Either of these options reduce patient care to numbers and paperwork because doctors are essentially controlled and incentivized by an administrator in some far-flung office. The ACO model is the insurance industry's version of "budgeting" the cost of health care which ultimately benefits insurers at the expense of doctors and their patients.
Doctors say that basing their pay on treatment outcomes creates an incentive for them to avoid tough cases whose outcomes could "kill my numbers." "Paradoxically," writes Dr. G. Keith Smith, "doctors who are doing sham surgery will be the ones with the best outcomes, as their patients, many of whom don't need surgery in the first place, will exhibit great, basically perfect outcomes. Physicians who don't do unnecessary surgery will be pushed to do so to improve their 'scores.' 'Pay for performance' trends in medicine are not a good idea in my opinion. Paying based on patient outcomes will have perverse effects, not the least of which will be the complete denial of care to the very sick."
The ACA also requires Health Insurance Exchanges to establish a navigator program to inform the uninsured about the availability of government-approved subsidized plans at an Exchange and to facilitate enrollment in these plans, but it leaves the design of the program up to each Exchange.
Depending how an Exchange sets up its program, some Navigators will sell plans offered by an Exchange while others will be responsible for maintaining the existing market but may also be allowed to sell Exchange plans. All seller Navigators will be compensated either by Exchanges or insurance carriers for the plans they sell. Many options are being considered by Exchanges including using insurance agents. Hopefully, Navigators and insurance agents will not be knocking on your door or contacting you by phone. That would be over the top. Here's a link to read what the California Exchange is pondering with regard to its Navigation program.
10. ENROLL AMERICA, HERNDON ALLIANCE & THE EXCHANGES -- MASTERS OF SPIN
Since many Americans don't know about the ACA, somehow the word has to get out and people must be encouraged to purchase health insurance either in the open market or at an Exchange. And who better to do this?
Enter "Enroll America" -- a nonprofit 501(c)3, financially backed by Aetna, Blue Cross Blue Shield, UnitedHealth, America's Health Insurance Plans, hospitals, associations that represent drug manufacturers and nonprofits with vested interests. For insurers and pharma, the ACA is manna from heaven -- scratch that -- manna from Capitol Hill -- and the dollar signs in their eyes are on fire! These profit seekers and connected nonprofits will be using every avenue possible to maximize their bottom lines.
The mission of Enroll America per its website is to "ensure that all Americans are enrolled in and retain health coverage." It's Board of Directors and Avisory Council reads like a Who's Who in the Medical Industry Cartel -- CEOs, presidents, vice presidents and directors of such entities as the American Hospital Association, Express Scripts, Medicaid Health Plans of America, Kaiser Permanente and many others -- the list is long. If you would like to donate to these mega-profit vultures, you can do so on the Enroll America home- page. The goal is $100 million by 2014.
In its publication, "Ten Ways to Make Health Coverage Enrollment and Renewal Easy," Enroll America has recommended availability of web-based applications to increase the places where people can enroll in coverage: at home, at grocery stores, community health centers, state fairs, sporting events, places of worship, and more. Gee, you can apply for insurance while you pray. How thoughtful.
The strategy for insurers and state Exchanges to persuade you to purchase insurance and warn you about the penalties includes using ads, social media, blogs, YouTube, Flickr, Twitter, hospitals, health centers, McDonald's, in-store radio announcements, ballparks, county fairs, libraries, laundromats, community events, libraries, county fairs and drugstores -- you name it. Blue Cross Blue Shield has partnered with H & R Block. Health insurers are already setting up shop inside some supermarkets so they can answer your questions and sign you up for coverage while you do your grocery shopping. They will likely be showing up in shopping malls -- maybe even in parking lots, on street corners and at church fairs. And, their aim is to recreate themselves from the bloodsucking leeches that they are to your new, cool-dude friends.
We'll be living in Occupied Territory.
Let's connect some dots. The executive director of Enroll America is Ron Pollack, also president of Families USA -- a nonprofit and friend of the industry. On its website, Families USA bills itself as "a national non-partisan organization dedicated to the achievement of high quality, affordable health care for all Americans." Philippe Villers and Robert Crittenden, M.D. are on Families USA Board of Directors. Mr. Villers is also on the BOD of Herndon Alliance, Bob Crittenden is a Herndon staff member and Ron Pollack is a Herndon founder.
Herndon Alliance is an influential health care spinmeister creating messaging to change public opinion and tweaking each message to reach particular groups.
Herndon has close ties to Capitol Hill and helped market the ACA providing words politicians and supporters should use to promote the bill. For example, during the national health care debacle a few years ago, you heard Mr. Obama et al continually talk about "choice,' "we need a uniquely American solution,' "fair rules,' "investing in America's future' and "high-quality, affordable healthcare.' That last one is used in Families USA mission statement. The Council for Affordable Health Insurance, a frontgroup for the industry, gets right to the point -- its name. Ron Pollack worked with the Obama administration to help reshape public opinion of Mr. Obama's unpopular health care bill. Leading up to 2014 when the Exchanges are scheduled to open, there will most likely be a blitz of TV ads in which you will hear many of these same nebulous, feel-good words. And, you'll undoubtedly read or hear plenty of Herndon spin from your Exchange and throughout your state in the immediate future.
In the interest of coming up with messaging, Enroll America held a few focus groups and commissioned a nationwide survey in fall 2012. Research was provided by Celinda Lake from Lake Research Partners, a national public opinion and political strategy research firm. One takeaway was when a monthly premium cost was given, the majority of people polled thought that it was too expensive and the ACA would not provide affordable and comprehensive coverage even with the government tax credits (subsidies). So, Lake Research Partners advised Enroll America not to mention specific costs but to use the phrase "free or low-cost plans."
Herndon has been working on messaging various parts of the ACA that will be used by outreach partners, insurers and state Exchanges. Its messaging is not based on truth or evidence -- Herndon actually stays away from any mention of facts as you read above regarding the cost of plans. Instead, its messaging is designed to mislead an uninformed public.