Small Steps toward an Innovation-Driven Health System

Tertium Quids, a conservative advocacy organization, has been pushing three bills in the General Assembly designed to bring more “choice and accessibility” to Virginia’s healthcare system.

The goal of the “Virginia Healthcare Basket” Initiative, the group explains, is “to support the growth of innovative business models, insurance options, and technology with an eye toward creating an exciting new healthcare track which runs parallel to the overburdened and cost-prohibitive traditional health and insurance model.”

Conceptually, Democrats don’t have much to offer healthcare than more government involvement and more redistribution of wealth. Virginia Republicans have criticized the march to government-controlled medicine but they have not provided much of an alternative. The proposals touted by Tertium Quids won’t transform Virginia healthcare markets, but they would nudge the state in the direction of more innovative, entrepreneurial, market-driven healthcare.

Telemedicine. SB 1221 and HB 19720 would require insurers to cover remote patient monitoring services as part of their coverage of telemedicine services. Remote patient monitoring uses telecommunications technology to monitor patient data such as weight, blood pressure, pulse, pulse oximetry, blood glucose and other medical indicators. Crucially, the bill ensures that Virginia regulators cannot prohibit medical practitioners in good standing in other states from providing those services.

The bills have passed the House and Senate and now await Governor Ralph Northam’s signature.

Retiree licenses. HB 2457 provides that the Board of Medicine may issue retiree licenses to doctors of medicine, osteopathy, podiatry, and chiropractic, exempting them from certain regulatory requirements, for the purpose of providing charity care or in-home health services. This bill also has moved to the Governor’s desk.

Short-term health insurance. SB 1674, the most controversial of the three, is heading to the Governor’s desk after a narrow victory in the House. The bill provides that insurance carriers offering short-term, limited-duration health plans may offer a renewal guarantee. The guarantee protects customers from having plans canceled because of pre-existing conditions.

My only reservation is the mandate that insurance plans cover remote patient monitoring. Virginia has too many insurance mandates as it is, and adding more won’t make health insurance any cheaper. If remote monitoring is a cost-effective idea, insurance companies won’t need legislative mandates to offer the service. On the other hand, if you’re going to enact a mandate, at least open it up to out-of-state competition, which this legislation does.

Now, if only Tertium Quids would tackle the Certificate of Public Need, the most competition-squelching law on the books in Virginia. Still, small victories are better than none. Most significantly, Tertium Quids is creating visibility for the idea of a innovation-driven, competition-driven, market-based reforms, the only alternative to government-run healthcare.

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19 responses to “Small Steps toward an Innovation-Driven Health System

  1. One question here may be how can these new and similar technologies and systems be incorporated into local more rural small hospitals and health care care facilities that are now struggling financially, and perhaps quality wise too. The idea here is to work harder and more creatively to provide such quality health locally if at all possible. People need to have the means to take care of their own. Local patients need to know that is true too, and experience that truth first hand. This helps to knit and re-knit our communities back together again and keep them whole and self sufficient that way, not only the larger ones but the smaller ones, too.

  2. I agree with the need for support of rural, small hospitals. However, intuitively, it seems to me that “competition-driven, market-based” approaches would put these hospitals at a disadvantage. For example, remote patient monitoring, perhaps by an out-of-state practitioner, does not help knit communities together. If anything, it would further fracture the delivery of health care. This is another example of how health care does not fit easily into the market-based model.

    • Here Dick, perhaps I should have made myself more clear. What I was suggesting was using these technologies to allow the smaller more rural hospitals to leverage of expertise and perhaps machines physically located offsite at bigger institutions and urban hospitals. Hence local patients could be served locally at the local hospitals, without their need to travel to and be served, whether for a visit or for extended care, at a far bigger more distant hospital.

  3. re: ” Short-term health insurance. SB 1674, the most controversial of the three, is heading to the Governor’s desk after a narrow victory in the House. The bill provides that insurance carriers offering short-term, limited-duration health plans may offer a renewal guarantee. The guarantee protects customers from having plans canceled because of pre-existing conditions.”

    Totally dishonest. What good is a renewal “guarantee” if the insurance caps annual and lifetime coverage – effectively denying care after the caps are met?

    The problem with this and other Conservative approaches is they do not deal with the realities and they make bogus and untrue claims about covering pre-existing conditions.

    Basically – Conservatives are opposed to mandatory coverage of pre-existing conditions – but they try to camouflage it by saying they “guarantee” insurance but then let the insurance companies cap coverage.

