http://www.msnbc.msn.com/id/22804799/
Pennsylvania announced Tuesday it would no longer make Medicaid payments to hospitals for serious, preventable medical errors, apparently the first state in the nation to follow a similar policy by the federal government.
Wednesday, February 27, 2008
Health care spending to top $4 trillion by 2017
http://www.msnbc.msn.com/id/23342260/
By 2017, consumers and taxpayers will spend more than $4 trillion on health care, accounting for one of every $5 spent, the federal government projects
By 2017, consumers and taxpayers will spend more than $4 trillion on health care, accounting for one of every $5 spent, the federal government projects
Consumer Bill of Rights and Responsibilities
http://www.hcqualitycommission.gov/cborr/chap5.html
Chapter Five Respect and Nondiscrimination
Source of payment. The health care system currently is undergoing an historic transformation in which low-income Medicaid beneficiaries are being enrolled into private health plans. While this is a positive development in terms of access for traditionally vulnerable populations to high-quality care, it is almost certain to create additional tensions that could be manifest in discrimination. Providers who agree to accept Medicaid beneficiaries must provide equal access, care, and waiting times to those patients. It will be vitally important for State and Federal agencies to closely monitor the provision of care to Medicaid beneficiaries as they move into new health plans
Health plans will need to examine the standards and incentives that exist within their systems that may inadvertently discourage providers from attending to the interpersonal aspects of health care quality that can be manifest as disrespect. Consumers enrolled in health plans with defined networks of providers should have access to their plans' participating providers, without regard to the source of their coverage (e.g., Medicare, Medicaid, employer-sponsored plan
Chapter Five Respect and Nondiscrimination
Source of payment. The health care system currently is undergoing an historic transformation in which low-income Medicaid beneficiaries are being enrolled into private health plans. While this is a positive development in terms of access for traditionally vulnerable populations to high-quality care, it is almost certain to create additional tensions that could be manifest in discrimination. Providers who agree to accept Medicaid beneficiaries must provide equal access, care, and waiting times to those patients. It will be vitally important for State and Federal agencies to closely monitor the provision of care to Medicaid beneficiaries as they move into new health plans
Health plans will need to examine the standards and incentives that exist within their systems that may inadvertently discourage providers from attending to the interpersonal aspects of health care quality that can be manifest as disrespect. Consumers enrolled in health plans with defined networks of providers should have access to their plans' participating providers, without regard to the source of their coverage (e.g., Medicare, Medicaid, employer-sponsored plan
Managed Care Consumer Bill of Rights
http://www.legalaction.org/gmed28.htm
The right to be treated no differently than commercial enrollees
The right to be treated no differently than commercial enrollees
Managed Care Consumer Bill of Rights
http://www.oag.state.ny.us/health/compliance.html
There are three general areas in the new statute which the Attorney General is particularly concerned about because of their impact on consumers. First, the Bill gives consumers certain rights to information about their health plans. Second, the Bill provides consumers with certain rights to access specialty, out-of-network, and emergency care. Third, consumers are given various rights to contest certain health plan decisions through mandatory grievance and utilization review procedures
There are three general areas in the new statute which the Attorney General is particularly concerned about because of their impact on consumers. First, the Bill gives consumers certain rights to information about their health plans. Second, the Bill provides consumers with certain rights to access specialty, out-of-network, and emergency care. Third, consumers are given various rights to contest certain health plan decisions through mandatory grievance and utilization review procedures
Tuesday, February 26, 2008
New York Medicaid Fraud May Reach Into Billions
http://www.nytimes.com/2005/07/18/nyregion/18medicaid.html?pagewanted=7
Among the biggest beneficiaries of the Medicaid program have been executives of the state's nursing homes and clinics, many of whom earn substantial salaries and profits from the program.
According to records obtained from the Health Department under the Freedom of Information Law, 70 executives of nursing homes and clinics personally made more than $500,000 in 2002, the last year for which figures are available. Twenty-five executives made more than $1 million.
Among the biggest beneficiaries of the Medicaid program have been executives of the state's nursing homes and clinics, many of whom earn substantial salaries and profits from the program.
According to records obtained from the Health Department under the Freedom of Information Law, 70 executives of nursing homes and clinics personally made more than $500,000 in 2002, the last year for which figures are available. Twenty-five executives made more than $1 million.
A Guide to Monitoring Medicaid Managed Care
http://www.familiesusa.org/resources/tools-for-advocates/guides/monitoring-medicaid-mc-2.html
Multiple state agencies may have responsibility for monitoring the performance of Medicaid managed care plans
State Medicaid agencies are responsible for making sure that plans comply with federal Medicaid law and regulations and with Medicaid managed care contracts
Multiple state agencies may have responsibility for monitoring the performance of Medicaid managed care plans
State Medicaid agencies are responsible for making sure that plans comply with federal Medicaid law and regulations and with Medicaid managed care contracts
Policing Medicaid and Medicare Managed Care: The Role of Courts and Administrative Agencies
http://muse.jhu.edu/login?uri=/journals/journal_of_health_politics_policy_and_law/v027/27.3mello.html
The Role of Courts and Administrative Agencies Michelle M. Mello Harvard School of Public Health Abstract: The much-publicized 2000 case of Frew v. Gilbert, in which a federal judge castigated the State of Texas for deficiencies in its Medicaid program, brought renewed attention to the issue of regulating the quality of care in Medicaid and Medicare HMOs. Frew and other recent cases highlight both the promise and the pitfalls of relying on courts to correct deficiencies in public managed care programs
The Role of Courts and Administrative Agencies Michelle M. Mello Harvard School of Public Health Abstract: The much-publicized 2000 case of Frew v. Gilbert, in which a federal judge castigated the State of Texas for deficiencies in its Medicaid program, brought renewed attention to the issue of regulating the quality of care in Medicaid and Medicare HMOs. Frew and other recent cases highlight both the promise and the pitfalls of relying on courts to correct deficiencies in public managed care programs
Specialists less Likely to Provide Care to Medicaid Managed Care Patients
http://hbns.org/newsrelease/medicaid12-04-01.cfm
Specialists are just as likely to treat Medicaid patients as are primary care physicians, according to the results of a recent study conducted in California. They are, however, less likely to accept Medicaid patients who are enrolled in managed care plans
The survey, published in the December issue of the Journal of General Internal Medicine, also found that specialists have fewer numbers of Medicaid patients in their practices than do primary care doctors and that most doctors hold negative views of Medicaid patients
Specialists are just as likely to treat Medicaid patients as are primary care physicians, according to the results of a recent study conducted in California. They are, however, less likely to accept Medicaid patients who are enrolled in managed care plans
The survey, published in the December issue of the Journal of General Internal Medicine, also found that specialists have fewer numbers of Medicaid patients in their practices than do primary care doctors and that most doctors hold negative views of Medicaid patients
Jack P. Smith III, Managed Care
http://www.aslme.org/news/jlme/27.1f.html
Jury Awards $121 Mil. in Denial of Benefits Case against Aetna
Sunday, February 24, 2008
CIGNA settles massive managed care lawsuit
http://www.ama-assn.org/amednews/2002/12/16/prl11216.htm
That lawsuit -- which accuses CIGNA of bundling, downcoding and arbitrarily denying claims -- was the first physician-filed lawsuit against an HMO to get class-action certification. It now stands to be the first lawsuit in which physicians will recover tens of millions of dollars and will see some changes in the way that a managed care company interacts with physicians on matters of billing.
