Summary: “There are so many factors that go into the cost of mental health care that it’s impossible to say what’s normal. What kind of care you need, how often you need it, what kind of insurance you have, where you live, and so many other things can affect how much taking care of your mental health will cost you,” Anna Borges writes over at Buzzfeed. “To see just how varied these costs can be, we recently asked members of the BuzzFeed Community to tell us how much they spend on their mental health care. Here are some of their stories. … 1. Delaney, $220 per month after insurance coverage Age: 22 Location: Cincinnati, Ohio What that covers: Therapy, medication, psychiatrist appointments “After I was hospitalized, I was recommended to begin dialectical behavioral therapy (DBT) to help treat borderline personality disorder, depression, anxiety, and self-harm. … 2. Dan, $90 per month after insurance coverage Age: 28 Location: New Jersey What that covers: Therapy….” About 31 percent of those answering a poll said they were paying nothing because they could not afford treatment; 25 percent said they were paying between $100 and $500 a month. Anna Borges, “Here’s How Much Mental Healthcare Actually Costs,” Buzzfeed.
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Summary: Rob Lamberts, a family physician, wrote this useful piece over at his blog, “Musings of a Distractible Mind.” The money quote: “This incident is just one example of the terrible gaming that routinely occurs with the prices of drugs. There are plenty of others. Why, for example, do brand name medications continue having such high prices after the medication has gone generic (often 10-20x higher)? The reason is, if the generic no longer available, they get a cash windfall.” The post, with examples, is here. Caution: when you see pricing tools online, you should always ask 1) Where’s your data from? and 2) How do you make money? Sometimes money is made by putting the buyer and the seller together in the marketplace, and taking money for that service.
Summary: “Twenty major companies — including American Express Co., Macy’s Inc. and Verizon Communications Inc. — are banding together to use their collective data and market power in a bid to hold down the cost of providing workers with health-care benefits,” Louse Radnofsky writes at The Wall Street Journal. “The newly formed alliance of companies, which cover about four million people among them, plan to share information about members’ employee health spending and outcomes, with an eye toward using findings to change how they contract for care. Ultimately, some members say, they could even form a purchasing cooperative to negotiate for lower prices, or try to change their relationships with insurance administrators and drug-benefit managers. The move, given the size of the companies involved, could ripple through the world of employer-provided health coverage, which has long been the way most Americans—about 170 million—get their health coverage. Participants said they hoped others ultimately could join in their effort. Big employers typically self-fund their workers’ medical treatment, through plans administered by traditional insurance companies that collect employee contributions in the form of premiums and deductibles.” Louse Radnofsky, “Companies Form New Alliance to Target Health-Care Costs,” The Wall Street Journal.
Summary: “A fundamental precept of participatory medicine is that health care should not be a spectator sport — it’s best practiced in a participatory manner,” writes Danny Sands on the Society for Participatory Medicine blog. “This requires engagement from both the patient and the clinician. Yet the typical behavior of health encounters is not that. Too often, physicians still refuse to openly communicate, share information with patients, and partner with them in decision-making, and patients still assume a passive role, thinking that in some way they can get healthy without being engaged. This disengagement from both sides is what I call the ‘car wash’ model of health care, in which the disengaged patients passes through the health care system and gets ‘health’ sprayed on them by health care professionals. This model is not efficient, effective, or satisfying. But many, myself included, thought that that’s how many people think about their health care. So it was quite gratifying to see the results of a new Society for Participatory Medicine survey. The survey, fielded by ORC International, a professional survey firm, asked 1,000 adults five questions. …
Summary: “Express Scripts and its rivals including CVS/Caremark and OptumRX manage prescription drug coverage for insurers and employers,” Alison Kodjak writes over on NPR. “They’re trying to spark price wars among drugmakers by refusing to pay for some brand-name medications unless they get a big discount. The result is that average costs for many drugs are falling. At the same time, consumers are being forced to change medications, sometimes to brands that don’t work as well for them. Tim Kilroy is a father of five who runs a business out of his home in Arlington, Mass. Kilroy has attention deficit hyperactivity disorder — ADHD — and he is dependent on his medications to keep his mind, and therefore his business and family life, in order. … He spent six years trying medications, adjusting doses, switching and starting over before he and his doctor settled on a long-acting form of Ritalin. He’d finally landed on the drug that worked for him. But about a year ago he switched insurance and the new pharmacy benefit company — United Health Care’s Optum subsidiary — refused to pay. ‘I thought, “How dare you,” ‘ Kilroy says. ‘How dare this company that I pay money to tell me how to manage my health care. I was really, really angry.'” Alison Kodjak, “Insurers Are Refusing To Pay For Some Common Medications,” : Shots – Health News : NPR.
