A synopsis of the current health care insurance coverage dilemma

(Note: This was written some time ago....)

Solving Health Care Issues in the Virgin Islands

There is a solution for the three main areas of concern we face regarding healthcare in the territory. Quality; Cost; Availability.

I've spent a portion of my career engaged in projects involving the industry of health insurance and, as a resident of the Virgin Islands, I've observed the challenges we are faced with. Our community deserves facilities and staff that are on par with stateside equivalents. Our hospitals struggle under the financial burden of uncompensated care, inefficient processes (lost revenue opportunities), and reduced Government funding, which resulted in a drop in service to the point where one facility was at risk of losing CMS accreditation. Those with insurance seek alternatives to local treatment for elective matters, either stateside or in neighboring Puerto Rico, further reducing revenue sources.

Insurance premiums in the territory have skyrocketed, with reduced coverage and increased deductibles. Insurers incentivize patients to travel to Puerto Rico for treatment by lowering co-pays and in some cases reimbursing flights. This is likely due to higher reimbursement schedules therefore even the local providers must take some responsibility for the discrepancy in coverage.

And, even if an individual could afford the premiums, there are simply no health insurers doing business in the territory that offer individual coverage - if you are not employed by a sizable business, you are out of luck. This is a major disincentive for budding entrepreneurs and small businesses.

There is an approach, consisting of four parts, that may help solve these issues.

But first, lets start with a little analysis. When trying to impact any marketplace you have to consider the largest customer. In our case it is no surprise this is the government. They have the largest number of employees in the territory and therefore the largest number covered under any insurance plan, especially when you add in retirees covered. This results in huge premiums paid to the government's health plan provider of choice. Insurance providers are in the business to make a profit based upon the risk of a given population. Even though this profit is now limited under the affordable care act, an acceptable margin is just good business.

The first part of the solutions is for the government to establish it's own independent health plan. Premiums would still be paid by the government departments to this new insurer, however premiums should be slightly lower due to the elimination of the insurers profit margin. The bulk of processing membership, claims, and other services associated with a health plan can be outsourced to third party administrators. We don't need to build everything from scratch to make this happen.

The second part of this solution is going to be politically tough for the government. In recognizing the positive strides made by our hospitals toward improved quality, the new health insurance plan would be heavily skewed toward the utilization of local health care providers and government facilities. Any off-island treatments would be subject to punitive co-pays. This immediately results in two things. Firstly an increase in the utilization of our local health care facilities, meaning more spending retained locally. Secondly this results in a new level of demand for the highest level of care, that our facilities must be willing to meet. This is where we start addressing the first of the three areas of concern - Quality.

The third part of this solution is in how the new health plan negotiates reimbursement rates with providers and facilities. Now that it represents the bulk of their patients, and has guaranteed an increase in utilization, some reduction in fee schedules must be made. This again is not necessarily the most popular option but something must be done to reduce our overall health care costs. This partially addresses our second area of concern - Cost.

The fourth part of this solution involves opening up the new health plan options to all residents of the Virgin Islands. Yes, any individual, or group, should be able to purchase the same health care coverage as any government employee. This addresses the third area of concern - availability.

None of this is intended to replace the insurance companies that are doing business in the territory today. They would still be welcome to offer commercial coverage to any businesses as they do today. However in order to remain competitive they may need to make their products more attractive and reduce premium accordingly.

Even our current president has been vilified over health care, so I'm not expecting any major changes to happen here. But as an academic exercise understanding that the above steps, while highly simplified are yet, eminently doable. The solutions would require strong leadership, solid planning and an unending supply of political support. The greatest risk associated with this approach would be in ensuring the government departments pay the premium deductions and contributions promptly. As we have seen with the retirement system contributions, this is an area of concern.

There are other benefits to having a government health plan and infrastructure - including the ability to quantify uncompensated care, by registering every user of our facilities as non-contributing members of the insurance plan, however these and other benefits are added value to the core objectives mentioned above.

The ability to positively impact the quality, cost, and availability of healthcare in the US Virgin Islands is an option, given strong leadership and dedication of a responsible VI Government.

I'll just sit back and watch as the ACA collapses on the mainland and morphs into a single payer system like the rest of the civilized world enjoys.