"It's a great win for doctors," said Alton, Ill., otolaryngologist Timothy N. Kaiser, MD, who originally filed the lawsuit against CIGNA along with Irving, Texas, pediatrician Suzanne LeBel Corrigan, MD, because they were tired of getting the runaround when they billed for their services. "It demonstrates that individual physicians can make a big difference."
That lawsuit -- which accuses CIGNA of bundling, downcoding and arbitrarily denying claims -- was the first physician-filed lawsuit against an HMO to get class-action certification. It now stands to be the first lawsuit in which physicians will recover tens of millions of dollars and will see some changes in the way that a managed care company interacts with physicians on matters of billing.
"It's a great win for doctors," said Alton, Ill., otolaryngologist Timothy N. Kaiser, MD, who originally filed the lawsuit against CIGNA along with Irving, Texas, pediatrician Suzanne LeBel Corrigan, MD, because they were tired of getting the runaround when they billed for their services. "It demonstrates that individual physicians can make a big difference."
Friday, February 22, 2008
Fighting the idiocy of health insurance
http://disgruntleddoctors.org/index.html
Health Insurance needs to be considered as a method to protect personal finances, not to assure access to health care. Catastrophic health insurance with high deductibles with or without voluntary Health Savings Accounts are a reasonable financial protection. First dollar or low deductible/low copay health insurance plans are a recipe for excessive demand on resources, artificial cost controls, regulatory intrusion, Stalinist 5-year plans, and failure of the medical economy.
Health Insurance needs to be considered as a method to protect personal finances, not to assure access to health care. Catastrophic health insurance with high deductibles with or without voluntary Health Savings Accounts are a reasonable financial protection. First dollar or low deductible/low copay health insurance plans are a recipe for excessive demand on resources, artificial cost controls, regulatory intrusion, Stalinist 5-year plans, and failure of the medical economy.
Thursday, February 21, 2008
Tuesday, February 19, 2008
10 things your hospital won't tell you
http://articles.moneycentral.msn.com/Insurance/InsureYourHealth/10ThingsYourHospitalWontTellYou.aspx
Treatment errors are common, finding someone in charge can seem impossible, and patients sometimes wind up sicker than when they arrived. And here's a tip: Try to avoid hospitals late at night and in July
Treatment errors are common, finding someone in charge can seem impossible, and patients sometimes wind up sicker than when they arrived. And here's a tip: Try to avoid hospitals late at night and in July
More going without health care
http://articles.moneycentral.msn.com/Insurance/InsureYourHealth/MoreGoingWithoutHealthCare.aspx
Nearly half (48%) say they pay more in health-insurance premiums than a year ago, and 37% say they pay more out of pocket for medical services or prescriptions.
The results of the poll of 9,765 adults suggest that medical expenses are becoming a heavier burden on household finances, even for middle-income Americans. They underscore the findings of other recent studies that the cost of health care is becoming a more widespread problem.
Nearly half (48%) say they pay more in health-insurance premiums than a year ago, and 37% say they pay more out of pocket for medical services or prescriptions.
The results of the poll of 9,765 adults suggest that medical expenses are becoming a heavier burden on household finances, even for middle-income Americans. They underscore the findings of other recent studies that the cost of health care is becoming a more widespread problem.
Wal-Mart expanding in-store health clinics
http://articles.moneycentral.msn.com/Insurance/InsureYourHealth/WalMartExpandingInStoreHealthClinics.aspx
Wal-Mart is among several supermarket and drugstore chains that in the past couple of years have begun opening store-based health clinics, which are staffed mostly by nurse practitioners or physician assistants and offer quick service for routine conditions from colds and bladder infections to sunburns.
Wal-Mart is among several supermarket and drugstore chains that in the past couple of years have begun opening store-based health clinics, which are staffed mostly by nurse practitioners or physician assistants and offer quick service for routine conditions from colds and bladder infections to sunburns.
Monday, February 18, 2008
The three top executives of Western New York's dominant nonprofit health insurers boosted their combined takehome pay
http://news.manta.com/articles/description/200707081707520_10853300_0-0304
Jul. 8, 2007 (McClatchy-Tribune Regional News) -- The three top executives of Western New York's dominant nonprofit health insurers boosted their combined takehome pay to $3.77 million last year, even though their companies' total earnings surplus fell by more than 18 percent, according to state regulatory filings. HealthNow New York, Independent Health Association and Excellus Health Plan earned a total of $287.6 million in 2006, down significantly from $351.1 million the year before. Yet only Excellus' CEO, David Klein, saw any drop in pay -- and only by $3,300, holding above $1.78 million. Meanwhile, consumers continue to see high-single-digit or even double-digit premium...
Jul. 8, 2007 (McClatchy-Tribune Regional News) -- The three top executives of Western New York's dominant nonprofit health insurers boosted their combined takehome pay to $3.77 million last year, even though their companies' total earnings surplus fell by more than 18 percent, according to state regulatory filings. HealthNow New York, Independent Health Association and Excellus Health Plan earned a total of $287.6 million in 2006, down significantly from $351.1 million the year before. Yet only Excellus' CEO, David Klein, saw any drop in pay -- and only by $3,300, holding above $1.78 million. Meanwhile, consumers continue to see high-single-digit or even double-digit premium...
Friday, February 15, 2008
CUOMO ANNOUNCES INDUSTRY-WIDE INVESTIGATION INTO
http://www.oag.state.ny.us/press/2008/feb/feb13a_08.html
NEW YORK, NY (February 13, 2008) – Attorney General Andrew M. Cuomo today announced that he is conducting an industry-wide investigation into a scheme by health insurers to defraud consumers by manipulating reimbursement rates. At the center of the scheme is Ingenix, Inc., the nation’s largest provider of healthcare billing information, which serves as a conduit for rigged data to the largest insurers in the country.
