Perhaps planning for 2009, AHIP held a forum on the European countries, the Netherlands and Switzerlahd, that offer universal coverage through a privately operated system in contrast to Great Britain, for example, or Canada on our continent.

“Our community is committed to working to achieve coverage for all Americans,” said AHIP President and CEO Karen Ignagni, in opening remarks at the event. AHIP and Kaiser Permanente held the forum, Ignagni said, not to endorse a particular system or model. She noted that “there is confusion in our public debate between the idea of ‘universal coverage’ and the term ‘government run.’”

Harvard Business School Professor Regina Herzlinger previously has pointed to the Swiss system as a possible model for the U.S.

Earlier this week, HHS Secretary Mike Leavitt announced a five year demonstration project to encourage small and medium sized medical practices to implement electronic health records (EHRs). According to Healthcare HIT News, such medical practices would receive financial rewards for implementing EHRs and reporting on health care quality. CMS is still figuring out the bonus structure. The Blue Cross and Blue Shield Association endorsed the HHS program. Modern Healthcare.com reports on a study that finds that HHS has a tough row to hoe.

• The Wall Street Journal reports on the Democratic leadership’s “risky” appropriations strategy. According to the report, “No one predicts a government shutdown, but the Democratic majority faces a lame-duck president who has interpreted the 2006 elections as a call to vigorously exercise his veto power against spending.”
• According to a New York State Attorney General press release, CIGNA has entered into an agreement with Attorney General Cuomo, witnessed by the American Medical Association and Consumer’s Union, to provide more transparency over its doctor ranking process. The AP reports that CIGNA “said its list of preferred doctors, always based on quality and cost, won’t change because of Cuomo’s agreement. Cigna will still consider both but will begin sharing more information with customers.”
• A Wall Street Journal editorial directed me to an interesting study titled “Comparing Public and Private Health Insurance: Would A Single-Payer System Save Enough to Cover the Uninsured?” The study was written by Benjamin Zycher of the Manhattan Institute. The author explains in pertinent part that

Administrative costs for private health insurance, defined broadly, are in the range of 11-14 percent of total premiums.

Administrative costs reported directly in the Medicare budget, combined with a proportional allocation of the costs of other federal government administrative functions, yield a finding of 6 percent of Medicare outlays as the total reported administrative costs for Medicare. This more complete estimate is twice as high as a proportion of Medicare outlays as commonly asserted.

The lower reported administrative costs for Medicare are unsurprising, in that Medicare spends substantially less on such functions as marketing, risk evaluation, claims scrutiny, and compliance with the regulatory requirements of the individual states. This does not mean that the higher reported administrative costs of private health insurance are “wasteful.” Instead, they serve the interests of consumers by reducing the extent to which insurance creates cross-subsidies among consumer classes; such cross-subsidies reduce the economic benefits of risk-pooling. Private administrative functions also impose discipline on the consumption of health-care resources, thus reducing upward pressure on insurance premiums.

The study is worth reading.

• The President and Congress are pointing fingers at each over over the delays concerning the SCHIP reauthorization bill and the appropriations process. The continuing resolution that currently funds the federal government expires on November 16.
• BNA is reporting that the House mental health parity bill (H.R. 1424) should arrive on the House floor in November after a pay-go issue is resolved. A September 7, 2007, Congressional Budget Office report projected that the House bill would lead to a $3.1 billion decrease in taxable income over 10 years attributable to higher employer paid health benefit costs and lower wages and a $820 million increase in Medicaid expenses over 10 years.
• The House Science and Technology Committee approved a (H.R. 2406) bill that would give the National Institute of Standards and Technology a larger role in federal health information technology (HIT) efforts.
• Inside the Beltway Alert! The Office of National HIT Coordinator awarded Bearingpoint a contract to standardize HIT definitions.
• The National Committee on Vital and Health Statistics is drafting a report recommending that the HHS Secretary adopt stronger and more extensive HIPAA privacy and security rules.
• Seven large health insurers, including the Blue Cross Blue Shield Association, CIGNA, Aetna, and Humana, have joined the Patient Centered Primary Care Collaborative. The Collaborative encourages the use of the primary care physician as the medical home or care coordinator for her patients. The health insurers plan plan to create medical home pilots and take other steps to encourage adoption of this model.

