Archive for March, 2010

There are plenty of places to read about the Health Care Reform Bill (HCRB). In fact, it is nearly impossible not to find coverage of its passage, its fans, its detractors, its promises, and its pitfalls. In addition, there is more than enough commentary documenting the debris left behind by its warring factions, as well as illuminating the barriers to its effective implementation.

President Barack Obama reaches for a pen as he signs the health insurance reform bill in the East Room of the White House, March 23, 2010. (Official White House Photo by Lawrence Jackson)

One interesting way to view the healthcare landscape after passage of the HCRB, however, is through the health care reporter’s lens. Where do health care reporters see the action emerging?   Pia Christensen from the blog Covering Health selected four journalists and asked where they will be looking for news. What’s compelling is that the “breaking news” on the horizon teases out how changes in the provision of health care to individuals will impact employers, hospitals, states, provider groups, etc.–the partners and clients of insurers.

These are excerpts of what they said:

Jim Landers from The Dallas Morning News

The thing most people will want to know about this bill, and its local dimension, is the impact on insurance coverage – who now gets in, who stays out – and what the local “charity” hospitals think will happen to their patient loads in the ER.
…The bill has lots of stuff about gradual improvements in these. The most evident are the promises by hospitals and pharma to forego $155 billion and $80 billion. There are also the health IT efforts that everybody is pursuing.
The story on a quick turnaround, however, would be to question the high-cost hospitals (see American Hospital Directory for the retail prices) about why that is, and what they’re doing about it in light of the legislation. Hospitals are big targets, and someone should always be available to talk.

Trudy Lieberman from the CUNY Graduate School of Journalism

The affordability issues tucked into the health reform law cry out for exploration. Through this whole debate, people have been told that they would get subsidies to help them buy coverage, but all the nuances of those subsidies available through the state exchanges, or shopping services, and the amounts people will actually pay out of pocket have barely been discussed. Some readers, viewers and listeners will be in for a big surprise. They may have to decide between buying subsidized insurance with a hefty out-of-pocket outlay for premiums along with high deductibles – perhaps as high as $4,000 – or taking a tax penalty that will be a smaller hit on the family purse.
Subsidies are based on family income; those at the low end of the income spectrum will get more help than those with an income of $88,000, the upper limit for government help. Families with middling incomes will find themselves paying nearly 10 percent of their income on a policy with the government paying the rest. So a family making $66,000 would spend $6,257 for a policy that may cover only 70 percent of their medical expenses, on top of the deductible.
These insurance-buying dilemmas will make interesting and readable stories. Plus they will also get at the question of how well the law is working and whether people are really getting coverage. That, after all, was the central goal of the law. How are families going to make choices? Where will insurance actually fit in?

…Reporters may want to keep an eye on how insurance companies will try to get around the ban on pre-existing conditions. If they must cover sick people with all their expensive ailments, they will somehow have to bring money in the door to pay all those claims and make a profit on the side. What proxies for medical underwriting will they use? The new law sanctions age rating; in other words, looking at age in determining how much someone pays. While checking out Massachusetts, find out how older people, especially older women, are faring. In that state, insurers can charge an older person twice as much as a younger one for the same coverage in the same geographic area. Sometimes they must pay several hundred dollars more, making insurance unaffordable. Under the new law, insurers can charge three times more. While gender rating; that is, charging women more than men, will not be permitted, women who work for large companies with a predominantly female workforce can be charged higher rates until 2017.
Another story on the affordability beat will be employer wellness programs. HIPAA regulations allow employers to create wellness programs based on health factors. Workers who hit targets like having blood pressure readings below a certain number might get a discount on their premiums. But the value of the rewards can be no greater than 20 percent of the combined premium paid by the employer and employee. Workers who don’t meet the targets could pay higher premiums. The new law allows employers to offer a higher reward to “good” workers, up to 30 percent of the combined premiums. The secretary of the Department of Health and Human Services can increase it to 50 percent. Employers argued for flexibility.

[See an editorial in the New York Times by Dr. Sandeep Jauhar on just the troubles inherent in assigning “blame” to patients who don’t comply with best health practices.]
Noam Levey Los Angeles Times/Tribune Washington Bureau

Here are some stories you want to consider on a local level:
Insurance premiums aren’t likely to come down any time soon. Tracking what local insurers are doing, especially before a new regulatory regime is put in place would be worthwhile. Look for the kind of gaming that drug companies are accused of doing this year to boost prices. Tracking premiums in the individual market is very difficult, but it is worth checking with your state insurance commissioner, as many at least require insurance companies to report premium increases.