NEW YORK, NY (February 13, 2008) – Attorney General Andrew M. Cuomo today announced that he is conducting an industry-wide investigation into a scheme by health insurers to defraud consumers by manipulating reimbursement rates. At the center of the scheme is Ingenix, Inc., the nation’s largest provider of healthcare billing information, which serves as a conduit for rigged data to the largest insurers in the country.
Tuesday, February 12, 2008
Wednesday, February 6, 2008
World Health Organization USA death rate by years
http://www.who.int/whosis/database/mort/table1.cfm
Number of deaths (N) at ages (in years) and age-sex-specific death rates (rate) per 100 000 population (Infant death rates per 100 000 live births)
2000 all causes males numbers 1177518
females numbers 1225773
1999 all causes males 1175469
females 1215939
Number of deaths (N) at ages (in years) and age-sex-specific death rates (rate) per 100 000 population (Infant death rates per 100 000 live births)
2000 all causes males numbers 1177518
females numbers 1225773
1999 all causes males 1175469
females 1215939
Tuesday, February 5, 2008
This rise in salaries has generated controversy because non-profits are essentially subsidized by taxpayers. They are exempt from property, sales
http://compensationresources.com/press-room/non-profit-agencies-following-corporations--lead-in-paying-executives.php
In reaction to the rise in non-profit salaries, a 1996 law gave the Internal Revenue Service the power to fine or revoke the tax exemption of non-profits whose executives get excessive compensation. But the law gives groups a "safe harbor" if they have a written opinion from an outside expert justifying the pay. The IRS has also advised that salaries at comparably sized profit-making companies can be used as a guideline
In reaction to the rise in non-profit salaries, a 1996 law gave the Internal Revenue Service the power to fine or revoke the tax exemption of non-profits whose executives get excessive compensation. But the law gives groups a "safe harbor" if they have a written opinion from an outside expert justifying the pay. The IRS has also advised that salaries at comparably sized profit-making companies can be used as a guideline
Top hospital execs’ pay in WNY exceeds $1 million
http://www.buffalonews.com/businesstoday/localbusiness/story/250408.html
Kaleida Health paid its new chief executive officer, James Kaskie, $1.2 million last year, up from $844,333, after Kaskie was promoted to succeed Dr. William D. McGuire as CEO, according to federal tax filings provided by the hospital. That includes $852,731 in compensation, $331,085 in benefits and a $20,720 expense account.
At Catholic Health System, the No. 2 hospital network in Western New York, CEO Joseph D. McDonald received $1.03 million, a 26 percent raise from 2005. His pay includes $682,981 in compensation and $347,951 in other payments.
But even with Kaskie’s and McDonald’s salaries considered, total 2006 compensation for 16 top hospital executives in Western New York fell 7 percent to $5.9 million from $6.2 million, largely because of the departure of McGuire, who in 2005 earned $1.74 million — more than double that of any other local hospital CEO.
Kaleida Health paid its new chief executive officer, James Kaskie, $1.2 million last year, up from $844,333, after Kaskie was promoted to succeed Dr. William D. McGuire as CEO, according to federal tax filings provided by the hospital. That includes $852,731 in compensation, $331,085 in benefits and a $20,720 expense account.
At Catholic Health System, the No. 2 hospital network in Western New York, CEO Joseph D. McDonald received $1.03 million, a 26 percent raise from 2005. His pay includes $682,981 in compensation and $347,951 in other payments.
But even with Kaskie’s and McDonald’s salaries considered, total 2006 compensation for 16 top hospital executives in Western New York fell 7 percent to $5.9 million from $6.2 million, largely because of the departure of McGuire, who in 2005 earned $1.74 million — more than double that of any other local hospital CEO.
Construction on HealthNow New York's corporate headquarters is moving on schedule and the first wave of the company's employees
http://buffalo.bizjournals.com/buffalo/stories/2006/08/28/daily21.html?jst=s_cn_hl
"The project is on schedule," said Dennis Gorski, HealthNow's vice president of government programs and former Erie County Executive
"The project is on schedule," said Dennis Gorski, HealthNow's vice president of government programs and former Erie County Executive
Sunday, February 3, 2008
2007 Monthly Medicaid Managed Care Enrollment
2007 Monthly Medicaid Managed Care Enrollment
http://www.health.state.ny.us/health_care/managed_care/reports/enrollment/monthly/2007/docs/en12_07.pdf
http://www.health.state.ny.us/health_care/managed_care/reports/enrollment/monthly/2007/docs/en12_07.pdf
Five-Year Time Trends by County, New York State
New York State Cancer Registry
http://www.health.state.ny.us/statistics/cancer/registry/vol3.htm
2007 New York State Managed Care Plan Performance Report
http://www.health.state.ny.us/health_care/managed_care/qarrfull/qarr_2007/docs/qarr2007.pdf
http://www.health.state.ny.us/statistics/cancer/registry/vol3.htm
2007 New York State Managed Care Plan Performance Report
http://www.health.state.ny.us/health_care/managed_care/qarrfull/qarr_2007/docs/qarr2007.pdf
Saturday, February 2, 2008
60 Minutes
U.S. Heading For Financial Trouble?
http://www.cbsnews.com/stories/2007/03/01/60minutes/main2528226.shtml
David Walker, comptroller general of the U.S., totaled up our government's income, liabilities and future obligations. He concluded the numbers don’t add up
MUST SEE VIDEO
http://www.youtube.com/watch?v=KGpY2hw7ao8
http://www.cbsnews.com/stories/2007/03/01/60minutes/main2528226.shtml
David Walker, comptroller general of the U.S., totaled up our government's income, liabilities and future obligations. He concluded the numbers don’t add up
MUST SEE VIDEO
http://www.youtube.com/watch?v=KGpY2hw7ao8
Senator Kuehl's Universal Health Insurance bill in california
http://www.youtube.com/watch?v=jB0Vn_BppwM
Senator Kuehl's Universal Health Insurance bill in california
MUST SEE
http://www.onecarenow.org/index.html
The statewide OneCareNow grass roots campaign is devoted to educating Californians and building massive support for Senate Bill 840, titled "The California Universal Healthcare Act", authored by Senator Sheila Kuehl.
Senator Kuehl's Universal Health Insurance bill in california
MUST SEE
http://www.onecarenow.org/index.html
The statewide OneCareNow grass roots campaign is devoted to educating Californians and building massive support for Senate Bill 840, titled "The California Universal Healthcare Act", authored by Senator Sheila Kuehl.
