David Harlow of the HealthBlawg hosts the Turkey Edition of the Health Wonk Review. As we head into Thanksgiving next week, you’ll need something good to read while all that food digests. I suggest this.
Whether you’re elated or deflated by the midterm election results, the way to celebrate or commiserate is sure to be found in the Election Week Edition of the Health Wonk Review hosted by Jennifer Salopek at Wing of Zock. Go read it here.
It’s hard to believe, but we’re getting close to the end of 2014–the first year that the major provisions of the Affordable Care Act (that is, the Marketplace and the Medicaid Expansion) have been in effect. That means one thing: open enrollment is about to be upon us once again. For those of you who are still uninsured, or who enrolled in a plan through a state-based or federal health insurance exchange (the Marketplace) at the start of the year, it’s time to take action. Open enrollment begins on November 15th. If you’re uninsured and want to enroll in a plan for the first time, this is your chance. If you’re in a Marketplace plan and want to change to a different Marketplace plan, this is the first day you can do that. And, importantly, if you’re in a Marketplace plan and you want to keep that coverage, you’ll need to take action during open enrollment to confirm your coverage.
To ensure that you have coverage beginning on January 1, 2015, you’ll have a month to take action once open enrollment begins. Let me say it again: You must enroll by December 15th to ensure that you have coverage on New Year’s Day. That’s because, no matter whether you enrolled last October or waited until March, all current Marketplace coverage terminates on December 31st. If you take action by December 15th, you’ll be able to maintain continuous coverage. If not, your coverage is likely to lapse. However, for the procrastinators among you, the open enrollment period continues until February 15th. If you do not enroll in a plan by February 15th, you will not be able to obtain coverage through the Marketplace for the rest of the year unless you experience a change in circumstances like getting married, having a child, or losing your job. However, Medicaid is the exception. There is no open enrollment period for Medicaid coverage and you may apply for it at any time. Still, it’s best not to experience a gap in coverage, as you never know when you might need it. After all, that’s the purpose of health insurance. For additional information on obtaining coverage, take a look at this helpful information.
I’m back in Iowa today, after spending most of last week in New York City. I was visiting my sister, who lives in the 400 block of West 148th Street. You can imagine my surprise when I pulled out my phone while having a slice of pizza after an evening of live music at The Outlaw Roadshow and saw that there was a case of Ebola in the city. Surprise took an ever so slight turn into fear when I learned that the infected individual lived in the 500 block of West 147th Street, and had ridden the same subway line as we had. Then my rational mind chimed back in with all of the facts about how Ebola is and is not transmitted, and how improbable the outcomes I worried about actually were. Still, I washed my hands very thoroughly when I got back to the apartment. Sure, that’s not a bad thing to do for a host of reasons after a night out in the city (especially as we enter flu season), but to be honest, there was still a little tinge of fear motivating my actions.
What I was experiencing was the rapid oscillation between the two types of thinking envisioned by dual process theory: a fast thinking, error-prone type of gut instinct, and a slow thinking, less error-prone type of reasoned thought. The thing is, while I’m not an infectious disease specialist, or even a medical doctor, I do have a biology degree and advanced training in public health, which gives the slow thinking part of me something to process. For others, it is easier for the fast thinking part of the brain to dominate. This is especially true when the thing we’re thinking about evokes fear, as Ebola most certainly does because of how lethal it tends to be. Much has been written about how difficult it is to spread Ebola, how unlikely it is to catch it, and how useless it is to worry about it. But, if you’ll notice, that hasn’t done much to alleviate much of the fear experienced by the public, or the overreactions taken to quell that fear by instituting mandatory quarantines for health workers returning from Western Africa–including the now notorious case of the nurse in New Jersey.
Instead of offering yet another post that says “Stop worrying about catching Ebola,” I want to write a post that reframes the discussion much like the way Amazon.com sells complementary goods. They use a “Customers who bought this item also bought this other item” approach. So, think of this as the “If you’re scared of catching Ebola, you should also be even more scared of catching the flu.” Now, I could pick a great number of other accidents, illnesses, and conditions that are more likely to be experienced by the average American than Ebola, but given the time of year, I think the flu highly appropriate. Now, many people very quickly say “The flu may be spread more easily than Ebola, but it isn’t as deadly as Ebola if you catch it.” This is a matter of perspective. It is true that the flu is typically less lethal. We speak of the case fatality rate–that is, of the people who have the disease (the cases), how many die? For flu, the estimates of the case fatality rate are somewhere between 0.1% and 2.5%. However, there is also the H5N1 strain of avian influenza, which the World Health Organization estimates has a case fatality rate of roughly 60%. By comparison the average Ebola case fatality rate is about 50% (ranging from 25% to 90% historically). So, yes, the typical flu is far less fatal than Ebola, but there are strains of flu that appear to be just as fatal as Ebola. We should be especially worried about such high fatality, easily transmitted diseases, but I don’t need to pick something so exotic to make my point.
