The Health Shopper

Yestereday, MinuteClinic announced it had opened its 200th clinic, and reiterated its plans to enter every market where CVS/Pharmacy stores are located. "By the end of 2007," said Michael Howe, MinuteClinic CEO, "we expect to have more than 400 MinuteClinic locations and longer term, based on consumer demand, we expect to have MinuteClinics in over 2,500 CVS/pharmacy locations."

In-store clinics like MinuteClinic typically operate at 30 percent to 50 percent less cost than a traditional physician's office, 30 percent less than an urgent care office, and a fraction of the cost of a visit to the emergency room. In an age where more people are responsible for paying their own doctor's bill, a MinuteClinic makes a lot of sense.

But a HealthLeaders-InterStudy report released Monday indicates further concern from physicians about these in-store health clinics. The report echoes earlier calls for state regulation of MinuteClinics and similar Take Care Health Centers opening in Walgreens stores in Illinois. "Because these clinics aren't part of an integrated health system, physicians believe care may be fragmented," states Roy Moore, market analyst for HealthLeaders-InterStudy and author of the report. "Doctors fear that a patient's primary care physician won't know his patient is taking certain medications."

A couple of questions we have for groups that oppose the clinics: Isn't it true that patients always had the option to seek health care from clinics outside of their HMO or PPO? Why then are in-store clinics like MinuteClinic (operating in CVS stores) more likely to make care "fragmented"? Could the real worry have something to do with price competition?

In a July 5 essay in HealthLeaders Media, Richard L. Reese identifies MinuteClinic-like facilities as part of a string of new innovations that are helping cut the costs of health care and make lives easier by making health care more convenient and retail-like. "Because of this restructuring, still in its early stages, general hospitals may go the route of downtown department stores, no longer able to provide everything-for-everybody and forced to diversify. Hospitals will have to decentralize, downsize and 'act small.'"

If you’ve seen Michael Moore’s “Sicko,” you’re probably familiar with the story of Jim Kenefick. Jim runs the anti-Moore site MooreWatch.com, and last year ran into financial trouble over his wife’s health. As Moore puts it in “Sicko”: "He was faced with a choice of either keep attacking me, or pay for his wife's health. Fortunately, he chose his wife.”

Kenefick had posted requests for donations to help cover skyrocketing health-care expenditures for his wife, who had been turned down for insurance because of a pre-existing condition. Then, an anonymous donor gave him $12,000. It turns out the donor was Moore, who used Kenefick’s predicament as an example of the health care crisis that’s gripping America.

What wasn't covered in Moore's documentary was the end of Kenefick's health insurance odyssey. Kenefick did eventually get insurance for himself and his wife – and his success had nothing to do with Moore’s donation. Although he had been unable to get it on his own, he secured the help of a licensed health insurance agent, and was able to qualify his wife for a plan.

"A year later, I went to a broker to find out what the legal requirements were to do the Anthem plan the right and legal way,” he said. Eventually, he secured a health plan with Anthem. “And we're still with that plan, and pretty happy with it,” he told Vimo.

No big surprise there. Using an agent makes the process of finding a health plan much, much easier, especially if you or someone you love isn’t in good health. In an article in the L.A. Times, writer Kathy Kristof described how she shopped for health insurance policies at Vimo. Once she spoke to an agent, she learned some helpful ways to get insurance. “For instance, one agent raised the possibility of getting a policy through a small-business group plan that he sold, which would eliminate the need for a physical exam. (If you aren't in good health, that's a good option that didn't show up on the websites.)”

In short, if you seem to be having trouble getting insurance on your own, talk to an agent.

Drug companies don't like generics entering the market, and with good reason. Generic drugs create competition, which reduces prices. The National Law Journal just published a story on how drug companies are fighting generic competitors in the courts. "As major pharmaceutical companies' patent monopolies over lucrative drugs wind down toward expiration, the legal maneuvering to keep generic competitors out of the market heats up."

Meanwhile, insurance companies are implementing some creative tactics of their own to encourage members to buy generic.

Humana just announced they are giving away free drugs to members that make the switch. Humana announced that plan enrollees will have their first copayment for a generic equivalent waived when utilizing Humana’s prescription home delivery service, RightSource.

The new promotion, announced this summer, is an expansion of a plan Humana launched earlier this year, which targeted all fully-insured commercial members using six classes of drugs where a generic alternative was available. While participants are still taking advantage of that program, Humana says early results show that members have realized a total annualized savings of more than $1 million for their out-of-pocket healthcare costs. The second phase of the promotion includes fully-insured commercial members with tiered copay prescription drug plans and individuals enrolled in HumanaOne.

