Patients, firms shop for better health care deals

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Paul Freeman drove 600 miles last year to save himself and his employer thousands of dollars on his surgery.

Freeman's insurer covered his travel costs and the entire bill because a medical center in Oklahoma City could remove the loose cartilage in his knee for about 70 percent less than a hospital closer to Freeman's Texhoma, Okla., home.

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At first, the community bank CEO hesitated because he thought the lower price would mean lower quality. But he knew if he didn't make the roughly 10-hour roundtrip trek, he'd pay about $5,000 out of pocket.

"You immediately think, 'Oh they're going to take me into a butcher shop and it's going to be real scary,'" Freeman, 53, says, noting that instead he had a "wonderful experience."

People shop for deals on everything from cars to clothes to computers. Why not for health care, too?

Insurers, employers and people are shopping around for health care as they try to tame rising health care costs. Companies are doing things like paying for workers to travel if they agree to have a surgery performed in another city where the cost is cheaper. They're also providing online tools to help people search for better deals in their home market.

And some patients are bargain-hunting on their own. Through a website called MediBid, people who pay out of pocket are soliciting doctors, hospitals and medical centers to bid to perform knee surgeries and other non-emergency procedures.

Patients who shop for care represent a tiny slice of the roughly $2.7 trillion spent annually on health care in the U.S., said Devon Herrick, an economist who studies health care for the National Center for Policy Analysis. But he and other experts expect this trend to grow, especially as more companies offer insurance plans that require employees to pay thousands of dollars before most coverage starts. These so-called high-deductible plans also will be among the cheapest options available on the public exchanges set up as part of the health care overhaul to enable millions of uninsured people to shop for coverage.

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Farmers sorting out impact of health care

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MIDDLETOWN, Mo. For pork producer Jim Fisher, providing health care insurance for his employees is a way to make sure he gets good workers.

He farms in Northeast Missouris Pike County with his brother, David.

The family has 2,600 sows and markets about 65,000 pigs annually. They have eight salaried, full-time employees.

Businesses with fewer than 50 employees are exempt from the Affordable Care Acts employer mandate to provide health insurance. But, for Fisher, having health insurance for employees is a good business practice.

If you want to attract employees, good employees, thats probably the No. 1 thing, Fisher says of providing health insurance. I always try to look at it, if I were looking for a job, Id be asking the same thing.

Fisher buys the group insurance policy for his employees through an agent in nearby Bowling Green.

All our employees, we pay 100 percent of their health care (insurance premiums), Fisher says.

Like most people, Fisher has felt the effects of rising health-care costs.

In the past weve had to raise the deductible, he says. . . . We try to adjust their salary to what the health care is costing us. If you get an older person, it costs more.

Fishers brother, David, gets health insurance through his wifes off-farm job. Jim Fisher buys an individual health insurance plan for himself, separate from the farm-employee plan.

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Farmers sorting out impact of health care

GOP, Obama address poor performing health care website

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WASHINGTON --

President Barack Obama's weekend media message is about the troubled health care website and he's asking people to give it a chance as experts work to fix it.

Obama vowed that "in the coming weeks, we are going to get it working as smoothly as it's supposed to." He assured citizens that "everyone who wants insurance through the marketplace will get it."

The administration says the website should be running much better by the end of November.

For the Republicans, Michigan Rep. Fred Upton, the chairman of the House Energy and Commerce Committee, wondered whether the website's troubles are a harbinger of what's ahead for the entire health care law.

He also asked how the administration can "punish innocent Americans by forcing them to buy a product many cannot afford, from a system that does not work?

Hi, everybody. A few weeks ago, we launched an important new part of the Affordable Care Act.

Its called the Marketplace. And for Americans without health insurance, and Americans who buy insurance on their own because they cant get it at work, its a very big deal.

If youre one of those people, the Affordable Care Act makes you part of a big group plan for the first time. The Marketplace is where you can apply and shop for affordable new health insurance choices. It gathers insurers under one system to compete for your business. And that choice and competition have actually helped bring prices down.

Ultimately, the easiest way to buy insurance in this Marketplace will be a new website, HealthCare.gov. But as you may have heard, the site isnt working the way its supposed to yet. Thats frustrating for all of us who have worked so hard to make sure everyone who needs it gets health care. And its especially frustrating for the Americans whove been trying to get covered. The site has been visited more than 20 million times so far. Nearly 700,000 people have applied for coverage already. That proves just how much demand there is for these new quality, affordable health care choices. And thats why, in the coming weeks, we are going to get it working as smoothly as its supposed to. Weve got people working overtime, 24/7, to boost capacity and address these problems, every single day.

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As health care marketplaces open, Vt. eyes bigger goal

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MONTPELIER, Vt. As states open insurance marketplaces amid uncertainty about whether they're a solution for health care, Vermont is eyeing a bigger goal, one that more fully embraces a government-funded model.

The state has a planned 2017 launch of the nation's first universal health care system, a sort of modified Medicare-for-all that has long been a dream for many liberals.