For now, let’s focus on the typical seasonal flu–and let’s assume the 0.1% case fatality rate. We also know that from year to year anywhere between 5 to 20% of the U.S. population contracts the flu. The current U.S. population is 319.2 million people. So, if we multiply that figure by 0.05 or 0.2, we estimate that between 16 and 64 million people in the U.S. will get the flu this year. Those are our cases. Then, remember, we assume that 0.1% of those cases will result in death. So we multiply again, and predict that between 16,000 and 64,000 people in the U.S. will die of the flu this year. By contrast, there have been 4 confirmed cases of Ebola initially diagnosed in the U.S. this year, and only one of those persons has died. So, even if we use this most conservative estimate of flu mortality, the flu is 16,000 times worse than Ebola on a population level. It all comes down to the fact that on the individual level, case fatality rate–the lethality of the virus–is the most important factor in making us fearful (it tells us our rough probability of dying from the disease if we contract it), while on the population level, case fatality rate is only part of the story–ease of transmission can lead to much worse outcomes in the aggregate (because so many more people contract the disease to begin with). So, I’m not saying don’t be worried about Ebola–it is a truly scary disease. I’m just saying don’t be complacent about the flu just because it seems less deadly on a person-by-person basis. It is possible that more Americans will die from the flu this year than there are cases of Ebola worldwide, and we have the ability to prevent that. Remember that there is a vaccine to guard against the flu that can keep you from getting sick, but which may also prevent others from getting sick or dying as your vaccination helps to break the transmission cycle. Perhaps, if we were as scared of the flu as we were of Ebola, we would do something about it. In fact, University of Chicago professor Harold Pollack recently took to Twitter to offer people $10 if they’d simply go get a flu shot. He’s willing to spend up to $1,000 to put his money where his mouth is, and hopefully others will pick up where he leaves off. So, if fear’s not your motivator, maybe a free lunch is. Just remember to wash your hands before you eat.
It is a drizzly gray day here in New York. The perfect weather for a good cup of coffee or cider and the Falling Leaves edition of the Health Wonk Review hosted by Louise at the Colorado Health Insurance Insider. Go grab that warm beverage and give it a read here.
As the percentage of large employers that consider a shift to defined contribution and/or private exchange increases, the number of options – and flexibility in those options – must also increase. Consideration for those options rose last year from 14% to 18% among large employers (500+ employees). Further, those who are considering the move to a private exchange want to because of their desire to offer more and better plan options, as well as realize cost-savings. Shifting to the defined contribution framework allows employers to moderate their subsidies to employees, and employees to make better trade-offs among plan options. Additionally, by increasing choices, defined contribution makes it easier for employers to integrate their health incentive and wellness programs by layering them “on top” of the defined contribution.
With this economic opportunity in the market, it is imperative that health plans and enrollment become more tailored to individual and company needs, in addition to the one-size-fits-all solutions of the past and present.
Private health exchanges, according to bswift, like their new Springboard Marketplace, could be the platform to give consumers that greater choice and increase individual decision-making. Given that most large employers who are considering a defined contribution will remain self-insured, bswift is taking a calculated gamble that employers will continue to invest in cost management solutions such as incentives, wellness programs, consumerism as opposed to simply shifting costs to employees under the “fix it and forget it” cost sharing approach suggested by some competitors.
Customize Your Cart
The Springboard Marketplace that bswift has created has the online functionality healthcare.gov could only have dreamed of, and the choice construction of a grocery store. In fact, the terminology the company uses alludes to “Stocking the Shelves” with your benefit choices and “Shopping” for your ideal group of benefits. This is all done through the interactive benefits advisor, Emma, who walks employees through an online step-by-step process to fill their cart with health care options.
For those aware of bswift’s background as a tech company it may not be a surprise that the software and services offered are aimed at streamlining a very sophisticated system, and making the user experience easy. And for those that know the company’s Executive Director of Exchange Solutions Brad Wolfsen, the shopping experience and ease of transition into a new set of consumer options will easily resonate. Mr. Wolfsen, before joining the team, built and led Safeway’s wellness and retail strategy programs, and was the President of Safeway Health.
According to Mr. Wolfsen, the real benefit he sees to bswift’s products are that they, “allow employers to focus on equity for employees and shift to a retail view on providing health benefits.” Or, as the Society for Human Resource Management labels it, From Parenting To Partnering.
New Plans Equal New Decisions
With a growing demand for health benefit options that resemble a choose your own adventure book, but with a set amount of money to spend, the development of software must also be functional for employers and employees. The Springboard Marketplace has been constructed so that functionality can simply be turned on and off, so that choices are simplified. Additionally, since there is not a standard approach to benefit choices and many legacy systems that have to be revamped due to mergers, acquisitions and partnerships, greater automation for employers means less paperwork for HR departments. By making workflow, reporting and administrative work more efficient through automation, cost-savings increase even further.
“The best and brightest clients are currently driving what is in the bswift system now,” says Mr. Wolfsen. “As we move towards expanding the suite of benefit options and meeting compliance standards, we are also investing in the shoppers experience.”
He, along with his colleagues at bswift, believe that their tech company is nimble in ways that others are not, and that with the help of their platform and Emma, more and more employers will begin the migration to defined contribution and private exchanges. If true, that growing shift could redefine how health benefit decision-making is done by employees in the future.