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September 24, 2010

Talkin’ Health Insurance Rate Increase Blues

 A super-enormous spending bill gets press attention, so I’ve been talking with the media these days (1) regarding recent health insurance premium rate increases following the enactment of health reform, which is estimated to cost approximately $250 billion per year once fully realized.  While rate increases by Aetna and certain Blue Cross and Blue Shield plans correlate with the recent passage of health reform, it is hard to believe health reform is the cause, at least not entirely.  The fact is that health insurers have been raising premiums at hard-to-believe rates for well over a decade.  The primary cause then and now is runaway healthcare inflation.  It is true that for the most part insurers, like any other business, look to maximize profits, but most markets for health insurance are extremely price competitive.  Generally it is the increase in expected medical expenses that drive rate increases, and unfortunately demand for medical care has been increasing at approximately 3x the rate of general inflation.  From what I can tell this will continue forever until fundamental structures in the healthcare system change, so expect ongoing rate increases from insurers to persist, despite the political pressure.

A recent study by the Kaiser Family Foundation, while subtle in its presentation, is astounding in its exposition of runaway medical inflation’s impact on health insurance premiums.  Take a look at the charts below.

       

Compounded Annual Growth

   

Absolute 10 Year Growth

Total Health Insurance Premiums   7.8%   114%
Employee Contribution to Insurance Premium   9.5%   147%
Employer Contribution to Insurance Premium   7.3%   103%
US Inflation   2.4%   26.8%
US Real GDP (2000-2009)   1.6%   15.3%

From just this small amount of data it is clear that health insurance premiums have been sky rocketing for almost two decades.  US inflation averaged 2.4% per year, while health insurance inflation has averaged 7.8% per year, with the brunt of this premium increase being absorbed by employees at an average rate of 9.5% per year.  Wage increases have essentially kept up with inflation, meaning the annual disposable income of the average insured family, in real terms, was reduced by nearly $2,000 over the past decade as a result of medical inflation.  W/r/t employers, their bills rose at 7.8%, about 3.25x their ability to raise prices.  Result: employees and shareholders are getting squeezed.

Why so much medical inflation?

There are lots of little reasons that emanate from one major trend: we (the US and its medical profession) keep getting better and better at keeping people alive.

There are many definitions of the word “doctor,” the most relevant to understanding medical inflation being (from MWD – free version):

Doctor : (n) a person who restores, repairs, or fine-tunes things

Today there are an astounding number of ways to restore, repair and fine-tune humans. “Take two aspirin and call me in the morning” is all but gone.  We now understand thousands of causes of the headache, from too much protein in the diet, to brain tumors, to meningitis, to stress, to something called Syringomyelia ($1 to the first reader that knows what this is, and no fair if you are Neurologist), and so on. 

We now know so much that we are increasing exponentially the things that doctors can restore, repair and fine-tune, creating treatments for ailments, many of which were once life-threatening that are now survived regularly, leaving us with an older and sicker population that costs more and more to fine-tune every year.  In short, much of our medical inflation is a symptom of our amazing technology and our wealth.  Modern medicine, while an awesome exposition of human inventiveness, is slowly and steadily eating away at the more productive sectors of our economy that created the means for such inventiveness in the first place.

Will it end?

If the “it” is invention, the answer is clearly no.  We will forever be extending our life expectancy and reducing the health and fitness levels necessary to achieve it.  Medical invention will not be stopped.

If the “it” is medical inflation, the answer is not anytime soon.

Much of the healthcare chat on this blog, and that of my business partner Lisa Suennen, involves the many structural changes that must take place within the healthcare economy in order for medical inflation to come under control without the government resorting to over-reaching measures like rationing of care and reimbursement controls.  Many changes are underway, and everyday we meet new companies designing new systems and technologies created to both reduce healthcare costs and improve quality.  Unfortunately it will be many years, perhaps decades before the healthcare system begins to function primarily around a cost/quality paradigm.  I would look for measureable changes in the following areas before expecting any meaningful downward shift in the medical inflation trends:

  1. Patients evolve toward more active, cost and quality conscience consumers of healthcare and health insurance.
  2. Insurers evolve to managers of health risk rather than pure underwriters.
  3. Providers evolve their business models from a strict fee-for-service reimbursement model to a more pay-for-performance model, like most advanced industries (will doctors offer one-year warranties? – why not?).

 Such an evolution spawns subsets of ideas like wellness, care management, value-based health insurance, healthcare information exchanges, insurance exchanges, provider pricing based on quality scoring, telemedicine, and on and on.  I have been and will be discussing them all with the understanding that without meaningful progress medical inflation is here to stay.  Expect it (healthcare inflation) to continue at about 8%, so in 5 years our average family will cost about $20,000 or more a year to insure.