The plan is especially ambitious in the current atmosphere surrounding health care in the United States. Republicans in Congress balk at the federal health overhaul years after it was signed into law. States are still negotiating their terms for implementing it. And some major employers have begun to drastically limit their offerings of employee health insurance, raising questions about the future of the industry altogether.

In such a setting, Vermont's plan looks more and more like an anomaly. It combines universal coverage with new cost controls in an effort to move away from a system in which the more procedures doctors and hospitals perform, the more they get paid, to one in which providers have a set budget to care for a set number of patients.

The result will be health care that's "a right and not a privilege," Gov. Peter Shumlin said.

Where some governors have backed off the politically charged topic of health care, Shumlin recently surprised many by digging more deeply into it. In an interview with a newspaper's editorial board, he reversed himself somewhat on earlier comments that Vermont would wait to figure out how to pay for the new system. He said he expects a payroll tax to be a main source of funding, giving for the first time a look at how he expects the plan to be paid for.

The reasons tiny Vermont may be ripe for one of the costliest and most closely watched social experiments of its time?

It's the most liberal state in the country, according to Election Day exit polls. Democrats hold the governor's office and big majorities in both houses of the Legislature.

It has a tradition of activism. Several times in recent years, hundreds of people have rallied in Montpelier for a campaign advocating that health care is a human right.

It's small. With a population of about 626,000 and just 15 hospitals, all nonprofits, Vermont is seen by policy experts as a manageable place to launch a universal health care project.

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Health Care Checkup: Advocates say health care industry not ready for ACA

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CARLISLE Regardless of the ongoing political debate about the Affordable Care Act, officials and advocates say the current health care industry faces challenges when it comes to making parts of the act successful in Pennsylvania.

Panelists and audience members at the Building Common Ground Summit Saturday morning at Trickett Hall at Penn State Dickinson School of Law voiced concerns over those challenges and what is actually available in the health care industry.

Panelists focused their concern on the number of primary care physicians who would be available to take on the potential increase in newly insured patients looking for the complete coverage of preventative and wellness services.

While answering a submitted question from the crowd, Becca Raley, executive director of Partnership for Better Health, said there has been a problem for years with the availability of primary care physicians a problem that will become more prominent as more people receive new Affordable Care Act plans.

Raley cited the Community Health Needs Assessment completed last year by Holy Spirit Health System, PinnacleHealth and Penn State Hershey Medical Center, an assessment that covered five counties in the Midstate. Raley focused on the data for Perry County, an area in dire need of primary care.

Its a county with basically no health infrastructure whatsoever, she said. There are more than 3,000 people per primary care physician.

Panelist Athena Smith Ford, advocacy director of the Pennsylvania Health Access Network, said movement is taking place to help address the low number of primary care physicians. Like Raley, she said many students graduating from medical school even those intending to go into family medicine are choosing higher-paying specialties. Ford said the motivation for students to choose specialty fields heavily relies on the fact those graduates will have sizeable loans to pay off.

A program that started in 2010, however, is available for graduates to help prevent that move to specialty services, Ford said.

It pays off student loans to have primary care physicians in under-served areas, she said.

Ford said measures exist in the Affordable Care Act to provide more funding for the program. It will take time to build up the available number of primary care physicians, nurse practitioners and mental health providers, but Ford said there has already been a significant increase in the number of primary care physicians available since that program was implemented.

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Health Care Checkup: Advocates say health care industry not ready for ACA

Health Care Checkup: Preventive services already available to women

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With millions of people across the country looking at the Affordable Care Acts health exchange, the federal Health and Human Services secretary wants women to know what is and should be available to them.

As National Breast Cancer Awareness month comes to a close, Kathleen Sebelius, secretary of Health and Human Services, posted a blog entry Thursday about how the Affordable Care Act affects womens health coverage. While the act and the health exchange aim to offer low-cost insurance options for people, Sebelius said the act has already started offering ways for women in the country to receive

preventative screenings and counseling.

Though the health exchanges insurance wont be effective until next year for those who enroll now, the act, which was passed in 2010, has already affected parts of the health care industry. For womens health, one part of the act began in Aug. 1, 2012, to give women free access to a large number of preventative services.

According to the Health and Human Services site, the 22 covered preventative services for women are screenings for anemia, bacteriuria, gestational diabetes, Hepatitis B and Rh incompatibility for pregnant women; screenings for breast cancer, cervical cancer, chlamydia infection, domestic violence, gonorrhea, HIV, osteoporosis, tobacco use and syphilis for all women; counseling for BRCA, breast cancer chemoprevention, breastfeeding, domestic violence, tobacco use and sexually transmitted infections; access to contraception and folic acid supplements; and annual well-woman visits.

Since 2010, women can also receive mammograms and colonoscopies that are completely covered by insurance companies.

These preventive services are critical to keeping women healthy, Sebelius said in her blog post. For example, breast cancer is the most common cancer affecting women and the second leading cause of cancer death for women in the U.S., after lung cancer. But when breast cancer is caught early and treated, survival rates can be near 100 percent.