The Red Sox are clobbering the Rockies so why not do a little blogging?

• The Health Information Technology Standards Panel has released a privacy and security architecture for electronic medical records.
• The Employee Benefits Research Institute has released its 10th annual study on consumer confidence in our health care system. The interesting twist is that high medical costs are encouraging Americans to take better care of themselves and talk with their doctors about the cost of medical care. Aren’t these the primary objectives of consumer driven health care? In this regard, CIGNA just released a two year study of its consumer driven health plans which finds that medical trend and member out of pockets costs were significant lower for consumer driven plan members as compared to CIGNA PPO plan members.
• Washington Post correspondent Steve Barr held on online chat today with OPM Deputy Associate Director Kathy McGettigan.

Much has been written in the press about the rise of primary care clinics, such as Minute Clinic, located inside chain pharmacies, and the American Medical Association has gone on the war path against these competitors. Vanessa Fuhrman wrote an article in the Wall Street Journal today about a Wheeling WV doctor of osteopathic medicine, Vic Wood, who is offering unlimited urgent and primary care for $83 per month for an individual or $125 per month for a family. Medical Economic magazine has described Dr. Wood’s practice as a bargain basement version of concierge medicine. Ms. Fuhrmans reports that health insurers are exploring the merits of these prepaid plans. Dr. Wood is speaking at December 2007 conference of the Society for Innovative Medical Practice Design.

Meanwhile the Orange County California Register reports that “When retail clinics [such as Minute Clinic] first started, all visits were cash-only. But lately, as health care costs continue to soar, some insurers have started covering the visits as a less expensive alternative to a traditional doctor’s office. Locally, Aetna and Cigna are among about a dozen insurers that cover visits to Minute Clinics.

It’s a sure sign of fall when Washington Post columnist Steve Barr writes his first Open Season piece in the Federal Diary column, and that happened today. OPM also has begun to gear up its Open Season web site. Open Season begins November 12.

• The President’s veto of the compromise SCHIP reauthorization bill was sustained last Thursday as the House of Representative’s override vote fell short by 13 votes. Meanwhile, Congress is not making much progress in bringing its 12 appropriations bills for the current federal government fiscal year to the President’s desk. According to Govexec.com, the Congressional leadership plans to present the President first with a Labor- HHS appropriation bill that the President has vowed to veto. We are less than one month (Nov. 16) from a likely showdown between these two branches of government.
• OPM issued a benefits administration letter establishing the ground rules for the Federal Benefits Open Season to be held next month.
• Perhaps in reaction to the FEHBlog entry on preventive health care, OPM issued an FEHBP carrier letter on that topic.
• OPM also issued an interesting report on the FEHB Program’s compliance with the President’s August 2006 Executive Order on health information technology and health care pricing and quality transparency. It is evident from the report that FEHB plans have made great progress in implementing the four cornerstones of the Executive Order. Personal health records are available to 90% of the federal and postal employees and annuitants enrolled in the FEHB Program. However, according to OPM less than 5% of FEHB Program enrollees have taken advantage of this opportunity. As over 4 million people are enrolled in the FEHB Program, 5% of the enrollment is 200,000 people. Nevertheless, that is a surprising statistic that OPM and carriers are sure to investigate.
• Also this week a Coalition for Patient Privacy urged Congress to incorporate greater privacy protections in any health information technology legislation. Ironically, Microsoft, whose products are afflicted by security issues, joined in the letter as a member of the Coalition. Of course, Microsoft just released its Health Vault product. Google announced this week that its health initiative will be launched early in 2008.
• New York State Attorney General Cuomo is questioning the efforts of New York health insurers to rank the performance of doctors. The American Medical Association is applauding his efforts, according to Modern Healthcare.com.
• The Federal Times reports that according to a study by the U.S. Merit Systems Protection Board, the average age of a new federal employee is 33.

• An annual report on cancer rates in the U.S. released yesterday “shows cancer death rates decreased on average 2.1 percent per year from 2002 through 2004, nearly twice the annual decrease of 1.1 percent per year from 1993 through 2002.” According to HealthDay, Dr. David Espey, a cancer epidemiologist
  from the U.S. Centers for Disease Control and Prevention in Atlanta,
  

  “We have a lot of work [to do] in colorectal cancer. We’ve been making progress in lung cancer, but that’s a perennial battle to try to control tobacco use initiation and tobacco cessation.” The “low-hanging fruit” in terms of cancer prevention and early detection right now is colorectal cancer, Espey continued. Less progress has been made here than in breast and cervical cancer, he said.

