Can there be any value that comes from skyrocketing medical costs? Perhaps the medical cost trend will force an important debate about the role of health insurance.

Often, discussions about insurance lead to discussions about cost and affordability. Initially, health plans and insurers introduced the idea of managed care as a means to control medical costs and improve health. Now, the health care community recognizes the importance of performance and cost “transparency” as a prerequisite to engaging consumers and providers as part of the cost and quality debate.

We all recognize the value of transparency. But, because it’s a strategy that’s in its infancy, how do we know it will have enough “teeth” to help tame the medical cost beast that threatens to undermine our collective objective of access, affordability and quality?

Why not do more and take a page out of the auto and life insurance industries? Why not consider rewarding individuals who make healthy decisions and lead healthier lives? Read more…

If our experience at Fallon Community Health Plan is any indication, the Commonwealth Health Insurance Connector can start saving people as much as 13 percent on their health insurance premiums.

The reason lies with what we call “limited and higher performing” provider networks.

By now, it’s no secret that increasing health care costs pose a long-term threat to the state’s new health reform law. High costs are especially a problem for individuals, families and small businesses who are mandated to purchase health insurance under the new law but do not qualify for subsidized care.

The Connector is offering insurance to this group through a program called Commonwealth Choice, which provides four options based largely on the level of deductibles and co-pays: Gold, Silver, Bronze and Young Adult.

For the past six years, Fallon Community Health Plan has been offering two HMO products — Select Care, a broad network that offers access to the vast majority of providers in the state, and Direct Care, which offers a network of community-based providers. While limited, the Direct Care network must meet high standards for quality. The savings over Select Care is 10-13 percent — and the savings are driven by the use of the network, not any difference in benefits. Read more…

For more than two years, many of us have been working first to pass, and now to implement, health care reform. But making health care reform work in the long run will require holding down costs. And that will require engaging everyone in an effort to promote healthy lifestyles.

One example of what I’m referring to is childhood obesity, which I’ve been talking and writing about quite a bit lately.

One in four Massachusetts high school kids is overweight or at risk of becoming overweight. Those students are more at risk for heart attacks, strokes, diabetes and other serious diseases later in life. And their medical status will drive up the health care costs for them and everyone else in the health insurance risk pools. Nationally, obesity adds $90 million to medical bills every year.

Dealing with this problem will require a broad and constant effort on all of our parts. We need to support funding for physical education and after-school athletics. Read more…