The Health Insurance Benefit as Umbilical Cord

--By Anna Shepherd, Health & Personal Finance Professional
We are all aware now that Obamacare has had some positive benefits for the less-than-27 years of age crowd: young adults can stay on their parent's health plan up to age 26. (Read more: http://www.sacbee.com/2010/05/09/2736160/personal-finance-health-care-rules.html#ixzz13b68jp7V )

As someone who is no longer on their parent’s plan, I have mixed feelings about this part of the legislation. It would be much easier to get back on Dad’s health plan, and I would certainly have a greater sense of security as I strike out on my own. But at the same time, as I’m trying to find a dentist for cheap in my new locale, I’m learning a lot and being selective because my bank account is at the forefront of my mind.

Part of the problem with American healthcare is that the true costs are not reflected in the prices (premiums) people pay due to the tax benefits of employer plans as well as the individual idea that “I’m not paying for it, the insurance company is.” I think these types of inclusions in the health care law further exacerbate that type of thinking. It allows young people to sort of write-off an expense onto their parents and not to have to think about the true costs until they smack them in the face later on. Now, people can certainly debate the pros and cons of young people not having to worry about their health care. As the linked article states, they are freer to find work, particularly non-profit social work, because health care coverage doesn’t have to be a prerequisite for a job. However, this also allows them to not have to think critically about planning their health and finances on their own.

Furthermore, we must ask, who is paying for this? The answer is often going to be: companies already cash-strapped and trying to cut costs in their health-plans. This is certainly not the best news for them, especially in this economic climate. These adult-children are not working for the company and increasing output and thus revenue, but they are reaping a reward for the work of others.

In the end, this is another example of inefficient cost-redistribution endemic in our health care system. Unfortunately, I view it as forestalling the inevitable—these kids have to own up sometime, whether it happens at 23, 29 or 35 god-forbid, the bottom line is always there and someone’s going to have to pay for it.

Online Medical Consult Offered by HealthPartners

By---Terri Bernacchi, PharmD, MBA, Health Advisory Professionals

Minnesota companies have long been in the forefront of leading health care initiatives in technology, insurance, and consumerism. Certainly, HealthPartners is familiar to most of us in health care as one of those thought leading companies.

This week, they announced the launch of the “virtuwell” offering to consumers for 24-hours-a-day, 7-days-a-week on-line access to a medical professional (nurse practitioners) for the diagnosis and treatment of simple medical conditions for a small ($40) fee. Ostensibly, this treatment would be isolated to the treatment of conditions that are easily and safely confined to “evidence based” decision-trees and medical flow charts: such ailments as colds, cough and allergy, ear pain, yeast and urinary tract infection.

But the new online service does raise some interesting questions from several angles: legal/liability (who is responsible for quality issues that could arise) ; clinical best practices (you cannot really “see” or “touch” a patient or peek inside the ear or smell their breath or gain the context you can when you are in the same room); what is done for communication and follow up perspectives? There are additional questions that relate to privacy, quality of care without reliable access to a relevant patient history, and practical concerns relating to continuity of care if the patient does have a primary care practitioner or drug interactions if they are on other medications. Since most health practitioners (and particularly those that prescribe drugs) are licensed on a state-by-state basis, there are also interesting questions in terms of how the caregiver is licensed or managed in one state while rendering care to a person in another state. Will this care require payment outside of the established insurance process or will it be covered at all?

Regardless of the details or the answers to some of these compelling questions, this is certainly going to be a service of interest to many consumers. A key question that one must ask when you see a party blazing a new health care trail is this: Would I use that service for myself or a member of my family? The answer to that question (at least for me), is YES. I have personally already used one of the now famous in-the-retail-pharmacy nurse clinics. And as a pharmacist, I must admit, I was pleased with the care of the nurse practitioner treating my conjunctivitis.

Change is not always a great or even good thing. But this evolving way of relating to the needs of an individual patient may offer value in these cost and access-challenged times. At a minimum, it will be interesting to see what progresses from here.

