Dr. HSA

Guest Columnist, David Harris

National Healthcare Revenue Cycle Partner

Pay for Medicare Advantage (P4M)

February 2010 - Vol. 22

David Harris

If Government is serious about extending insurance coverage to more than 30 million people by 2019, let's start with those who can afford it--but opt out of our employer-based insurance system because premiums for individuals, families and small business are too high.  Universal insurance coverage is DOA, but there's still hope for at least a portion of the 30 million uninsured who have the ability to pay.  Government should consider making Medicare Advantage available to Americans who want insurance at an affordable cost based on their age, gender and family status.  Although Medicare was designed for the elderly, the infrastructure exists to expand coverage to all working Americans willing to pay insurance premiums to the Government.  At a minimum, it forces insurance companies to become more competitive in their individual markets.  The long-term goal should be to allow for inter-state purchase of health insurance

Today, the average annual insurance premium for a family is $13,375 according to the Kaiser Family Foundation.  What if the self employed--without access to group rates through an employer--could by buy Medicare Advantage for say…. $8,000 - $10,000 depending on the benefit plan design?

Bring down the premium even more by incorporating a high deductible option--whereby consumers pay for services out of pocket until their deductible is met (very similar to car insurance).  For example, Kaiser Permanente offers deductible-based HMOs in the state of California.  Go even further and couple a Health Savings Account (HSA) with a commercially available deductible-based Medicare Advantage product.  Don't stop with tax breaks!  Create incentives or rewards for healthy behavior in the form of:

• Discounts on health club dues (or just make it part of the annual premium),
• Gift cards for participating in health risk assessments and annual physicals,
• Coupons for healthy food groups at national retailers such as Walmart,
• Rebates for health equipment over a certain dollar amount, and
• Discounts on generic pharmaceutical drugs

WARNING…. I am not suggesting more entitlement programs.  Don't introduce "sliding scale" premium packages whereby those making less than their neighbor pay less for the same coverage.  Provide tax breaks as an incentive for working Americans to purchase healthcare insurance.  Yes, this is a slippery slope for both Republicans and Democrats looking for reform.  We need more choices and a government option might not be a bad idea if it's designed to address systemic problems associated with the cost and payment of healthcare in the U.S. such as:

1. Lack of competition between insurance companies
2. Complicated benefit plans designed to confuse members, providers and employers alike
3. Short-term philosophy on wellness versus long-term approach to promote healthy living

An HSA qualified Medicare Advantage product for people under the age of 65 with incentives built in for wellness is a hybrid of what the Republicans started in the "consumerism" movement and what some Democrats are now advocating with a government option.

As select members of the House and Senate prepare for President Obama's Bipartisan Healthcare Summit on February 25, they should ponder what's working well and how we can expand coverage and access to the best healthcare system in the world.  It's either that simple or if only it were that simple.  I don't know the answer, but we have to start somewhere.

 >> What's your point of view? Email Dr. HSA. We look forward to hearing from you!

About the author...

David Harris is a Partner with the Healthcare Advisory Practice in PricewaterhouseCoopers' New York office. He has over twenty years industry experience in the health care and information systems field. David is the National Partner for PwC's revenue cycle practice that specializes in, payer, hospital and physician revenue cycle operations improvement, operation turnarounds/workouts, process redesign and business office integration, as well as denial management. He is responsible for the thought leadership, products and methodologies used by PwC's more than 100 revenue cycle professionals with in-depth knowledge of patient access, clinical documentation, health information management, inpatient and ambulatory coding, billing, claim adjudication, collections, A/R management and information systems.