THE STATE OF HEALTH CARE QUALITY 2007
http://web.ncqa.org/Portals/0/Publications/Resource%20Library/SOHC/SOHC_07.pdf
THE STATE OF HEALTH CARE QUALITY 2007
NATIONAL COMMITTEE FOR QUALITY ASSURANCE
WASHINGTON, D.C.
2008 NCQA Board of Directors
Robert J. Margolis, M.D. (Chair) -- HealthCare Partners Medical Group
David F. Durenberger -- National Institute of Health Policy
Robert S. Galvin, M.D. -- General Electric Company
Elizabeth Gilbertson -- H.E.R.E.I.U. Welfare Fund
William Goss -- Cain Brothers
Glenn Hackbarth -- Independent Consultant
Jerome P. Kassirer, M.D. -- Tufts School of Medicine, Yale School of Medicine
Peter V. Lee, J.D. -- Pacific Business Group on Health
Dolores Mitchell -- Group Insurance Commission, Commonwealth of Massachusetts
Ralph W. Muller -- University of Pennsylvania Health System
Debra Ness -- National Partnership of Women and Families
Joseph Newhouse, Ph.D. -- Harvard University
Margaret E. O’Kane -- National Committee for Quality Assurance
Ellen Stovall -- National Coalition for Cancer Survivorship
John Tooker, M.D., MBA, FACP (Chair-elect) -- American College of Physicians
I. Steven Udvarhelyi, M.D. -- Independence Blue Cross
Insurance premiums are a poor gauge of health care costs, masked by market competition and plans’ability to negotiate provider discounts. Yet most employers and consumers choose a plan based on the lowest premium offered. A more accurate measure is the value a plan adds by delivering high-quality care while using the fewest possible resources in doing so.
THE STATE OF HEALTH CARE QUALITY 2007
NATIONAL COMMITTEE FOR QUALITY ASSURANCE
WASHINGTON, D.C.
2008 NCQA Board of Directors
Robert J. Margolis, M.D. (Chair) -- HealthCare Partners Medical Group
David F. Durenberger -- National Institute of Health Policy
Robert S. Galvin, M.D. -- General Electric Company
Elizabeth Gilbertson -- H.E.R.E.I.U. Welfare Fund
William Goss -- Cain Brothers
Glenn Hackbarth -- Independent Consultant
Jerome P. Kassirer, M.D. -- Tufts School of Medicine, Yale School of Medicine
Peter V. Lee, J.D. -- Pacific Business Group on Health
Dolores Mitchell -- Group Insurance Commission, Commonwealth of Massachusetts
Ralph W. Muller -- University of Pennsylvania Health System
Debra Ness -- National Partnership of Women and Families
Joseph Newhouse, Ph.D. -- Harvard University
Margaret E. O’Kane -- National Committee for Quality Assurance
Ellen Stovall -- National Coalition for Cancer Survivorship
John Tooker, M.D., MBA, FACP (Chair-elect) -- American College of Physicians
I. Steven Udvarhelyi, M.D. -- Independence Blue Cross
Insurance premiums are a poor gauge of health care costs, masked by market competition and plans’ability to negotiate provider discounts. Yet most employers and consumers choose a plan based on the lowest premium offered. A more accurate measure is the value a plan adds by delivering high-quality care while using the fewest possible resources in doing so.
US NEWS BEST HEALTH PLANS
Best Health Plans
Healthcare costs continue to rise, and most employees are getting no healthier. Employers are beginning to introduce wellness programs with teeth, rather than those that offer small perks like discounted gym memberships.
Healthcare costs continue to rise, and most employees are getting no healthier. Employers are beginning to introduce wellness programs with teeth, rather than those that offer small perks like discounted gym memberships.
US NEWS BEST HEALTH PLANS
http://www.usnews.com/directories/health-plans/index_html/plan_cat+commercial/
Commercial
1. Harvard Pilgrim Health Care (HMO/POS)Maine, Massachusetts
Based on Consumer assessment, Prevention and Treatment
Medicare
1Fallon Community Health Plan (HMO)Massachusetts
Prevention, Treatment
Medicaid
1 Fallon Community Health Plan (HMO)Massachusetts
Consumer assessment, Prevention and Treatment
The 2007 Rankings Methodology
Let's select a managed care plan at random and conduct an inquiry. How good is it at encouraging members at risk of heart attack to get their bad cholesterol into safe territory and keep it there? If it's a Medicare plan, are physicians effectively steered away from prescribing certain antihistamines, muscle relaxants, and other drugs that could be dangerous to elderly patients? Are doctors alert for kidney disease in diabetic members? Are members happy with claims handling?
To someone trying to pick a health plan, answers to these kinds of nuts-and-bolts questions are useful. And November kicks off "open season," when millions of families decide whether to stick with their current plan or move to a different one.
So for a third year, U.S. News and the National Committee for Quality Assurance, managed care's leading accrediting and standards-setting body, have joined forces to rank health plans based on just such questions.
More than 500 HMOs and POS plans, including most large commercial, Medicare, and Medicaid plans and many smaller ones, have been evaluated, using data submitted annually to NCQA. Their performances in 50 measures for commercial plans, 28 for Medicare plans, and 35 for Medicaid plans were scored on a scale of 1 to 5 and converted to overall scores that determined their rankings.
Inside the measures. Some results came from a consumer survey asking members how satisfied they were, for example, with how well their doctors communicated with them and how quickly care was provided. The rest were medical, divided between prevention (such as whether members were screened for colorectal cancer) and treatment (such as whether asthmatic children from 5 to 9 years old got the right medication).
Plan performance in dozens of individual measures can be found at the Web address provided. It is the first time we've shown such fine detail; in the past, we displayed results only for some measures, although all of the data went into the final scores. The measures can be used to search, sort,and compare plans.
Health plans that couldn't be ranked because of insufficient data are grouped below ranked plans, with scores for measures they did submit. Plans that submitted no data at all, or did but refused to make it public, are listed at the bottom of the rankings. Sometimes there's a good reason—a plan is being phased out, say. Most of the time, however, that's not a place where you want to see your plan, or one that might interest you
Commercial
1. Harvard Pilgrim Health Care (HMO/POS)Maine, Massachusetts
Based on Consumer assessment, Prevention and Treatment
Medicare
1Fallon Community Health Plan (HMO)Massachusetts
Prevention, Treatment
Medicaid
1 Fallon Community Health Plan (HMO)Massachusetts
Consumer assessment, Prevention and Treatment
The 2007 Rankings Methodology
Let's select a managed care plan at random and conduct an inquiry. How good is it at encouraging members at risk of heart attack to get their bad cholesterol into safe territory and keep it there? If it's a Medicare plan, are physicians effectively steered away from prescribing certain antihistamines, muscle relaxants, and other drugs that could be dangerous to elderly patients? Are doctors alert for kidney disease in diabetic members? Are members happy with claims handling?