Our government messed up healthcare on the mainland.
Why would anybody think that VI government can manage healthcare in the islands any better? Is there a single project that VI government has done right, on schedule and within the budget?

The best solution for the islands is to invite Kaiser Permanente to take over hospitals and be an exclusive capitated provider and insurer in the islands.

The other option would be looking at Singapore health care system as a model. It is the best and most efficient system in the world. It runs on 6% of GDP and covers everybody in the island.

EpiPen story is a testimony to failure of American healthcare. Epinephrine has been around as a medication for 100 years.
The vial of epinephrine costs $5. Once Mylan loads epinephrine in a pen it becomes $600 drug. The gov through FDA grants monopoly to drug companies. Pharma has the government locked through one of the most powerful lobby second only to military industrial complex. Obamacare has done nothing to stop the rampant abuse perpetrated by Pharma. Furthermore it gave license to steal to big hospital conglomerates. Following introduction of Obamacare hospital profits escalated and now this translates to skyrocketing insurance premiums and insurance cos exiting healthcare exchanges. Brace yourselves for 2017.

Healthcare is a new for of slavery in US. Slavery to your insurance, slavery to drug companies, slavery to your employer, slavery to work for insurance.

EpiPen story is a testimony to failure of American healthcare. Epinephrine has been around as a medication for 100 years.
The vial of epinephrine costs $5. Once Mylan loads epinephrine in a pen it becomes $600 drug. The gov through FDA grants monopoly to drug companies. Pharma has the government locked through one of the most powerful lobby second only to military industrial complex. Obamacare has done nothing to stop the rampant abuse perpetrated by Pharma. Furthermore it gave license to steal to big hospital conglomerates. Following introduction of Obamacare hospital profits escalated and now this translates to skyrocketing insurance premiums and insurance cos exiting healthcare exchanges. Brace yourselves for 2017.

Healthcare is a new for of slavery in US. Slavery to your insurance, slavery to drug companies, slavery to your employer, slavery to work for insurance.

You don't HAVE to use EpiPen

The EpiPen has been the auto-injecting epinephrine standard for so long that your pediatrician and family allergist may not even be aware of Adrenaclick. Like EpiPen, Adrenaclick is designed to deliver an emergency shot of epinephrine for anyone suffering a bout of anaphylaxis due to an allergic reaction.

It’s hard to get a firm grip on how much an Adrenaclick pack costs, what with varying prices at pharmacies, confusing insurance copays, and manufacturer coupons. But families with high deductibles should save money by going with Adrenaclick over EpiPen.

According to Consumer Reports, an Adrenaclick two-pack can run as little as $140 with coupons.

Not sure of the relevance of EpiPen which is an emergency resort but, FWIW:
http://www.cbsnews.com/news/mylan-generic-epipen-price-allergy-drug-epinephrine-pharma/

EpiPen story is a testimony to failure of American healthcare. Epinephrine has been around as a medication for 100 years.
The vial of epinephrine costs $5. Once Mylan loads epinephrine in a pen it becomes $600 drug. The gov through FDA grants monopoly to drug companies. Pharma has the government locked through one of the most powerful lobby second only to military industrial complex. Obamacare has done nothing to stop the rampant abuse perpetrated by Pharma. Furthermore it gave license to steal to big hospital conglomerates. Following introduction of Obamacare hospital profits escalated and now this translates to skyrocketing insurance premiums and insurance cos exiting healthcare exchanges. Brace yourselves for 2017.

Healthcare is a new for of slavery in US. Slavery to your insurance, slavery to drug companies, slavery to your employer, slavery to work for insurance.

Dont hate the Player, Hate the game

Don't hate the game - play the game.

Healthcare investment is part of my retirement portfolio.

The game is greed. CEO of Mylan pays herselve $18M salary this year. She succesfully doubled the price of EpiPen overnight after all.

And we get a bone tossed in a form of generic epipen for $300 while 1mg Epinephrine vial costs $5.
That $300 generic is still three times more what Canadians are paying.

Perhaps OT will find it more relevant.
This is from NPR:

"I have carpal tunnel syndrome in both wrists. I visited a hand surgeon at his office who gave me a cortisone shot in my right wrist. His bill was $450, of which my insurance covered $420. But I also received another bill from the hospital with which his practice is affiliated that included a $1,702 facility fee for which I have a $400 co-payment. This seems so unfair. What can I do to avoid owing that charge?"