Even if you aren't a member of Humana, it makes dollars and cents to switch to generic drugs. Many of the new drugs we see advertised on television are "me too" drugs based on generic products that sell for a fraction of the price.

Companies and individual buyers of insurance can expect to see premiums rise by more than 10 percent over the coming year. A survey of more than 70 leading health care insurers (representing more than 100 million insured individuals) found that over the next 12 months health care costs are projected to increase by 10.9 percent for HMOs, 10.8 percent for POS plans, 11.2 percent for PPOs and 10.7 percent for CDH plans. This represents rates of increase lower than one year ago, when HMO cost increases were 12.2 percent, 11.9 percent for POS plans, 12.4 percent for PPOs and 12.5 percent for consumer driven health plans. The study by Aon Consulting blames increasing demand, rising hospital and medical technology costs, rising prescription drug prices and poor lifestyle choices for the inflation.

Aon recommends the adoption of consumer driven health plans as a way to help offset the rising prices. Although they've seen the steepest inflation, they are much cheaper than the other plans, as you'll find if you compare plans and deductibles at Vimo.com.

Is it a conflict of interest for a pharmacy to open its own in-store clinic? Maybe, according to the American Medical Association, which is concerned that pharmacies have too much of a financial interest in writing prescriptions to customers.

The AMA has asked federal and state agencies to investigate the issue. "It seemed to many [AMA] members that there was an inherent conflict of interest in a relationship between a health clinic and a pharmacy chain in terms of writing prescriptions and getting them filled in that pharmacy," said Dr. Peter Carmel, a member of the AMA board of trustees, and chairman of the Department of Neurological Surgery at New Jersey Medical School.
 
Carmel said that, before the vote, there were "allusions to reports" of potential conflicts, in which clinic operators earn more money or get promotions based on the amount of prescriptions they wrote.
 
While in-store clinics are great for consumers, shoppers should be wary of the fact that a clinic located inside a pharmacy might pose a conflict of interest. Then again, people for years have charged that doctors over-prescribe drugs — and reap financial benefits from the drug companies for doing so.

A Pennsylvania health care agency studied 60 hospitals that perform heart-bypass surgery, and found there was little if any relationship between the quality of care or the price of the procedure in 2005. "In a Pennsylvania government survey of the state’s 60 hospitals that perform heart bypass surgery, the best-paid hospital received nearly $100,000, on average, for the operation while the least-paid got less than $20,000. At both, patients had comparable lengths of stay and death rates."

As Dr. Ronald Paulus, an executive with Geisinger Health System of central Pennsylvania, put it to the New York Times, there's no financial incentive in the present system for hospitals to provide care leading to better outcomes and lower payments. Maybe that will start to change with the price transparency being delivered by Vimo.com.

A look at Vimo's own "comparison shopping for surgery" engine finds a wide disparity in asking prices within a driving distance of Philadelphia. In 2007, asking prices for the same procedure range from $359,100 at Temple University Hospital to $39,500 at Bellevue Hospital Center in New York (just a 2 hour drive).

The findings from Pennsylvania came from the state's Health Care Cost Containment Council, the independent agency charged with analyzing and reporting data that can be used to improve the quality of health care, in a report entitled "Cardiac Surgery in Pennsylvania 2005."

Michael Moore's "Sicko" is doing decent business at the American box office. To counter some of the film's admitted bias, a group called Health Care America has formed with the sole intention of delivering facts not included in the movie, including:

• Cancer patients in single-payer countries are dying because of the long wait lists for care
• In Cuba, excellent health care is offered to foreigners but not Cubans
• Canadians have to wait months for care

Meanwhile, Google ran a clarification to a blog post that initially opposed Moore's position. "Our internal review of the piece before publication failed to recognize that readers would — properly, but incorrectly — impute the criticisms as reflecting Google's official position. We blew it."

And another Web site, FreeMarketCure.com, has posted short films that counter Moore's movie. At the site, you can watch mini-documentaries about Shirley Healey, a resident of British Columbia, who was scheduled for "urgent" surgery on her blocked mesenteric artery — in four months' time. Ontario man Lindsay McCreith was offered a "critical" MRI on his cancerous brain tumor – again in four months' time. Both gravely ill patients crossed the border into the United States, where they received life-saving treatment within days. The site hosts commentary and a weblog by policy experts David Gratzer (a physician and senior fellow at the Manhattan Institute), David Hogberg (a senior analyst at the National Center for Public Policy Research), and David Catron (an expert on health care finance).

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