By Laura Meckler The Wall Street Journal

Small business: Many small businesses have opposed the bill, but they are eligible for tax credits if they offer insurance this year. Look at a small business that is eligible and see if they plan to offer coverage.
Medicare cuts: The health bill cuts Medicare reimbursement rates for many health care providers. One worth looking at is Medicare Advantage, the private managed care program that is offered in some parts of the country. Experts say these plans are, on average, overpaid by about 14 percent, and their rates will be cut by the new law starting next year. Insurers predict this will prompt companies to pull out of certain communities where it is more expensive to provide care. Is yours one of them?
20-somethings: Find some 20-somethings who will be newly subject to the individual mandate (starting in 2014) and see what they think. Are they resentful that they will have to buy insurance, or excited that they may get help paying premiums?


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Data 2010

We have been thinking about data visualization, data storage, and data analysis lately.  Here are a few interesting ideas we are tracking, followed by a short guide for working with data:

The Economist recently ran an article on “data”:  the vast amounts of data, the surfeit of data, the potential of data, the headaches of data.  The Economist compared the shifts brought about by the speed and quantity of data generation and data exhaust (for individuals and societies)–in terms of scale and importance–to the changes brought about by the industrial revolution.

“Wal-Mart, a retail giant, handles more than 1m customer transactions every hour, feeding databases estimated at more than 2.5 petabytes—the equivalent of 167 times the books in America’s Library of Congress (see article for an explanation of how data are quantified). Facebook, a social-networking website, is home to 40 billion photos. And decoding the human genome involves analysing 3 billion base pairs—which took ten years the first time it was done, in 2003, but can now be achieved in one week.

…What we are seeing is the ability to have economies form around the data—and that to me is the big change at a societal and even macroeconomic level,” says Craig Mundie, head of research and strategy at Microsoft. Data are becoming the new raw material of business: an economic input almost on a par with capital and labour. “Every day I wake up and ask, ‘how can I flow data better, manage data better, analyse data better?” says Rollin Ford, the CIO of Wal-Mart.”

Wired’s Chris Anderson argues that the massive quantities of data available make “scientific theory obsolete.”  In The End of Theory, Anderson proposes that

At the petabyte scale, information is not a matter of simple three- and four-dimensional taxonomy and order but of dimensionally agnostic statistics. It calls for an entirely different approach, one that requires us to lose the tether of data as something that can be visualized in its totality. It forces us to view data mathematically first and establish a context for it later. For instance, Google conquered the advertising world with nothing more than applied mathematics. It didn’t pretend to know anything about the culture and conventions of advertising — it just assumed that better data, with better analytical tools, would win the day. And Google was right.

Allison Walker’s post in FastCompany called Mama, Don’t Let Your Babies Grow Up to Be Infographics introduced us to a gorgeous video by Motion Theory. While she (gently) mocks IBM’s commercial/spot, the data floating from that baby is very relevant to the work done in data collection and analysis at Health Plans. (It also reminds us of Harvard professor John Palfrey’s work, esp. see Born Digital.)

Even if we don’t have the math chops to analyze megabites of data, we can adhere to some principles in analysis.  The following is summarized from a posting by Nathan Yau on his terrific blog Flowing Data.  This is what you have to do, he says:

  • Pay Attention to the Details:  “The point is that trends and patterns are important, but so are outliers, missing data points, and inconsistencies.”
  • See the Big Picture: This means, don’t get so caught up in the details that you miss the point.
  • No Agendas: “This should go without saying, but approach data as objectively as possible. I’m not saying you shouldn’t have a hunch about what you’re looking for, but don’t let your preconceived ideas influence the results. Because if you go to length looking for some specific pattern, you’re probably going to find it. It’ll just be at the sacrifice of accurate results.”
  • Look Outside the Data: “Context, context, context. Sometimes this will come in the form of metadata. Other times it’ll come from more data.The more you know about how the data was collected, where it came from, when it happened, and what was going on at the time, the more informative your results and the more confident you can be about your findings.”
  • Ask Why:Finally, and this is the most important thing I’ve learned, always ask why. When you see a blip in a graph, you should wonder why it’s there. If you find some correlation, you should think about whether or not it makes any sense. If it does make sense, then cool, but if not, dig deeper.”

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