California Individual And Group Health Insurance Plans

The San Diego Union-Tribune - Oct. 13: Medicare officials say it's time to modernize the health plan by providing America's seniors with more information and choice. But critics say information and choice are just euphemisms for confusion and higher cost.In many ways, the new Medicare initiatives reflect a shift within the private insurance market to more "consumer-driven" health care. In essence, patients pay part of their health care costs so they have more incentive to stay healthy and choose cost-effective care when they're sick.The prescription drug plan launched last year has been the most highly publicized of Medicare's efforts. But it's also pressuring hospitals to release more information on cost and quality. Later this year, the program will start covering more preventive tests, including an introductory physical designed to catch illnesses before they advance. And next year, Medicare will offer plans similar to health savings accounts, which allow enrollees to pay for some medical costs with tax-free dollars."A lot of people think, 'Consumer-driven health care, here's a check and a here's a phone book, go figure out what's best for you," said Dr. Mark McClellan, administrator for the Centers for Medicare and Medicaid Services, the federal agency that oversees the programs. "That's not what this is."Still, many of the changes require more money and time from Medicare enrollees. Using quality and cost data requires Internet research. Plans with health savings accounts come with higher deductibles. And patients will have to chip in for the preventive tests, typically paying about 20 percent."Beneficiaries have always been responsible for a portion of their cost in Medicare, the problem was the benefits they had available didn't let them lower those costs," McClellan said.Traditional Medicare helped seniors pay for hospital and doctor costs when they got sick, but McClellan said the system's done little to help people stay well, catch problems early or manage illnesses with medication. "In 2006, that's not the way health care should work," McClellan said. Medicare has a big stake in patients managing their health.About 78 percent of Medicare beneficiaries have at least one chronic condition. Nearly two-thirds have two or more. Care for those patients soaks up 95 percent of Medicare's dollars each year. Medicare officials believe many of those dollars could be saved and patients could stay healthier if their illnesses were better managed.Part of the challenge is finding doctors and hospitals who perform the best care at the lowest cost. Earlier this year researchers at Dartmouth Medical School found Medicare could have saved about $40 billion nearly one-third of the total spent if all hospitals had followed the same highest-quality, lowest-cost practices.When Medicare started covering prescription costs last year, McClellan's theory was to let private firms compete for patients and let patients determine which company offered the best deal for them. At the time, many seniors complained they were overwhelmed by options and unable to wade through so much information.But a year later, about 90 percent of seniors have drug coverage through Medicare or a former employer. About 80 percent of them told the nonprofit Kaiser Family Foundation they're happy with their plan. And, average costs for the Medicare prescription plans, called Part D, will be lower than expected this year. "There's no question that the choice available for Part D was a big change," McClellan said. "There's also no doubt that because of competition we are getting the plan we want."McClellan said those same concepts of information and choice can help Medicare improve health care quality and patient satisfaction while reducing costs. "It's the only way we're going to keep Medicare sustainable for the future," McClellan said.Not everyone's convinced. "In my view, consumer-driven health care is quite poorly designed for this population," said Jonathan B. Oberlander, a health policy professor at the University of North Carolina-Chapel Hill. "You have to have a reality check about who the Medicare population is."The cost and quality information Medicare provides is limited and available only on the Internet. It examines how often physicians followed best practices for three common conditions and reports how much Medicare pays for 30 common procedures. The quality data is hospital-specific. The cost data is released by county.Oberlander and other health policy experts say many Medicare patients don't have access to the Internet or can't easily navigate it. Others struggle to understand the information."How are you going to expect someone who is sick to be a good consumer?" asked Stuart Guterman, senior program director for the Commonwealth Fund's Program on Medicare's Future.