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Sunday, December 16, 2007

Homecare Switching Heats Up

So what is going on out there? I have gotten more emails this past week about homecare switching than ever.

Tom wrote in to ask if all Anthem Blue Cross patients with hemophilia will be required to use Precision Rx as their factor provider? He is livid, if this is true. Another mom wrote in to report that she is hearing that Anthem in Ohio is forcing a switch in home care companies. She heard that Anthem's doses may be +2%, not the current industry of dose +10%. She is concerned that this means fiddling around with the vial sizes and number of vials we get.

Still another mom, employed by a homecare company herself (so she buys factor from her employer) is being forced to switch to another homecare company--a competitor!-- that she doesn't like and has not heard good things about. She is very concerned. I would be too: if my son is a source of revenue for my employer and then no longer supplies revenues, will my job be on the line? A lot of parents and patients are employed in the homecare industry.

I had a long conversation with Bob Robinson, the executive director of the Illinois chapter, and he tells me now that Blue Cross Blue Shield is doing the same thing in their state. This trend is gaining speed, and this will be happening more and more. Bob and I talked about how our community is going to have to start accepting that some change is inevitable and that we are going to have to learn to compromise. There is just no way we can have "our way" any more. Most disturbing is that the insurance companies are setting up their own in-house specialty pharmacies. So they are paying for factor and getting the profits at the same time. Can they can charge whatever they want? Who is monitoring this practice?

It seems shocking, but you know, this at first seemed like much more of a market correction than an out-of-the-blue change. Health costs have risen astronomically, so payers are naturally going to do something to lower costs, as long as this does not put the patients in danger. This is what managed care is all about, and it is here to stay, whether we like it or not. Best we can do immediately is to document everything, carefully, every call, every EOB, every charge. We do pay good money, but the payers can simply say "Then go find another plan." Harsh reality but it is the reality.

But the scary part is this: it's not just about lowering health care costs, but control. Insurers are definitely wrestling control of our health care management. Competition is dwindling. When insurers have their own in-house specialty pharmacy (to allegedly control costs) and see the profits rolling in, who will authorize cost control then? They will be fixing the reimbursement price, and reimbursing themselves. Conflict of interest? Big time. The questions become: what is competition, how is it defined and what is fair?

I've been predicting this trend for three years now, since the November issue of PEN in 2004. If you've been reading our work this should not be such a surprise. Only the speed at which it is happening is quickening. Keep those letters and emails coming to us; let us know your insurance and homecare switching story so we can pass it along to NHF, HFA... we are all working to preserve care and control, at fair cost.

Great Book I am Reading: Into Africa: The Epic Adventures of Stanley and Livingstone. Still slogging my way through as Livingstone slogs thorugh Africa. But riveting! Great book to curl up with in a snowstorm, which we are currently having. This will make a good Christmas gift for anyone who like adventure.

3 comments :

Bill said...

This issue has been creeping up on the Bleeding Disorders Communty for some time now. Choice is paramount to our wellbeing over all.
Anthem/Precision Rx is "testing the waters" and eliminating adequate choice for the consumer. If this approach works, look for the other Big Blues to follow suit.The Community must have their choice to access expert care in treating this condition not an insurance company that has absolutly no knowledge, experience or expertise in providing care to our very unique Community. Hemophilia care IS NOT factor in a box.
Our Community must stand up and be heard or our choice of provider will go away.Educate, advocate and motivate yourself to stand up against this issue. Our lives depend on it.
Bill Jamison
Harrisburg, PA

Lenox Lizwi Mhlanga said...

This issue makes interesting reading indeed. Our health care system in Zimbabwe is on its knees living the ordinary people at the mercy of private companies. This include private hospitals and, Drug stores and Medical Insurance companies which we call Medical Aid here. Its now health for those who can afford it and in a country where people have to survive on US$1 a day, its tantamount to genocide. We are all warry about the propfit motive in the health care system at the expence of preserving life. The question is, where is the morality in us humans? Its now each man for himself and god for us all, the law of the jungle I suppose. Out of interest I came across another shocking indictment of the American health system in the form of a documentary entitled: Pregnant in America by Steve Buonaugurio. The film examines the betrayal of humanity's greatest gift-birth-by the greed of U.S. corporations. Hospitals, insurance companies and other members of the healthcare industry have all pushed aside the best care of infants and mothers to play the power game of raking in huge profits.

His wife pregnant, first-time filmmaker Steve Buonaugurio sets out to create a film that exposes the underside of the U.S. childbirth industry and help end its neglectful exploitation of pregnancy and birth.

And though he set out to fight the system, Steve finds that he and his wife must depend on it when a hospital struggles to save their newborn daughter's life.

Pregnant in America is the controversial story of life's greatest miracle in the hands of a nation's most powerful interests.

I hope this will serve as both an eye opener and a film that will stir up the collective conscience of a great nation. I would really love to watch it.

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