Larry Hausner knows that making health insurance sustainable is hard, but he wants agents, brokers, health insurer executives and others in the insurance community to remember that having diabetes, multiple sclerosis or leukemia is also hard.
Hausner, the former chief executive officer of the American Diabetes Association, now runs a consulting firm that tries to make the patient’s voice heard in health policy and health business strategy discussions.
One of the goals in the back of his head is figuring out how to promote efforts to give the entities that pay for health care today more of a stake in improving the quality of people’s lives, and cutting future health care, disability and long-term care (LTC) services costs, by spending on preventive care and high-quality condition management programs now.
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“I think it’s beginning to happen,” Hausner says, “but it’s slow. Nobody wants it to be slow.”
Some of the people Hausner is trying to speak for are the clients who buy individual products from you, and the business owners and benefits managers who buy benefits products from you.
For a look at four things Hausner wants to tell you, on their behalf, read on.
1. He understands that Patient Protection and Affordable Care Act (PPACA) changes have been hard on many health insurance agents and brokers.
Hausner says he knows producers in the health insurance market and recognizes that PPACA
For them, “it’s much more up in the air,” he says. “Their attitude is, ‘Why did someone make my life change? Now I need to learn new things.”
See also: What will replace PPACA 1.0?
2. He says that PPACA may not be perfect, but that it has done a lot of good for people with chronic health problems.
For people with expensive chronic health problems, PPACA World, with all of its faults, “is better than where we were before,” Hausner contends. In 2013, before PPACA came along, most adults with diabetes that he met had Medicaid, Medicare or employer-sponsored coverage, or they were uninsured, he recalls.
The uninsured people with diabetes had little or no ability to control what kind of care they got, and, if they were able to get insulin or other medications, they often tried to make supplies meant to last for one month hold out for three or four months.
When he talked to low-income African American people with diabetes, they would tell him, “None of us here are really able to take care of ourselves. We know one out of four of us is going to lose a limb.”
In 2014, when the PPACA ban on use of personal health status information other than location, age and tobacco use helped people with diabetes and other chronic conditions get covered, many of those people simply signed up for coverage without thinking much about the coverage, Hausner says.
During the second open enrollment period, he heard people talking more about out-of-pocket costs.
This year, he says, they are more interested in personalization, and in understanding exactly what providers and what medications are covered.
Hausner would like people who hate the PPACA changes to think more about what it’s like to walk in the shoes of people who have lost their feet.
”The way you do things has to be relearned,” he says.
Some people who lose limbs have trouble paying for any prostheses, let alone the best prostheses, and people who have lost limbs due to diabetes may find that the people around them blame them for the amputations, Hausner says.
3. He feels as if some in the insurance community avoid doing as much as they can to improve chronic care because they are still angry about PPACA.
Hausner says he sees drug companies making active efforts to promote patient engagement, and hospital companies slowly starting to realize that they have to do what they can to prevent avoidable readmissions, even if that leads to some short-term losses in revenue.
He says he sees a wide range of reactions from people in the insurance community, but that some seem to justify a lack of action on chronic care by pointing to PPACA upheaval and saying all the problems are not their fault.
Whatever PPACA’s flaws are, “whatever would come after it is going to have issues, too,” Hausner says.
People in the insurance community need to get over their anger and do what they can to make the system that exists now work, Hausner says.
4. He wishes the plans that cover working-age people had more of a financial incentive to care about efforts to spend some money now to prevent expensive complications later.
Government rules now punish hospitals when a high percentage of Medicare patients return soon after they are discharged.
The PPACA risk adjustment program also tries to encourage insurers to think more about the quality of care for people with serious health problems. In theory, if the risk-adjustment program works, a plan that has an enrollee with a serious health condition, such as diabetes, and holds down the enrollee’s medical bills will get to receive, and keep, extra risk-adjustment program cash.
In the real world, the Medicare hospital readmissions penalty and the PPACA risk-adjustment program still seem to be generating more talk than action, Hausner says.
Hausner says the traditional Medicare program itself is an example of an insurance program with managers who seem to have some ability to take a long-term view of spending.
He recently signed up for Medicare and discovered that he no longer has to worry about co-payments for blood pressure pills or cholesterol pills.
One reason may be that “I’m not going anywhere else,” Hausner says.
Because Medicare has to pay the bills for the same patient over many years, it has an obvious stake in minimizing bills over the course of the patient’s life, Hausner says.
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