Michael J. Peck MD,MS’ Post

Just had a listen to Sam Mangers interview with Rachel David from Private Healthcare Australia. Some dramatic oversimplification of clinical risk and alternatives (such as focussing on mortality of multilevel fusions in older cohorts and comparing these to management of patients with simple back pain - these are not the same people)…..but also some interesting discussion on the role of private insurers in primary care. First up Rachel represents for profit insurers. Her discussions around big industry lobby groups seems to ignore the fact that her organization is a lobby group for large private insurers. So gotta take it all with a grain of salt. A lot of narrative around value based care and directing patients down conservative management pathways aligns with the teachings in Australian primary care. Insurers like this approach as it’s cheaper. GPs like this approach as outcomes from conservative management for some conditions are equal or superior to invasive management with lower risk. The tricky part of this whole conversation is where funding is coming from for these different types of management. Private health insurers in the current environment often end up cost shifting conservative management from their books to their patients. From the patient perspective, it is often cheaper to go to hospital and have a microdiscectomy than to have community conservative management. I know a lot of GPs disagree with this idea but I’m personally very interested in working more with private health insurers in the management of my exisiting privately insured patients. These patients should be allowed to extract more value from their policy and access preventative care, conservative management and chronic disease care through their GP rather than relying on inpatient management. Insurers should also be bolstering their conservative management options so patients wear less cost when choosing non-invasive care. If you have been offered a knee replacement but are still overweight I’d love for a patient to be offered expansion of their extras cover for more EP input or further assistance with weight loss. I know Rhod McKensey has done a lot of work in this area with Honeysuckle Health but I’d really like to see more integration and discussion between their programs and community GP. And if there are insurers out there interested in trialling programs directly with small community general practice I’d love to chat more. https://lnkd.in/gUNqYd2z

The Business Times recently published an article on why health insurance costs in Singapore are spiking, its understandable as the country will face a growing challenge in maintaining its high healthcare standards while an aging population demands more from the healthcare system. A growing demand for healthcare and its impact on costs is a global issue, and this report from the WTW group cast an interesting light on the degree of healthcare cost inflation by region and why this is occurring. It highlights healthcare cost increases are occurring Asia wide, with the rate of increase actually lower in Singapore compare to surrounding countries like Indonesia and Malaysia. Its not surprising to see the factors impacting healthcare cost in all countries boils down to rising healthcare unit costs combined with increased demand for healthcare. This is showing up in countries like Malaysia, Indonesia and the Philippines as a sharp increase in waiting times for access to public healthcare and blow outs in govt healthcare budgets. It is also driving demand for private healthcare services with people opt for alternatives as over-burdened public systems strain under growing demand. Challenges are a great opportunity creator, particularly for digital health companies in the region. Without exception governments around the region are trying to use digital enabled healthcare to deliver improved standards of care in a more cost effective manner. This also leads to a greater awareness and acceptance of digital health by both healthcare providers and consumers. One particular area of interest for digital health companies is the increased willingness of insurers to add health and wellness program to their portfolio, with 64% of Asia Pacific adding these services to their portfolio compared to global average of 48%. While the growth in healthcare costs does create its own challenges it also offers opportunities for companies that can help mitigate this problem. Link to the full report is in the article.

Good Tuesday Afternoon, MABillers! Health Prices Are Getting More Transparent, but It's Still Not Enough, Experts Say — Price data need to be specific, searchable, and easy, according to one expert https://lnkd.in/eUpjbjZ7 #MAB #CMBS #CPSP #MARA #MedicalBilling #Medical #Billing #Reimbursement #Credentials #Training #RemoteWork #Remote

Pssst, it’s not fee for service (ffs) that’s devastated American Healthcare access, outcomes or costs. The Bismarck Healthcare Model used in several democratic capitalistic nations such as Germany, Japan, Switzerland and others enables private insured and private ffs manufactured medical care for all citizens at a fraction of the cost and with better clinical outcomes (preventive, medical, surgical and palliative) and access to healthcare than in America. Bismarck Nations have more private hospitals and health insurers COMPETING per capita than in America. This is achieved simply by making health insurers profit-neutralized utilities instead of luxuries. Read about Bismarck Here: #tripleaim #publicprivatepartnerships Ge Bai #healthinsurance #medicare