Read the details at the following link: http://www.healthcareitnews.com/news/healthpartners-launches-247-online-clinic

Terri currently works for a large health sciences firm serving payers, pharmaceutical and device manufacturers and other stakeholders in health care as a Senior Principal in Managed Markets. The thoughts put forth on these postings are not necessarily reflective of the views of her employer nor other Health Thought Leader colleagues. Terri has had a varied career in health related settings including: 9 years in a clinical hospital pharmacy setting, 3 years as a pharmaceutical sales rep serving government, wholesaler, managed markets and traditional physician sales, 3 years working for the executive team of an integrated health system working with physician practices, 4 years as the director of pharmacy for a large BCBS plan, 12 years experience as founder and primary servant of a health technology company which was sold to her current employer three years ago. She has both a BS and a PharmD in Pharmacy and an MBA.

Health Care Perspectives from the Next Generation - Anna Shepherd Inaugural Post

By Anna Shepherd, Health & Personal Finance Professional

I’m a 23 year old college grad with a degree in Personal Finance and Economics. I’ve worked with the elderly continually since high school and am currently working 2 part-time jobs; one as an in-home caregiver, the other as a transition manager—helping someone downsize their home and life.   In these fields, I touch the outskirts of the medical field and see personally how people face and make the decisions related to their own health.

I was asked to write this from the perspective of youth in this country. I think that is a big task, because I believe a lot of youth aren’t paying attention. With the background of finance, I’m terrified at what’s happening in this country in terms of healthcare spending. It’s unfortunate, because I believe in some of the things in HR 3200. For example, I think that it’s necessary to open up insurance markets and allow the resultant competition to do its job. But then I inevitably reference the results of a 1980s RAND study in which people were given a 0%, 25%, 75% or 100% co-pay for their healthcare. Lo and behold, those with no co-pay used the most healthcare resources. In essence, this experiment is going to take hold nationwide in the next decade and I’m not sure how the results will play out. I must state that I have not read the entire bill, though I’m working at it.

I feel like my thoughts are full of conflict as I try to muddle through the right and wrong of entitlements. I work with the elderly and see how worried and scared they are about money, but see Social Security as a burden that I’m never going to be able to count on. I also care for people coming home from questionable and invasive surgeries only to pass away in recovery.

In the end, my personal view on my health: it’s all up to me. I’m the one who has to do everything possible to prevent myself from ever having to enter this industry as a patient. Unfortunate events happen, and I’m glad we have a system of professionals there to help--I’m not advocating for any extreme anti-medical establishment diatribes--I’m just saying that I’m going to take the best care of my body possible because as I’ve come to realize over the last 2 years, my actions are just about the only thing I can control.

Giving People the Power to Make Choices is a Tricky Proposition

Terri Bernacchi, PharmD, MBA
Health Advisory Professionals
England’s infamous health care system is always undergoing flux and scrutiny as leaders try to find new and better ways to save money, provide care, and meet expectations for quality and outcomes. The concept of “shared decision making” and patient empowerment is proving to be difficult there, too, however, as evidenced by a recent article published in the British Medical Journal. The British government has publicized its plans to introduce wider choice and shared decision making within the NHS, but they are finding that it may be challenging to implement based on several factors, some of them unforeseen.

For example, evidence suggests that while patients like the idea of a choice of physician and being involved in personal health decision making, the clinicians are not necessarily warm to the idea. Changing these attitudes in the provider community requires changing entrenched styles and operating beliefs within the professional community itself.

Moreover, while the UK National Health System already provides patients with information on quality, safety and outcomes and promises to publish more detailed information in the future, the evidence suggests the patients are not using it! And it appears that physicians don’t really understand what the patients themselves want regarding information and decision making.

While there are decision aids for many diseases and conditions already in place, the NHS and its practitioners continue to struggle with how to embed these tools, and how to shift attitudes and skills so that shared decision making will be put into more routine practice.