    That’s the easy way to judge Conservative “ideas”. Go straight to the part about annual and lifetime caps and that’s where you’ll find the truth of what they are offering.

    Basically what Tertium Quids is doing is stealth denial of coverage for pre-existing conditions and dressing it up with some other proposals – all of which could be done right now – no one is preventing retired folks from participating again and remote telemedicine is going forward with many existing insurances.

    The only way to cost-effectively cover pre-existing coverage to people is large pools of insured. That’s what Medicare does and so does the ACA – BOTH of which – have non-govt doctors and other medical providers. There are no govt doctors in Medicare, MedicAid or Obamacare. it’s all non-govt providers – paid for by taxes.

    • The legislation does provide some limit on renewals. It seems to say that any short-term policy, with extensions and renewals, cannot have a duration longer than 36 months. Even so, this proposal is an attempt to increase the ability of these companies to “skim the cream” by taking the healthiest persons out of the pools that would be covered by the ACA policies. The legislation passed the House by 3 votes, a straight party line vote. This looks like veto bait.

    • Agree with you. Large-scale pooling is essential to making the ACA or any insurance based system viable. If people don’t want pre-existing conditions excluded, they must allow, even compel, a broad aggregation of people with different health statuses in each such pool. What Ted Cruz did through his amendment to the ACA was destroy the “compel” part of that — opening the door to fly-by-night insurers with low annual caps etc. who IMO are simply fleecing the market — they skim the healthy young people off the broader pools, which saves the young people money as long as they remain healthy — but God forbid they get a serious disease or injury as that annual cap will effectively leave them uninsured — while driving up the pool’s average health cost and thus the cost of pool insurance for everyone else (by removing its healthiest members). I don’t think it’s fair to say this is a ‘stealth denial of coverage for pre-existing conditions’ but the annual caps are clearly a form of denial of coverage (for ANY condition) when the insured needs it most.

    • The fault lies with Obama. Bound to the strategy of big giveaways to buy votes, the President: 1) chose to expand coverage and not work to drive out costs; and 2) add coverage for an extremely broad array of procedures. The result was high premiums and an economic disincentive for younger and healthier people to purchase ACA policies. In typical leftist style, ACA relied on coercion instead of incentive.

      Had there been any lower-priced options for younger and healthier people, we would likely see more of those folks buy those policies. And once they started buying insurance, I suspect many would begin to purchase more coverage and making risk pools bigger. An incremental approach would have been much more successful.

      • “The fault lies with Obama.”

        Yes, exactly. For instance, common sense went out the window with the trash. Have you ever tried to get an appointment with a good doctor for a condition that could require surgery, only to have to wait a month or two or three to be seen by that doctor, much less be dealt with properly? Medicine today is either a miracle or a disaster. Odds between two are 50/50 either way.

        • I have had no trouble getting an appointment with my doctor when I needed one. Luckily, I have not needed surgery except for a periodic colonoscopy (OK, that’s not surgery, but it is an outpatient procedure in a hospital), and I have had no problem scheduling those.

          I doubt if Obamacare really affects anyone participating on this blog, who have either employer-provided insurance or are on Medicare. And, by the way, there were measures in the ACA directed at containing costs. It is beyond my expertise to opine on how effective they were or might be.

          • Reed Fawell 3rd

            Well, you’re a very fortunate fellow not to live around DC or Baltimore. I could tell you horror stories on what happening in modern medicine today, what’s is happening to so many people it fails to serve, under this current system, many of these people lost and alone, with no where to turn, no one who cares. This is what happens when the glue of society falls apart. The medical system suffers first, like the canary in the gold mine, even the affluent now are feeling the results. The culture of humanity is dying in this county.

          • Reed Fawell 3rd

            Dick –

            One central driver behind this loss of competence and humanity within the modern health care system is that the system breeds narrowly focused technocrats, highly trained technicians who see only very narrow problems with often only very narrow, often highly expensive solutions. And at the very same time thos system is driving out of business the generalists, the primary care physician, the internists, the wise old man who knows the whole patient, all of him or her, and has for a long time. So is a relationship of humanity and real caring between patient and doctor is being destroyed by the system. But a decent and caring and competent system demands such a conductor of the band, the guy who knows the patient and out, and knows the specialists, and how they must interact, be called on and off stage.