I‘ve noticed a graphic circulating from the group representing the US suppliers of medical implants and surgical supplies, suggesting Australian health funds are making excessive profits. This is an intentional misrepresentation of the Australian private health market by powerful vested interests.   It’s a well-known fact that health fund profits, just like the premiums members pay and the claims the funds pay for, are meticulously monitored by Federal Government regulators to prevent profiteering. During the pandemic when health funds began to rapidly accumulate cash as a consequence of the lockdowns and private hospitals shutting down elective surgery, a process was put in place to return all of it to members. This was monitored by the ACCC and as of April $4.3 billion had been returned to customers. During this time, all the big device companies did was throw money at lobbyists to oppose reform so they could continue to milk more money out of the Australian health system. The figure shown in the device company bar chart profit line includes some of the pandemic funds which have since been returned. Australian health funds are profitable because our regulators do not permit unprofitable health funds to operate, but unlike the rest of the sector, all of their financial metrics are reported publicly and are available for scrutiny every quarter through Australian Prudential Regulation Authority. It can actually be pretty tough to track down any data on how the big device companies operate in Australia, but we’ve had a go. With prices fixed 30-100% more than in comparable countries it’s no wonder they call Australia ‘Treasure Island’. The health funds have promised they will return any savings made from reform of the broken Prescribed List price fixing system to consumers. At Private Healthcare Australia we will continue to work tirelessly to ensure people with private health insurance get value for money. #PrivateHealthcare #MedTech  Mark Butler Billy Moore

Financial health management is crucial for podiatry practice in today’s healthcare. It is necessary to keep track of ins and outs, deal with trick insurance, and watch their spending, at the same time they have to take care of patients. Which becomes a hassle for podiatrists. To improve financial health management, podiatry practices can implement strategies to optimize for streamline the accounting process. * Implement comprehensive budgeting for accurate forecasting. * Speed up patient payments and billing to improve cash flow. * Utilize Technology to simplify financial tasks * Track key financial performance metrics * Optimize pricing strategies for sustainable revenue * Invest in staff training for podiatry practice billing Implementing strategies can optimize financial health management for success in podiatry practice anyway. But during the process, many challenges may arise which podiatrists should learn to tackle. A few common challenges in financial health management for podiatry practices include: * Inconsistent cash flow management * Complex insurance reimbursement processes * Rising operational costs burden * Inefficient billing system issues * Limited financial literacy skills Optimizing financial health management for podiatry practice is crucial for success. If you want to improve your practice cash flow and manage the revenue cycle, Vozo RCM service is here with a comprehensive solution. “Reach out to Vozo and Leverage RCM service to streamline your Practice Revenue Cycle” https://lnkd.in/gis3UJAC #rcm #billing #healthcare #insurance #podiatry #EHR #saas

Prior authorization is hindering access to affordable healthcare. In a new article from Sidecar Health COO Veronica Osetinsky, she delves into the detrimental effects of this process and highlights innovative solutions driving change in the industry. #Healthcare #HealthInsurance #PriorAuthorization #Innovation #PositiveChange

#CashLeaks in the form of poor revenue cycle management is a killing agent for any health organisation. Key is that, implement right #ehr and #practicemanagement systems along with strong process and people.

Top 7 key pieces of information to know about WHA’s healthcare cash plan. What's covered: - Healthcare cash plans help cover the cost of everyday healthcare expenses. You’re typically reimbursed for a portion or all of the costs associated with routine medical expenses like dental check-ups, eye exams, physiotherapy, and more. - Affordability: Our low cost Healthcare cash plan starts for as little as £6.28 per month! This makes WHA’s #cashplan accessible to a wide range of individuals. - Cash Reimbursements: Unlike traditional health insurance that directly pays healthcare providers, cash plans reimburse you directly. You submit receipts or claims for eligible expenses, and the plan reimburses you for a predetermined portion of the cost. - Flexibility: Cash plans offer flexibility in choosing your healthcare providers. You can often see any qualified practitioner or specialist of your choice, as long as the service is covered by the plan. - No Age-Related Premium Increases: Unlike some types of insurance, healthcare cash plans typically do not increase in cost as you get older. This helps maintain affordability over time. - Range of Benefits: In addition to the core benefits like dental and optical, some cash plans offer additional coverage for services such as chiropractic care, acupuncture, counselling, and more. You can tailor the plan to your specific needs. - Complementary Coverage: Cash plans can be used alongside other insurance policies. Designed to complement your existing healthcare cover, helping you cover expenses that may not be fully paid by other plans. Join today - https://loom.ly/9uD9F9c #everydayhealthcare #lowcost #cashplan