We believe that the health plan coverage guidelines as developed by the Institute of Medicine (IOM) will help ensure that the women in our service area will receive a comprehensive set of preventative services without regard to their ability to pay for such services, said Rich Newell, CEO of Carlisle Regional Medical Center.

Screening concerns

Dr. Peter Cardinal, medical director of Holy Spirit Health Systems outpatient offices, said having such coverage will help prevent higher costs later on, but he added that theres a caveat to the free access to screenings. As good as it is to offer them, he said a patient needs a physician to guide them through the screening and talk about whether or not a screening is needed.

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Health Care Checkup: Preventive services already available to women

Health care fees are shifting gears

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WORCESTER At a time when most health care organizations are struggling to keep up with the changes sweeping the industry, Reliant Medical Group stands out in one important way.

At Reliant, a Central Massachusetts-based doctors' group, nearly three-quarters of the 180,000 patients are covered by health plans that, to some level, reward doctors for keeping patients healthy and penalize them with lower payments when the quality of care falls.

These plans pay doctors a set amount of money to care for each patient. They encourage primary care physicians to make sure their patients are getting regular checkups and screenings, so illness doesn't grow undetected. They are alternatives to the long-ingrained fee-for-service method of payment, which compensates for the quantity of care over the quality.

Now in an effort to slash costs, improve quality, cut waste and comply with new state and federal laws, the health care industry is moving to these types of alternative payment plans. But few have embraced payment reform to the extent Reliant has.

Systems and millions

A report released this year by the state's Center for Health Information and Analysis said 61 percent of the commercial health insurance market in Massachusetts is fee-for-service. At UMass Memorial Health Care, the biggest hospital system in Central Massachusetts, an overwhelming 95 percent of payments are fee-for-service. At Reliant, that figure is around 25 percent.

Reliant's outlier status can be traced back to its history, when it was called Fallon Clinic and was part of a system that included an insurer, Fallon Community Health Plan, and a hospital, St. Vincent. Fallon Clinic, later renamed Reliant, continued to focus on what are known as global or capitated payment models, even after separating from the health plan and hospital.

"You have to have the systems in place," said Dr. Armin Ernst, president and chief executive of Reliant. "It takes many years to build that."

It also takes many millions of dollars. Reliant spent $24 million to roll out its Epic electronic health record system and has 24 full-time employees dedicated to operating it. The group also has 59 data analysts, many dedicated to monitoring patient data.

Technology, analysis

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Health care fees are shifting gears

Drama – MANDELA: LONG WALK TO FREEDOM – TRAILER 2 | Idris Elba, Naomie Harris, Tony Kgoroge – Video

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Drama - MANDELA: LONG WALK TO FREEDOM - TRAILER 2 | Idris Elba, Naomie Harris, Tony Kgoroge
MANDELA: LONG WALK TO FREEDOM is based on South African President Nelson Mandela #39;s autobiography of the same name, which chronicles his early life, coming of...

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Drama - MANDELA: LONG WALK TO FREEDOM - TRAILER 2 | Idris Elba, Naomie Harris, Tony Kgoroge - Video

Brown allows freedom to CA woman who killed pimp

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AP/October 27, 2013

LOS ANGELES (AP) California Gov. Jerry Brown has decided to allow freedom to a woman who received a life sentence when she was a teenager for killing her former pimp.

Brown decided late Friday not to take action on a state parole boards decision to grant parole to Sara Kruzan, thereby allowing the decision to go into effect, his spokesman Evan Westrup said Saturday.

Kruzan was 17 when she was sentenced to die in prison for the 1994 shooting death of George Gilbert Howard in a Riverside motel room. She contended that he sexually abused her and had groomed her since she was 11 to work for him as a child prostitute.

Her case became a high-profile example used by state Sen. Leland Yee, D-San Francisco, who sought to soften harsh life sentences for juveniles.

It is justice long overdue, Yee told the Los Angeles Times. He called Kruzans case the perfect example of adults who failed her, of society failing her. You had a predator who stalked her, raped her, forced her into prostitution, and there was no one around.

Kruzans case garnered widespread publicity in 2010 after Human Rights Watch posted a six-minute interview with her on YouTube.

The year culminated with Gov. Arnold Schwarzenegger commuting her sentence to 25-years-to-life with the possibility of parole on his last full day in office. Schwarzenegger said he still considered her guilty of first-degree murder, but he sympathized with her defense that the man she killed had sexually abused her and served as her pimp for years.

Given Ms. Kruzans age at the time of the murder, and considering the significant abuse she suffered at his hands, I believe Ms. Kruzans sentence is excessive, the governor wrote in his commutation message, it is apparent that Ms. Kruzan suffered significant abuse starting at a vulnerable age.

This January, a Riverside judge further reduced her first-degree murder conviction to second degree, making her immediately eligible for release.

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Brown allows freedom to CA woman who killed pimp