To someone trying to pick a health plan, answers to these kinds of nuts-and-bolts questions are useful. And November kicks off "open season," when millions of families decide whether to stick with their current plan or move to a different one.
So for a third year, U.S. News and the National Committee for Quality Assurance, managed care's leading accrediting and standards-setting body, have joined forces to rank health plans based on just such questions.
More than 500 HMOs and POS plans, including most large commercial, Medicare, and Medicaid plans and many smaller ones, have been evaluated, using data submitted annually to NCQA. Their performances in 50 measures for commercial plans, 28 for Medicare plans, and 35 for Medicaid plans were scored on a scale of 1 to 5 and converted to overall scores that determined their rankings.
Inside the measures. Some results came from a consumer survey asking members how satisfied they were, for example, with how well their doctors communicated with them and how quickly care was provided. The rest were medical, divided between prevention (such as whether members were screened for colorectal cancer) and treatment (such as whether asthmatic children from 5 to 9 years old got the right medication).
Plan performance in dozens of individual measures can be found at the Web address provided. It is the first time we've shown such fine detail; in the past, we displayed results only for some measures, although all of the data went into the final scores. The measures can be used to search, sort,and compare plans.
Health plans that couldn't be ranked because of insufficient data are grouped below ranked plans, with scores for measures they did submit. Plans that submitted no data at all, or did but refused to make it public, are listed at the bottom of the rankings. Sometimes there's a good reason—a plan is being phased out, say. Most of the time, however, that's not a place where you want to see your plan, or one that might interest you
HEDIS site
http://www.opm.gov/insure/health/hedis2002/9G.asp
HEDIS (Health Plan Employer Data and Information Set) is developed and maintained by the National Committee for Quality Assurance, a not for profit organization committed to assessing, reporting on, and improving the quality of health care. We present HEDIS results on managed care plans to:
allow consumers to reliably compare health plan performance, and
spur the health plans to make internal efforts at quality improvement.
HEDIS (Health Plan Employer Data and Information Set) is developed and maintained by the National Committee for Quality Assurance, a not for profit organization committed to assessing, reporting on, and improving the quality of health care. We present HEDIS results on managed care plans to:
allow consumers to reliably compare health plan performance, and
spur the health plans to make internal efforts at quality improvement.
DOH 2005
http://www.health.state.ny.us/health_care/managed_care/qarrfull/qarr_2005/supp05.pdf
Managed Care
Plan Performance
Report Supplement
Compares plans in very different ways.
Managed Care
Plan Performance
Report Supplement
Compares plans in very different ways.
REPORT ON EXAMINATION
http://www.ins.state.ny.us/exam_rpt/55107f03.pdf
REPORT ON EXAMINATION
OF
EXCELLUS HEALTH PLAN, INC.
AS OF
DECEMBER 31, 2003
Excellus Health Plan, Inc. is a not-for-profit health service corporation organized
and licensed under Article 43 of the New York Insurance Law. The Plan also holds a
Certificate of Authority under Article 44 of the New York Public Health Law as a health
maintenance organization. The Plan operates using two assumed names, Excellus Blue
Cross and Blue Shield and Univera HealthCare.
At the examination date, Excellus, Inc. was the sole member of Excellus Health
Plan, Inc. Excellus Inc. changed its name on January 23, 2004 to Lifetime Healthcare,
Inc. d/b/a The Lifetime Healthcare Companies. Excellus Health Plan, Inc. is the
surviving entity resulting from the mergers of the Blue Cross/Blue Shield Plans in the
Rochester, Central New York, and Utica-Watertown regions and HMOs in Central and
Western New York including HMO-CNY and Univera Healthcare of Central and
Western New York.
The Plan’s mission, as cited in its internal website, and as ratified by the
board of directors at its October 1, 2004 meeting, is quoted in part as follows:
“Being responsible stewards of our communities’ health care premiums
and health care resources.”
Within its strategy statement, also cited within the internal website, the Plan notes
the following as a value:
“Reducing unnecessary, wasteful expense is essential.”
As of December 31, 2003 health care services were provided to 1,890,430
members. The following chart shows annual membership changes by number and
percentage:
1998 1999 2000 2001 2002 2003
Members 1,909,220 1,858,024 2,293,291 1,893,224 2,001,806 1,890,430
Change % -2.7% +23.4% -17.5% +5.7% - 5.6%
It is noted that the increase during calendar year 2000 was due, in large part, to a
restatement of membership associated with the 2001 merger with Univera, Inc. The
subsequent decrease during 2001 was the result of a change in treatment of the Plan’s
minimum premium/premium credit business.
Parent company
Lifetime Healthcare, Inc.* non for profit but the company under area many for profit have about 25 division ? companies
REPORT ON EXAMINATION
OF
EXCELLUS HEALTH PLAN, INC.
AS OF
DECEMBER 31, 2003
Excellus Health Plan, Inc. is a not-for-profit health service corporation organized
and licensed under Article 43 of the New York Insurance Law. The Plan also holds a
Certificate of Authority under Article 44 of the New York Public Health Law as a health
maintenance organization. The Plan operates using two assumed names, Excellus Blue
Cross and Blue Shield and Univera HealthCare.
At the examination date, Excellus, Inc. was the sole member of Excellus Health
Plan, Inc. Excellus Inc. changed its name on January 23, 2004 to Lifetime Healthcare,
Inc. d/b/a The Lifetime Healthcare Companies. Excellus Health Plan, Inc. is the
surviving entity resulting from the mergers of the Blue Cross/Blue Shield Plans in the
Rochester, Central New York, and Utica-Watertown regions and HMOs in Central and
Western New York including HMO-CNY and Univera Healthcare of Central and
Western New York.
The Plan’s mission, as cited in its internal website, and as ratified by the
board of directors at its October 1, 2004 meeting, is quoted in part as follows:
“Being responsible stewards of our communities’ health care premiums
and health care resources.”
Within its strategy statement, also cited within the internal website, the Plan notes
the following as a value:
“Reducing unnecessary, wasteful expense is essential.”