  FEHB plans cover routine tests for colorectal cancers, such as periodic colonoscopies upon reaching age 50. Covering the cost is only half the battle when it comes to uncomfortable tests like these, but it’s hard to read stories like this without realizing extending your life is worth the discomfort.

• The Milken Institute has a created an interesting web site based on its study “An Unhealthy America: The Economic Burden of Chronic Disease.” Utah is the state with the lowest incidence rate for seven common chronic diseases and West Virginia has the highest incidence rate. The study makes two recommendations:
  

  The incentives in the health-care system should promote prevention and early intervention. Employers, insurers, governments, and communities need to work together to develop strong incentives for patients and health-care providers to prevent and treat chronic disease effectively. In many respects, we’ve received what we paid for: a tiny fraction of health-care spending is devoted to the promotion of healthier behavior, despite the fact that preventable chronic diseases are linked to smoking, obesity, lack of exercise, and drug and alcohol use.

  As a nation, we need to renew our commitment to achieving a “healthy body weight.” Increasing obesity rates threaten to send treatment costs for diabetes and related conditions, such as heart disease and stroke, soaring over the next twenty years. There needs to be a strong, long-term national commitment to promote health, wellness, and healthy body weight.

• Finally, the National Coalition on Health Care issued a report on the cost effectiveness of preventive health care services. According to the author, Louise B. Russell
  

  [I]t is impossible to generalize about preventive interventions as though they were all alike. In particular, the evidence does not support the commonly accepted idea that prevention always, or even usually, reduces medical costs – although it sometimes does. Most preventive interventions add more to medical costs than they save, at the same time that they improve
  health.

  But even that statement needs to be made more specific. Preventive interventions need to be evaluated individually. Some, like smoking cessation programs, may be good investments almost regardless of how they are applied – they bring additional good health at a very reasonable cost. Other interventions are good investments when used selectively – targeted at those people who benefit most from them – bu not such good investments when used for more broadly defined groups of people.

  At the end of the report the author has included a table that evaluate the cost effectiveness of various preventive treatments.

• OPM Director Linda Springer issued a public letter about the upcoming Open Season which offers 2008 open enrollment for the FEHB Program, the Federal employees supplemental dental and vision program and the Federal employees flexible spending account program.
• Congressional leaders plan an October 18 over-ride vote on the President’s veto of the State Children’s Health Insurance Program reauthorization bill. The federal government is operating under a continuing resolution which expires on November 16. The President has issued veto warnings against many appropriations bills, none of which has been sent to the President yet. I wonder if we will see another federal government shutdown similar to the one that occurred in 1995, which would interfere with the Open Season.
• The health subcommittee of the House Energy and Commerce Committee approved a manager’s amendment to the House version of the mental health parity act (HR 1424). The Energy and Commerce Committee is the last of three House committees that must consider the legislation before it is referred to the Rules Committee. The original version of the House bill defined the scope of covered mental health services by reference to the Blue Cross Federal Employees Plan standard option. The manager’s amendment instead refers to the American Psychiatric Association’s DSM-IV.
• The AHIMA and e-Health Initiative conferences included discussions of the HIPAA Privacy Rule and the interrelationship between privacy/security and the National Health Information Network. Speaking at the e-HI conference, former CMS administrator Mark McClellan noted that
  

  The committee report accompanying the 2008 HHS appropriations bill in the House asked for a “privacy and security framework that will establish trust among consumers and users of electronic personal health information and will govern all efforts to advance electronic health information exchange.” The report specifies elements it wants to see in the framework, such as “allowing individuals to have a say in who and how their information is used” and maintaining data integrity.

  Other speakers predicted that a health information technology bill, like the Wired for Health Care Act, would pass Congress in 2008.

• Krogers, which operates food stores and pharmacies, in the Mid-West and New Mexico is now joining Target and Wal-Mart pharmacies in offering a variety of generic drugs for a $4 copayment.