Summary: Interesting things about our visitors from our analytics: Someone from Aetna in Connecticut visited us to learn about medical coding. Here’s a screenshot from our analytics page (click to enlarge). The post, “Alphabet soup: HCPCS codes, as well as ICD, DRG, CPT,” gets a fair amount of traffic. We’re happy to help when the insurance industry needs answers!
Summary: We’re often asked why our data is so valuable, in an era when “big data” is on everyone’s mind. My response: “Smart data beats big data any time.” Here’s another way of saying it, from Tricia Wang over at Medium. “When I was researching at Nokia in 2009, which at the time was the world’s largest cellphone company in emerging, I discovered something that I believed challenged their entire business model,” Wang writes. “After years of conducting ethnographic work in China from living with migrants to working as a street vendor and living in internet cafés, I saw lots of indicators that led me to conclude that low-income consumers were ready to pay for more expensive smartphones. I concluded that Nokia needed to replace their current product development strategy from making expensive smartphones for elite users to affordable smartphones for low-income users. I reported my findings and recommendations to headquarters. But Nokia … said my sample size of 100 was weak and small compared to their sample size of several million data points. In addition, they said that there weren’t any signs of my insights in their existing datasets.
“By now, we all know what happened to Nokia. Microsoft bought them in 2013 and it only has three percent of the global smartphone market. There are many reasons for Nokia’s downfall, but one of the biggest reasons that I witnessed in person was that the company … put a higher value on quantitative data, they didn’t know how to handle data that wasn’t easily measurable, and that didn’t show up in existing reports. What could’ve been their competitive intelligence ended up being their eventual downfall.
“Since my time at Nokia, I’ve been very perplexed by why organizations value quantitative more than qualitative data. With the rise of Big Data, I’ve seen this process intensify with organizations investing in more big data technology while decreasing budgets for human-centered research. …According to a Gartner study of companies who had invested in Big Data capabilities, only 8% of were doing anything significant with their Big Data. The rest were only using Big Data for incremental advances. This means that a lot of companies are talking and investing in Big Data, but they aren’t doing anything transformational with it.” Tricia Wang, “Why Big Data Needs Thick Data,” Medium.
Summary: When journalism meets health care, the path is not always smooth. Here’s what happened when Melinda Beck, a Wall Street Journal reporter writing an article about health care pricing, got in touch with Memorial Sloan Kettering Cancer Center here in New York to check a price on the ClearHealthCosts.com web site.
Summary: “A respected group of cancer specialists developed a chemotherapy program for a breast cancer patient,” David Belk writes over at The Huffington Post. “But then her insurance company denied the claim, so the cancer center stuck her with a bill three times as large as what they would have required from the insurance company.
Summary: We’ve written a lot on prescription drug pricing; here’s our prescriptions page. Consumer Reports took up the topic recently: “Millions of Americans have been hit with high drug costs within the last year. In fact, a recent Consumer Reports National Research Center poll of 1,037 adults showed that a third of those who currently take a drug said they experienced a spike in their prescription drug prices in the past 12 months — anywhere from just a few dollars to more than $100 per prescription. According to the American Society of Health-System Pharmacists, big price jumps can be due to anything from a product shortage to a change in your insurance coverage. And in rare instances, manufacturers may raise prices simply because they have no competitors also selling the medication. … Our poll shows that most people just fork over the money. Only 17 percent comparison-shopped to see whether they could get a better deal. If you have a standard insurance co-pay, it might not occur to you to shop around. But sometimes the price you’d pay out of pocket … might be less than your co-pay. … Case in point: Metformin — used to treat type 2 diabetes — sells for just $4 for a month’s supply, or $10 for a three-month supply, at stores such as Target and Walmart, while a co-pay for a month’s worth averages about $11. And if you do decide to pay out of pocket, the prices retailers charge can vary a lot. To find out what various retailers were charging, we had secret shoppers check prices for five common generic drugs at stores around the country, including chain drugstores, big-box retailers, supermarkets, and independent pharmacies.” “Tips for Finding the Best Prescription Drug Prices,” Consumer Reports.