As of December 31, 2003 health care services were provided to 1,890,430
members. The following chart shows annual membership changes by number and
percentage:
1998 1999 2000 2001 2002 2003
Members 1,909,220 1,858,024 2,293,291 1,893,224 2,001,806 1,890,430
Change % -2.7% +23.4% -17.5% +5.7% - 5.6%
It is noted that the increase during calendar year 2000 was due, in large part, to a
restatement of membership associated with the 2001 merger with Univera, Inc. The
subsequent decrease during 2001 was the result of a change in treatment of the Plan’s
minimum premium/premium credit business.
Parent company
Lifetime Healthcare, Inc.* non for profit but the company under area many for profit have about 25 division ? companies
SPECIAL REPORT ON EXAMINATION
http://www.ins.state.ny.us/exam_rpt/hnsr1203.pdf
SPECIAL REPORT ON EXAMINATION
OF
HEALTHNOW NEW YORK INC.
AS OF
DECEMBER 10, 2003
Conflict of Interest Procedures
The examination review revealed that certain directors were engaged in outside business
practices that have, at least, the appearance of potential conflicts with their roles as directors of
the Plan. During the examination period, conflict of interest statements were submitted to the
7
Plan’s internal audit section and reviewed in conformity with the Plan’s policy. However, not all
of the Plan’s potential conflicts of interest were identified or noted in the Board or Committee
minutes of meetings.
A review of the Plan’s existing Conflict of Interest forms, signed by the Plan’s board
members and officers indicates that such form should be enhanced to provide for additional
disclosure of conflicts including disclosure of a medical practice in New York State, disclosure
of family members that work for, or have a connection with providers of health care services,
disclosure of filer or family member of filer as a supplier of services to the Plan or member of
the HealthNow holding company system, and disclosure of filer or family member are owners of
a corporation whose aggregate sales to (1) hospitals, (2) licensed medical professions and (3)
facilities of health service, hospital service and medical expense indemnity corporations exceed
5% of its total sales.
It is recommended that HealthNow enhance its conflict of interest forms for its directors,
officers and key employees by including such additional disclosure items as indicated above or
other items as necessary. It is further recommended that the Plan enhance its review of such
conflict of interest statements and require more comprehensive documentation to support a
determination that conflicts do not exist.
SPECIAL REPORT ON EXAMINATION
OF
HEALTHNOW NEW YORK INC.
AS OF
DECEMBER 10, 2003
Conflict of Interest Procedures
The examination review revealed that certain directors were engaged in outside business
practices that have, at least, the appearance of potential conflicts with their roles as directors of
the Plan. During the examination period, conflict of interest statements were submitted to the
7
Plan’s internal audit section and reviewed in conformity with the Plan’s policy. However, not all
of the Plan’s potential conflicts of interest were identified or noted in the Board or Committee
minutes of meetings.
A review of the Plan’s existing Conflict of Interest forms, signed by the Plan’s board
members and officers indicates that such form should be enhanced to provide for additional
disclosure of conflicts including disclosure of a medical practice in New York State, disclosure
of family members that work for, or have a connection with providers of health care services,
disclosure of filer or family member of filer as a supplier of services to the Plan or member of
the HealthNow holding company system, and disclosure of filer or family member are owners of
a corporation whose aggregate sales to (1) hospitals, (2) licensed medical professions and (3)
facilities of health service, hospital service and medical expense indemnity corporations exceed
5% of its total sales.
It is recommended that HealthNow enhance its conflict of interest forms for its directors,
officers and key employees by including such additional disclosure items as indicated above or
other items as necessary. It is further recommended that the Plan enhance its review of such
conflict of interest statements and require more comprehensive documentation to support a
determination that conflicts do not exist.
Report of examination of Healthnow New York Inc Dec 31,2003
http://http://www.ins.state.ny.us/exam_rpt/55204c03.pdf
The Plan reported reserves and unassigned funds of $221,993,959 as of December
31, 2003. As of December 31, 2003, the Plan’s required to be maintained statutory reserve
of $222,134,436 was impaired in the amount of $140,477. Subsequent to this report date,
the Plan has filed quarterly and annual statements which indicate a removal of the
impairment.
The Plan is a non-profit health service corporation organized under the provisions
of the Membership Corporation Law and Article 43 of the New York Insurance Law.
The Plan was incorporated on September 26, 1939 and commenced business in 1940
As of December 31, 2003 health care services were provided to 669,699
members. The following chart shows annual membership changes by number and
percentage:
1998 1999 2000 2001 2002 2003
Members 674,183 679,463 616,961 622,664 649,875 669,699
Change % +0.1% -9.2% +0.1% +4.4% +3.1%
Different Corporate Structures ie.
HealthNow Holdings, Inc.
As of December 31, 2003, this entity was a wholly owned subsidiary of
HealthNow Systems Inc. and currently is the for-profit holding company for
HealthNow Foundation, New York Care Plus Insurance Agency, Inc. and HealthNow
Contractor Services, Inc., which are all subsidiaries of HealthNow Systems, Inc. The
shares of HealthNow Holdings were transferred to HealthNow New York Inc. in
April, 2004.
HealthNow Foundation (Not-for-Profit Corporation 501(c)(3))
HealthNow Foundation (Foundation) is organized exclusively for charitable
purposes in the United States and abroad within the meaning of Sections 170(c)(2)(B)
and 501(c)(3) of the Code. The sole member of the Foundation is HealthNow
Holdings, Inc.
HealthNow Contractor Services, Inc.
HealthNow Contractor Services, Inc. is a wholly owned subsidiary of HealthNow
Holdings, Inc. This entity was dormant as of December 31, 2003.
Blue Care New York Benefits Agency, Inc. (BCNYBA)
The Plan maintained a 16.67% controlling interest in Blue Care New York
Benefits Agency, Inc. (BCNYBA) as of December 31, 2003. The Plan, along with
four other New York Blue Cross and Blue Shield Plans, formed BCNYBA, then
known as New York Administrative Plan Services, Inc., in 1995 for the purpose of
providing insurance marketing services for said Plans.
New York Care Plus Insurance Agency, Inc. (NYCPIA)
The Plan, in 1997, formed New York Care Plus Insurance Agency, Inc. for the
purpose of operating as an accident & health and life insurance agency. As of the
date of this report, New York Care Plus Insurance Agency, Inc. has remained a
dormant operation.
The following is a description of the inter-company agreements in effect between
HealthNow New York Inc. and other members of the holding company as of the
examination date:
The above ratio is outside Department benchmark guidelines. The Plan
experienced positive underwriting results in the traditional product lines in 2002 and
2003, particularly in the Buffalo area.
