heavy R&D budgets. Even so, given the maturity and growth achieved by the pharma industry over the past decade and the successes of leading firms such as Runback, Dr Reddy’s Laboratories, Cipla, Nicholas Piramal, Glenmark, Wockhardt and many others globally, the Indian industry today is not unduly worried by the challenges of the new regime.

Medicines Sans Frontiers (MSF), the Nobel Prize winning humanitarian organisation, says that Indian manufacturers of combination drugs for treating HIV/AIDS victims have been instrumental in bringing down the cost per patient from $10,500 per month to just $350 per year. They have, thus, revolutionised the treatment and care of AIDS patients across the world.

Power of Lean Healthcare

As healthcare costs increase at a faster rate than other products or services, healthcare providers, in particular hospitals, are under continuous pressure to dramatically improve service, reduce costs, improve patient safety, reduce waiting times, and reduce errors and associated litigation.

However, hospitals are not making the necessary improvements in cost, quality, and safety. A report by the U.S. HHS Office of the Inspector General finds that 20% of consecutive inpatient stay sequences were associated with poor quality care, unnecessary fragmentation of care, or both. The current organization and management of hospitals is an imperfect system that cannot effectively address these issues. Major projects to restructure hospitals, dramatically reduce cost, and improve customer care have had little impact on quality or cost.

In simplistic terms, current healthcare systems are not designed to make the process or ‘value stream’ of care flow smoothly. Healthcare services are often ‘batch and queue’, with patients spending most of their time waiting until the Healthcare Professional is ready i.e. push versus pull. As the population matures, patient cycle times in the hospitals, post-care facilities, and laboratories become key measurements that need to improve.

Our belief is that Lean Healthcare can provide a solution to successfully address some of these concerns with minimal cost but maximum benefit.

Lean in Healthcare

The essence of Lean Thinking is to eliminate waste through understanding how the patient defines value and how to deliver that value. Lean Thinking focuses on creating an efficient, waste-free continuous flow built on a pull vs. ‘batch and queue’ approach aligned with the continual pursuit of a perfect system.

Examples of Healthcare Waste:

o Redundant capture of information on admission

o Multiple recording of patient information

o Excess supplies stored in multiple locations

o Excess time spent looking for charts

o Patient waiting rooms

o Excess time spent waiting for equipment, lab results, x-rays etc.

o Excess time spent dealing with service complaints

Hospitals are made up of a series of processes with diverse lines of business. As a consequence, they need to build their delivery systems with these lines of business in mind. Hospitals need to know the businesses that drive 80% of their value proposition. They need to streamline their organization systems and processes to fully support the process required to deliver high quality care.

Commitment and support for any lean initiative needs to not only come from top healthcare management but, even more critically, from the ‘bottom up’ for implementation. Decision making and system development need to be pushed down to the lowest levels of any healthcare organization.

Management consultants are normally engaged as Lean change agents rather than as Lean facilitators. Healthcare staff should lead any Lean implementation program. These people are best equipped to understand the work environment, issues, challenges, what will work and what won’t. An empowered and knowledgeable team is therefore essential to achieve sustainable improvements and long-term success in any Lean initiative. Put simply, Lean will not work without an educated workforce.

Examples of Lean Healthcare Performance Metrics

o Improved patient satisfaction

o Increased operating room utilization

o Reduced time between procedures

o Lower tools and supplies inventory

o Reduced laboratory space

o Improved cost effectiveness

Lean Healthcare Accreditation

A new Lean Healthcare Green Belt Certification program (www.leanhealthcareservices.com) was recently developed to enable effective staff empowerment.

The on-line program represents the first International Healthcare Certification of its kind, and provides an essential ‘first step’ to not only understanding the theory but also the application of Lean tools and practices through detailed work assignments, in-line assessments, and final examination.

The program has been designed in association with the Irish Institute of Industrial Engineers, the Canadian Professional Logistics Institute, Lean Experts, and Healthcare Consultants in conjunction with the Leading Edge Group. It is open to personnel involved in any organization within the healthcare field, particularly those associated with hospitals, clinics, nursing homes, blood banks, laboratories, and pharmacies. Once these people have the ‘appropriate’ knowledge, they will be able to envisage and achieve results and, most importantly, meet the needs of patients now and in the future.

Please contact Joe Aherne CPA, Chief Executive Officer, Leading Edge Group, jaherne@leadingedge.ie; www.leanscm.com; www.leanhealthcareservices.com

Obama Care

We all agree the health care system is in need of reform. That’s not the issue. The debate is really what kind of reform is needed. There are those rooting for nationalizing health care - Obama Care. What’s that you ask? Obama’s idea of reform is a government takeover of the health care system. One of the most popular forms of government takeover is the “Massachusetts Model.” Those of us opposing “reform” that involves yet more government interference, wish to see a system that incorporates …

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