How can this information from the NHS help those of us in the United States, where the idea that a patient would not have choices is a foreign, even hostile concept? 2010's health care reform has been unpopular with a large percentage of Americans. But the reality that every individual’s inevitable need for health care looms in front of all of us and the lessons learned by the NHS are helpful. In order to create a fully empowered (and accountable) patient in the US, we need to make sure that:  

• the patient understands the information that should be considered in making decisions and the consequences of each option
• the physician and other supporting clinicians are encouraged to work with the empowered patient which may mean reforming paternalistic patterns of communication and care
• the financial system that is the underpinning for the empowered patient must support the process of “Shared Decision Making”, without creating disincentives to the physician, the patient, or other stakeholders like family members.

Read more: http://www.4ni.co.uk/northern_ireland_news.asp?id=117833

Terri currently works for a large health sciences firm serving payers, pharmaceutical and device manufacturers and other stakeholders in health care as a Senior Principal in Managed Markets. The thoughts put forth on these postings are not necessarily reflective of the views of her employer nor other Health Thought Leader colleagues. Terri has had a varied career in health related settings including: 9 years in a clinical hospital pharmacy setting, 3 years as a pharmaceutical sales rep serving government, wholesaler, managed markets and traditional physician sales, 3 years working for the executive team of an integrated health system working with physician practices, 4 years as the director of pharmacy for a large BCBS plan, 12 years experience as founder and primary servant of a health technology company which was sold to her current employer three years ago. She has both a BS and a PharmD in Pharmacy and an MBA.

PCPCC to Issue Briefs on Patient-Centered Medical Home - PATIENT

Terri Bernacchi, PharmD, MBA
Health Advisory Professionals

A coalition of more than 700 major employers, consumer groups, organizations representing primary care physicians, and other stakeholders who have joined to advance the patient centered medical home, the group promoting the use of the Patient-Centered Medical Home, the Patient-Centered Primary Care Collaborative (PCPCC) issued a press release in advance of two briefs it is expected to issue on October 21, 2010.  

• The first brief centers on the issue of Clinical Decision Making, offering a guide that defines clinical decision support and describes its role for enhancing quality and lowering costs in a patient-centered medical home. It also helps the physician’s office understand the requirements of “meaningful use” in order to garner stimulus dollars for paying for the technology.

• The second brief covers the unfolding IT aspect of the Medical Home. This brief provides a compendium of articles, case examples and tools for providers across the health care continuum to engage patients in their own care.

To get a copy of the briefs and to read the press release, follow this URL: http://www.prnewswire.com/news-releases/use-of-health-it-to-engage-patients-support-clinical-decision-making-topics-of-new-resources-from-patient-centered-primary-care-collaborative-104944154.html

The Medical Home concept is one that puts the use of resources and decisions based upon a patient-centered set of circumstances...including clinical, financial, social, practical and quality elements. It is sometimes defined as "an approach to providing comprehensive primary care”. The “Medical Home” facilitates partnerships between individual patients, and their personal professional Providers, and when appropriate, the patient’s family. (For more information on the patient centered medical home and a complete list of the PCPCC members, please visit http://www.pcpcc.net/  )



In so many ways, the Medical Home concept embraces the “empowered patient” concept, where the choices and ultimately, a good deal of the responsibility, for health maximization rest rightfully on the shoulders of the patient. The health professions are there to facilitate and support the efforts of the patient.

Terri currently works for a large health sciences firm serving payers, pharmaceutical and device manufacturers and other stakeholders in health care as a Senior Principal in Managed Markets.  The thoughts put forth on these postings are not necessarily reflective of the views of her employer nor other Health Thought Leader colleagues.   Terri has had a varied career in health related settings including:  9 years in a clinical hospital pharmacy setting, 3 years as a pharmaceutical sales rep serving government, wholesaler, managed markets and traditional physician sales, 3 years working for the executive team of an integrated health system working with physician practices, 4 years as the director of pharmacy for a large BCBS plan, 12 years experience as founder and primary servant of a health technology company which was sold to her current employer three years ago.   She has both a BS and a PharmD in Pharmacy and an MBA.