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 (1) Here are a couple of links.  First an brief piece on medical inflation from TheStreet.com along with a podcast interview (download the podcast titled “Best (and Worst) Bonds, Insurers and Obama, Gold’s Rush” – my segment comes in around the 23:00 mark).

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March 13, 2010

Lisa Suennen, Patient Safety and the Health Care Blog

Filed under: Healthcare — Steve Krupa @ 10:29 pm
Tags: , ,

There have been no posts over the past few days because I have been on vacation playing in a golf tournament with my father in St. Lucie, Florida.

In the meantime there seems to be a lively debate on the Health Care Blog with respect to my business parter Lisa Suennen’s recent post on investing in patient safety.  I recommend checking that out here.

See you in a few days when I am back in full work mode.

March 3, 2010

Lisa Suennen on PE Hub

Filed under: Healthcare,Venture Capital — Steve Krupa @ 4:13 pm
Tags: , , ,

My business partner Lisa Suennen is at it again, talking about cost savings through error reduction in hospitals.  Here’s her latest post on PE Hub, titled: Venture Capital Can Increase Patient Safety and Reduce Healthcare Waste and Error.  This is additive to the Psilos White Paper I discussed in yesterday’s post, expanding on the notion that billions of dollars can be saved in the healthcare system by reducing medical errors in hospitals.

The post also serves as a call to arms to venture capitalists to invest in healthcare IT, one of the more underserved areas of venture IT investing.  I think Lisa wishes we had more investment partners to choose from (I, on the other hand, wonder if we should not be keeping this great idea to ourselves!).

March 2, 2010

Psilos White Paper – Healthcare Reform and Combatting Rising Healthcare Costs

Please check out a fairly recent (and pretty awesome) white paper written by Al Waxman, Lisa Suennen and Darlene Collins, three of my partners at Psilos Group, titled Cost, Quality and Alignment: A Step-Wise Plan to Reform and Transform Healthcare (published in September, 2009).

The paper was written during the heat of the debate over healthcare reform, last summer, well before either the Senate or the House passed their respective bills.  It was sent to many members of congress (many actually read it) and media editorial boards (many actually wrote about it).

The overall theme of the Waxman et al paper parallels the message I sent a couple of days ago to Senator Patty Murray (D-Washington).  It recommends an incremental approach to healthcare reform designed to achieve the following goals over the next 10 years:

1.  Reduce overall healthcare inflation to 3%

2.  Enable universal access

3.  End prior condition refusals for insurance and policy cancellation for sick people.

4.  Extend solvency of the Medicare Trust Fund beyond 2017

5.  Reduce medical errors

6.  Improve the US healthcare quality ranking from #35 in the world to #5.

7.  Stimulate investment in new healthcare technologies that improve healthcare quality and lower costs

As a practical solution the current versions of the Senate and House bills (and Obama’s slightly abridged plan) have serious problems in that we don’t know the cost effect of many of the individual provisions let alone whether as a whole either bill will rein in healthcare costs (in the state of Massachusetts, universal care seems to have had no impact on rising costs).  They (the Congress) seem to be attempting to solve all of the problems in the system with one fell legislative swoop with little or no proof that their ideas will lower medical inflation.  As I discussed in my previous post, healthcare reform is not financially viable without successfully reducing healthcare costs and inflation.

Logically, the Psilos team recommends an immediate focus on cost reduction that, if successful, would yield much of the long-term financial capital necessary for expanding access (read: health insurance for the 47 million uninsured in the US).  Note that they are not just offering ideas, but proven solutions.  Among others, they note the following areas as low hanging fruit:

1.  Management of the chronically ill, particularly those in Medicare (could yield $750 billion in savings over 10 years)

and

2.  Deployment of technology to eliminate hospital-based errors (recall my prior post on Atul Gawande and checklists, one such error reduction program), which could yield $7-$10 billion annually to Medicare

More advanced programs that could improve costs include:

1.  Performance-based reimbursement for providers

2.  Financial incentives for individuals to lead healthier lifestyles

3.  Deployment of Personal Health Records and individual patient information for real-time point-of-care access

Obviouisly there is much to discuss here, including the young companies that are developing the technologies and programs that make these ideas work.  In the meantime, my colleagues’ white paper, a truly non-partisan view of the healthcare crisis and reform is extremely informative as to what’s possible in the ongoing effort to control runaway healthcare costs.

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