The underwriting ratios presented below are on an earned-incurred basis and
encompass the October 1, 1999 to December 31, 2003 period covered by this
examination:
Amount Ratio
Claims incurred $5,147,699,017 86.1%
Claims adjustment expenses incurred 328,037,492 5.5%
Other underwriting expenses incurred 409,944,999 6.8%
Net underwriting gain 96,482,015 1.6%
Premiums earned $5,982,163,523 100.0%
As noted in the above schedule, the Plan exceeded the 12.5% administrative
expense limitation prescribed by Section 4309(b) of the New York Insurance Law for the
years 1999, 2000 and 2001.
Sales and Advertising
The Plan disseminated comparison benefit summary charts in 2004 which
contained instances of misleading and/or incomplete comparisons of other Plans’
benefits. A total of eight (8) such comparison benefit summary charts were found to have
been presented to employer groups and/or brokers. This is a violation of New York
Insurance Department Regulation 34 (11 NYCRR 215.11) which states:
“An advertisement shall not directly or indirectly make unfair or
incomplete comparisons of policies or benefits or comparisons of noncomparable
policies of other insurers, and shall not disparage
competitors, their policies, services or business methods, and shall not
disparage or unfairly minimize competing methods of marketing
insurance.”
It is recommended that the Plan comply with the requirements of Department
Regulation 34 (11 NYCRR 215.11) relative to its sales and marketing advertising.
The Plan reported reserves and unassigned funds of $221,993,959 as of December
31, 2003. As of December 31, 2003, the Plan’s required to be maintained statutory reserve
of $222,134,436 was impaired in the amount of $140,477. Subsequent to this report date,
the Plan has filed quarterly and annual statements which indicate a removal of the
impairment.
The Plan is a non-profit health service corporation organized under the provisions
of the Membership Corporation Law and Article 43 of the New York Insurance Law.
The Plan was incorporated on September 26, 1939 and commenced business in 1940
As of December 31, 2003 health care services were provided to 669,699
members. The following chart shows annual membership changes by number and
percentage:
1998 1999 2000 2001 2002 2003
Members 674,183 679,463 616,961 622,664 649,875 669,699
Change % +0.1% -9.2% +0.1% +4.4% +3.1%
Different Corporate Structures ie.
HealthNow Holdings, Inc.
As of December 31, 2003, this entity was a wholly owned subsidiary of
HealthNow Systems Inc. and currently is the for-profit holding company for
HealthNow Foundation, New York Care Plus Insurance Agency, Inc. and HealthNow
Contractor Services, Inc., which are all subsidiaries of HealthNow Systems, Inc. The
shares of HealthNow Holdings were transferred to HealthNow New York Inc. in
April, 2004.
HealthNow Foundation (Not-for-Profit Corporation 501(c)(3))
HealthNow Foundation (Foundation) is organized exclusively for charitable
purposes in the United States and abroad within the meaning of Sections 170(c)(2)(B)
and 501(c)(3) of the Code. The sole member of the Foundation is HealthNow
Holdings, Inc.
HealthNow Contractor Services, Inc.
HealthNow Contractor Services, Inc. is a wholly owned subsidiary of HealthNow
Holdings, Inc. This entity was dormant as of December 31, 2003.
Blue Care New York Benefits Agency, Inc. (BCNYBA)
The Plan maintained a 16.67% controlling interest in Blue Care New York
Benefits Agency, Inc. (BCNYBA) as of December 31, 2003. The Plan, along with
four other New York Blue Cross and Blue Shield Plans, formed BCNYBA, then
known as New York Administrative Plan Services, Inc., in 1995 for the purpose of
providing insurance marketing services for said Plans.
New York Care Plus Insurance Agency, Inc. (NYCPIA)
The Plan, in 1997, formed New York Care Plus Insurance Agency, Inc. for the
purpose of operating as an accident & health and life insurance agency. As of the
date of this report, New York Care Plus Insurance Agency, Inc. has remained a
dormant operation.
The following is a description of the inter-company agreements in effect between
HealthNow New York Inc. and other members of the holding company as of the
examination date:
The above ratio is outside Department benchmark guidelines. The Plan
experienced positive underwriting results in the traditional product lines in 2002 and
2003, particularly in the Buffalo area.
The underwriting ratios presented below are on an earned-incurred basis and
encompass the October 1, 1999 to December 31, 2003 period covered by this
examination:
Amount Ratio
Claims incurred $5,147,699,017 86.1%
Claims adjustment expenses incurred 328,037,492 5.5%
Other underwriting expenses incurred 409,944,999 6.8%
Net underwriting gain 96,482,015 1.6%
Premiums earned $5,982,163,523 100.0%
As noted in the above schedule, the Plan exceeded the 12.5% administrative
expense limitation prescribed by Section 4309(b) of the New York Insurance Law for the
years 1999, 2000 and 2001.
Sales and Advertising
The Plan disseminated comparison benefit summary charts in 2004 which
contained instances of misleading and/or incomplete comparisons of other Plans’
benefits. A total of eight (8) such comparison benefit summary charts were found to have
been presented to employer groups and/or brokers. This is a violation of New York
Insurance Department Regulation 34 (11 NYCRR 215.11) which states:
“An advertisement shall not directly or indirectly make unfair or
incomplete comparisons of policies or benefits or comparisons of noncomparable
policies of other insurers, and shall not disparage
competitors, their policies, services or business methods, and shall not
disparage or unfairly minimize competing methods of marketing
insurance.”
It is recommended that the Plan comply with the requirements of Department
Regulation 34 (11 NYCRR 215.11) relative to its sales and marketing advertising.
Friday, February 1, 2008
Letter sent to The Attorney General
Letter sent to attorney general
I went into medicine to help patients, not just focus on the finances of medicine. There seems to be a Healthcare DICTATORSHIP initiated by the Managed Care markets. There is an abuse of power with regards to managing patients, and problems with fee fixing below realistic measures. The fees are fixed in the HMO's favor. When an insurance company pays on a medical claim, the payment is considered a lost because their profits shrink. When a provider receives payment on a claim, more often than not, it is also considered a lost. Instead of being paid for services rendered, providers are paid for services "allowed." The vast difference between the HMO loses and the Doctors’ loses is that the HMO hold the reigns. Patients are being managed without choices. Providers are being forced into fixed contracts that are monopolized, either take it or leave it. This has become a huge problem. PLEASE HELP ADDRESS THESE ISSUES AND RECTIFY A REMEDY.