This is the response and explanation:

There may not be much you can do after the fact. As hospitals continue recent efforts to purchase physician practices, hospital facility fees are increasingly common. In 2014, a third of doctors were either employed by a hospital or worked in practices that were at least partly owned by a hospital, an increase from 29 percent in 2012, according to a study by the American Medical Association. Even if the doctor's office is located across town, the physician practice essentially becomes part of the hospital, and patients are typically billed for both physician services and hospital facility charges.

I'm well aware of the problems with the US health care system, simply thought a link to a plan to produce generic and less expensive epinephrine doses might be of help to you. A rehashing of the problems of health insurance in general wasn't the point of my linking to the article about the problems in the USVI, simply thought it might of interest to prospective newcomers since it encapsulates the issues involved locally.

Our government messed up healthcare on the mainland.
Why would anybody think that VI government can manage healthcare in the islands any better? Is there a single project that VI government has done right, on schedule and within the budget?

The best solution for the islands is to invite Kaiser Permanente to take over hospitals and be an exclusive capitated provider and insurer in the islands.

The other option would be looking at Singapore health care system as a model. It is the best and most efficient system in the world. It runs on 6% of GDP and covers everybody in the island.

'

By default, the VI government is managing health care on the islands. The government operates the hospitals, provides health insurance for government employees and retirees and manages how Medicaid is divvied out.

By default, the VI government is managing health care on the islands. The government operates the hospitals, provides health insurance for government employees and retirees and manages how Medicaid is divvied out.

Through a group insurance plan just like any other large business and which I believe is still contracted with Cigna.

The game is greed. CEO of Mylan pays herselve $18M salary this year. She succesfully doubled the price of EpiPen overnight after all.

And we get a bone tossed in a form of generic epipen for $300 while 1mg Epinephrine vial costs $5.
That $300 generic is still three times more what Canadians are paying.

Again hate the game

Morons in government are still trying to learn how to add and subtract and their counterparts in the private sector have mastered Diff Eq, yet they think they're smart enough to regulate it?*-)

If you sit down to the poker table and cant figure who the mark is, you’re the mark

A stockholder would be glad to pay a CEO 18 million a year if that CEO could triple their dividends or holdings compared to a million dollar CEO.

I wonder how many people with pensions realize where their money in invested?

By default, the VI government is managing health care on the islands. The government operates the hospitals, provides health insurance for government employees and retirees and manages how Medicaid is divvied out.

Through a group insurance plan just like any other large business and which I believe is still contracted with Cigna.

So what? Risk is calculated into the cost.

The VI Government should just go ahead and hire the rest of us that don't have access to health insurance. 😛

haha!

I'm not at all shocked, saddened upset, whatever by the whole Epipen thing. They are operating within the rules set by both giant private insurers and our elected buffoons in Congress. I am not conspiracy minded, but part of me wants to believe this is a vast left wing conspiracy to push America towards single payer healthcare. I'm hopeful.

(tu)

A stockholder would be glad to pay a CEO 18 million a year if that CEO could triple their dividends or holdings compared to a million dollar CEO.

I wonder how many people with pensions realize where their money in invested?

Sorry for the late entry but the site confused my with the bot.:X

I am talking here about cortisone injection into the wrist. This procedure used to be done for $50 in Drs office. Since the doctor is now the employee of the mega hospital and the Drs office is now"outpatient hospital" this $50 procedure becomes $2000 procedure.

While you may kid yourselves that insurance picks up 90% of the cost the truth is that next year everybody's premiums go up.

Here's an alternative to the epi-pen should anyone require it.
https://m.facebook.com/photo.php?fbid=10153655878457234&id=505827233&set=a.134023347233.121807.505827233&source=48

Since BCBS pulled out of VI, we are.getting United Healthcare. My premiums have dropped, they offer less total out of pocket max, I can use this insurance anywhere in the United States, and they will do 90 prescriptions by mail. The current synopsis for me is Woo Hoo

(tu). Me too

Since BCBS pulled out of VI, we are.getting United Healthcare. My premiums have dropped, they offer less total out of pocket max, I can use this insurance anywhere in the United States, and they will do 90 prescriptions by mail. The current synopsis for me is Woo Hoo