            Hence, for example my comments on the long wait times, to get the right operation, and far too often the wrong operation, and/or the right operation after it is too late to work, or far harder to fix. So for example, one can rush hither and yon for months between “specialists” before one knows what the problem is. During that process one can often fall prey to the doctor who loves to do his specialty whether its appropriate or not, or find the right guy who when found should have been on the case from the very beginning. I have seen the circuses again and again, and it quite easy often to see them coming from a mile off. Just walk into a hospital with patients lined up like milk cattle in stalls to see a doctor they don’t know or hardly met before. Hence when the system works miracles are often performed. When the system fails the patient, the losses can be huge. I believe institutional medicine gone wrong looks like a fascist state. Two a week ago, I spoke with a guy in pain who spend 16 hours over two days waiting to see one doctor each day.

  4. The fact that the govt reimburses for medical care is really no different than employer-provided companies like Anthem doing the same.

    But they cover all and control costs by limiting reimbursements – for everyone equally.. For instance, an MRI is “covered” but reimbursement may require some out of pocket.

    With the insurances that Conservatives are offering -they want to save costs by essentially not covering people with expensive conditions.

    No matter how much they deny it – that’s essentially what their core philosophy is.

    They talk about “innovation” and “market driven” and all that – but at the end of the day – they don’t want to offer quality health care to those who are costly and that’s how they propose to keep premiums low for others.

    • Reimbursement controls are desperately needed. It doesn’t matter whether you are talking ACA or Medicare, our health system costs are largely uncontrolled except in ways the big providers have learned how to game. Whether private or government insurance pays for this is not the crisis we face today; changing from one to the other won’t fix it. The crisis is health care costs and creating the transparency and proper incentives to bring them under effective competitive and/or regulatory control. Personally I’m for fixing the ACA not scrapping it for a single-payer scheme, and for competitive market not pure regulatory control of costs, but in any event let’s discuss the cost control and payment sides of this debate separately.

      • The only “fixing” that ACA means is to undo the purposeful damage done to it in an effort to destroy it.

        re: ” The crisis is health care costs and creating the transparency and proper incentives to bring them under effective competitive and/or regulatory control.”

        I’m looking at the rest of the world and I’m asking WHERE out of more than 200 countries on earth do we have what you advocate?

        Instead – the ONLY countries on the face of the earth that cover all their people for much less money than us are ones where the govt controls health care.

        I’m not opposed to market-driven transparency and competition – quite the opposite – for instance I FAVOR the way that airlines ticket prices “work” as well as gasoline prices, car insurance, but health care does not work that way because in a real market – people who are sick and/or old are shed by companies to keep costs down for others. There is no way around that fundamental reality and that’s why there is Medicare.

        The problem is that in our society people in their 40 and 50s, long before Medicare also have “pre-existing” conditions and in a pure market-driven environment – they will not get affordable insurance – no more than folks in Arlington will get affordable housing.

        we need to ACCEPT these realities if we are truly going to do something about health care. Continuing the mantra that the “market” will fix it if only it was “transparent” is not real.

        A “transparent” market will still not offer affordable insurance to people who are sick – because companies that would do so – lose to competitors who don’t. It’s the same reason why we have subsidized flood insurance and assigned risk auto insurance with each one of us paying an extra fee for uninsured drivers.

        As long as we continue to “believe” this fantasy – it empowers those that really want to abandon those who are sick and expensive… that’s their preferred “solution”. We have to cover everyone – and we have to do it in a cost-effective way – like every other industrialized country on the planet HAS DONE and no other countries on the planet have accomplished through more free-market approaches.

  5. I think the telemedicine idea is great. Blue Cross/Blue Shield Federal Employee Program offers a $10 connect with an MD option and has offered talk to an RN free for years.

    I once did some legal work for a radiology practice in Kearny, NE that used broadband connections to read x-rays, etc. from all over Nebraska and part of South Dakota. And that was at least 15 years ago.

  6. I’m all for telemedicine as well as electronic medical records – for everyone.

    but “short term” cheap, minimal coverage insurance will destroy our insurance system because the young and healthy will abandon the more expensive comprehensive insurance – until they get sick or older then they’ll want back after not paying their share of premiums before then.

    Keep in mind – that this kind of proposal would also affect employer-provided unless they wanted to exempt it which would make it an even more dishonest proposal that only affected those without employer-provided or Medicare.

    it’s a simple thing – that Conservatives cannot seem to reconcile or worse – their approach is that if you are sick and old – you are screwed – end of story.

    • Yeah, and we do it to perfectly healthy human beings, born and unborn children, because they are inconvenient to someone, and then we lie about it, and disguise what we do to these innocence babies who lives we snuff out. Doctors get paid good money and make a good living by doing this in this barbaric and Godless country and culture. We will all reap what we sow.

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