I went into medicine to help patients, not just focus on the finances of medicine. There seems to be a Healthcare DICTATORSHIP initiated by the Managed Care markets. There is an abuse of power with regards to managing patients, and problems with fee fixing below realistic measures. The fees are fixed in the HMO's favor. When an insurance company pays on a medical claim, the payment is considered a lost because their profits shrink. When a provider receives payment on a claim, more often than not, it is also considered a lost. Instead of being paid for services rendered, providers are paid for services "allowed." The vast difference between the HMO loses and the Doctors’ loses is that the HMO hold the reigns. Patients are being managed without choices. Providers are being forced into fixed contracts that are monopolized, either take it or leave it. This has become a huge problem. PLEASE HELP ADDRESS THESE ISSUES AND RECTIFY A REMEDY.
Department of Health Response
Vida Wehren Bureau of Program Planning and implementation division of managed Care and Program Evaluation state in her replied that numbers of specialists participating in medicaid managed care plans in Erie County increase by 123% between 2005 and 2007. Medicaid managed care enrollees in the Western NY region indicate levels of satifaction with their speciality care providers tha are consistent with statewide averages. Similarly, measure of satifaction with care received, timeliness of care, quality of care, customer service and overall satifaction with the health plan met or exceeded statewide averages.
Medicaid Issues
My name is Dr. Raul Vazquez, MD. I am board certified in Family Practice and have been in private practice for 12 years. I provide care to a large Medicaid population on the Westside of Buffalo. In 2003 I relocated my office from 778 Niagara Street to 564 Niagara. I purchased a piece of land and built a "State of the Art"12,000 square foot medical facility. My facility employs over 25 people. Most of the employees are bi-lingual and live right in the community. We have diversified the office to learn from the population and the modalities in order to increase revenue. We perform office services like spirometries, ekgs, holters, arterial dopplers, stress testing, cryotherapy, hair removal and laser services. Extender operations include ophthalmology, x-ray, cardiology, surgery, podiatry, physical therapy, durable goods, and pain management; all private practice model.
Every year it is becoming more and more difficult to sustain due to the decreases in Managed Care reimbursement. Managed Care has in some instances cut fees up to 66%. Over the last 15 years, I have noticed an increase in premiums but a decrease in service. It would seem that by this time, outcomes would be improved. There should be better management of chronic diseases and a reduction of costs. However, the costs are being controlled by reducing reimbursement to providers. Managed Care is in the business of managing costs NOT managing care for patients. As a primary care physician, it is my responsibility to refer patients to the appropriate specialists. However, it is gravely difficult to find specialists that even accept my Medicaid Managed Care patients. Moreover, the providers that once accepted these patients are now declining them. It is simply insulting to expect providers to work for free. We have to provide malpractice and quality care to all of our patients, ill-respective of their medical insurance.
In this area the fees are so low that most providers are leaving, or in the process of leaving, which is what prompted this letter. Today Ophthalmologist, Dr. Rafael Medina, who has been in my facility for 5 years, told me that he would be leaving next month due to reimbursement decline. It is no longer feasible for him to manage this population.
I know that the county is concerned with the welfare of all its citizens; And you as a businessman can appreciate the struggles of another business entity. I have been able in the past 12 years to show improved outcomes on chronic diseases. Asthma, Diabetes and Hypertension is very prominent in this community, However, my asthmatic patients are admitted less than 1% with a 0% morbidity/mortality. My diabetics are controlled at an average HGA1C of <8. Nationally, diabetics are averaging HGA1c's of 9. My hypertensives, and my depressed patients are also well managed and improved. We receive no federal, state, county or city funding. I am simply asking the County and the State to look at the present problems. I do not want to abandon my patients; I feel that I am providing a necessary service. I have some suggestions for improving care and managing populations NOT solely managing costs.
I would be honored to sit down with the elected officials and brainstorm an alternative to the status quo. Insurance companies are concerned with patients accessing emergency rooms for routine care that could be performed by their primary care doctor at a fraction of the costs. Well, if current trends continue, more patients will be forced into the ER's due to a decline in the number of providers that will accept them. This type of segregation creates a cast system that I am sure New York State would not be proud of. Healthcare has become desensitized and patients with substandard coverage are being ostracized by the entire industry, including the pharmacies, the doctors, the extenders and the insurers.
Sincerely,
Dr. Raul Vazquez, MD, FAAFP
Every year it is becoming more and more difficult to sustain due to the decreases in Managed Care reimbursement. Managed Care has in some instances cut fees up to 66%. Over the last 15 years, I have noticed an increase in premiums but a decrease in service. It would seem that by this time, outcomes would be improved. There should be better management of chronic diseases and a reduction of costs. However, the costs are being controlled by reducing reimbursement to providers. Managed Care is in the business of managing costs NOT managing care for patients. As a primary care physician, it is my responsibility to refer patients to the appropriate specialists. However, it is gravely difficult to find specialists that even accept my Medicaid Managed Care patients. Moreover, the providers that once accepted these patients are now declining them. It is simply insulting to expect providers to work for free. We have to provide malpractice and quality care to all of our patients, ill-respective of their medical insurance.
In this area the fees are so low that most providers are leaving, or in the process of leaving, which is what prompted this letter. Today Ophthalmologist, Dr. Rafael Medina, who has been in my facility for 5 years, told me that he would be leaving next month due to reimbursement decline. It is no longer feasible for him to manage this population.
I know that the county is concerned with the welfare of all its citizens; And you as a businessman can appreciate the struggles of another business entity. I have been able in the past 12 years to show improved outcomes on chronic diseases. Asthma, Diabetes and Hypertension is very prominent in this community, However, my asthmatic patients are admitted less than 1% with a 0% morbidity/mortality. My diabetics are controlled at an average HGA1C of <8. Nationally, diabetics are averaging HGA1c's of 9. My hypertensives, and my depressed patients are also well managed and improved. We receive no federal, state, county or city funding. I am simply asking the County and the State to look at the present problems. I do not want to abandon my patients; I feel that I am providing a necessary service. I have some suggestions for improving care and managing populations NOT solely managing costs.
I would be honored to sit down with the elected officials and brainstorm an alternative to the status quo. Insurance companies are concerned with patients accessing emergency rooms for routine care that could be performed by their primary care doctor at a fraction of the costs. Well, if current trends continue, more patients will be forced into the ER's due to a decline in the number of providers that will accept them. This type of segregation creates a cast system that I am sure New York State would not be proud of. Healthcare has become desensitized and patients with substandard coverage are being ostracized by the entire industry, including the pharmacies, the doctors, the extenders and the insurers.
Sincerely,
Dr. Raul Vazquez, MD, FAAFP
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