Whose Decision SHOULD it Be?

Monday, October 11, 2010 by

           Terri Bernacchi, PharmD, MBA
           Health Advisory Professionals

Against the great backdrop of the 2010 US Congress’ vote on the health reform legislation (that a small majority of Congressional leaders voted for but many admitted they never read) is a key issue that often escapes those of us in and around health care. Who makes “the decision”?

Which decision is that? Any decision on health care---small or great----whether to start or continue a medication, join a health club, have a mammogram, vaccinate a child, eat a cheeseburger or to buy health coverage of a particular variety. All day-to-day health care decision-making for a specific individual can ultimately have a profound impact on personal, family, and social levels. As an example, the person who chooses to smoke, and becomes addicted to the tobacco, inflicts suffering and cost on her own life, but also effects those around her, the health plan that underwrites her and the society that could pick up the tab for her illnesses should she end up impoverished and in need of state-sponsored coverage. Yet tobacco use is a state-subsidized and legal activity. And the individual is exercising her own freedom in choosing to use it.

So, whose right or responsibility is the decision-making itself? Does it differ by today’s cost or risk impact of the decision (drinking a sugary soft drink versus choosing to have a full mastectomy rather than a lumpectomy)? Does it differ based upon which state one lives in or who pays for the health care coverage? Or, is it possible that the decision itself is ultimately the single right of the individual and is part of his inalienable right to life, liberty and the pursuit of happiness?

Is the responsibility of the decision “shared”, as is implied in an evolving domain of medical research known as “shared decision making”? This concept has been codified in the Patient Protection and Affordable Care Act (PPACA) as a new expectation in medical practice. The law incorporates measures to foster adoption of decision “aids” as well as to establish a series of standards for their quality and governmental support for the expansion of this concept.

Recently released results of the DECISIONS Study indicate that, “although patients perceive themselves to be informed participants in medical decisions, their recall of the important factual information deemed critical to decision making was found to be lacking. Furthermore, what patients described as ‘‘participating’’ often equated to assenting to the recommendations of their physician without much discussion in the way of options or weighing of risks and benefits.” 1

It is important to reflect on the fact that the financial yield of the physician or provider rests on the patient choosing to utilize the very services based on their recommendation (e.g., surgery, procedures, more visits)

Patients often sign “informed consent” documents without a real understanding of the implications of what will follow.

In the future, as a greater understanding of the options, costs and consequences is realized by patients through various means, the empowered patient make take on a more activist role in his or her own care, sometimes rejecting the recommendation of the clinician caring for him.

One aid that could help patients make more reasoned decisions---large or small---could be assistance from an experienced and empathetic health “guide” ---a clinical party with no financial stake in the patient’s care---one who sits on the same side of the table as the patient and the family, to review and compare options, weigh them, and understand them in the context of the medical, financial, spiritual, and social realities of the individual patient.

Such guidance may even save a few bucks, but the real payoff may be measured in the terms of an individual’s own humanity.

1[1] Braddock, Clarence H.  The Emerging Importance and Relevance of Shared Decision Making to Clinical Practice.  Medical Decision Making, Sep – Oct 2010.  Pp. 5s-7s.  Taken from the URL:  http://mdm.sagepub.com/content/30/5_suppl/5S.full.pdf+html

Terri currently works for a large health sciences firm serving payers, pharmaceutical and device manufacturers and other stakeholders in health care as a Senior Principal in Managed Markets.  The thoughts put forth on these postings are not necessarily reflective of the views of her employer nor other Health Thought Leader colleagues.   Terri has had a varied career in health related settings including:  9 years in a clinical hospital pharmacy setting, 3 years as a pharmaceutical sales rep serving government, wholesaler, managed markets and traditional physician sales, 3 years working for the executive team of an integrated health system working with physician practices, 4 years as the director of pharmacy for a large BCBS plan, 12 years experience as founder and primary servant of a health technology company which was sold to her current employer three years ago.   She has both a BS and a PharmD in Pharmacy and an MBA.