Photo by Flickr user MeddyGarnet/used under Creative Commons license
Photo by Flickr user MeddyGarnet/used under Creative Commons license


Information is like a genie in a bottle. It can be used for good purposes and for bad. It’s good to keep both in mind.

Healthcare has its share of charlatans, incompetents, poseurs and crooks. Does the availability of more accessible information empower these people or disable them? Surely both. But believers in the free market of ideas start with the assumption — call it false optimism if you will — that in the world of ideas good will drive out bad.

Fishkill-based MedAllies, founded in 2001, is in the business of implementing electronic health records (EHR) in order to facilitate physician office redesign, improve office practice efficiencies, and enhance population health. Its thinking has been influential in the ideas contained in the New York State Health Innovation Plan adopted by the state government last year.

Its CEO, Dr. A John Blair III, is also president of the 5000-member Taconic IPA, whose physician members have been at the forefront of transforming healthcare delivery in the Hudson Valley through meaningful use of health information technology and pay-for-performance incentives. MedAllies boasts of now including nearly 2500 healthcare organizations and 40,000 users in its Direct network. It connects to more than 6000 healthcare organizations and 200,000 users.

The company appears to be continuing its expansionary mode. “MedAllies is experiencing unprecedented growth, both internally and in terms of market share,” said Blair recently.

Blair’s a nationally recognized expert in the use of healthcare information. He realizes that information is a tool for change. Revolutionary healthcare transformation, he wrote last month, “required the use of health information technology as a tool, care coordination as a process, and realigned payments as an incentive.” That’s the present New York State plan in a nutshell.

Meaningful Use

American healthcare transformation has been a long slog, as its pioneers are fully aware. The perils of information misuse and abuse are very real. Security and the protection of privacy are real concerns, as any veteran of the health information technology field is well aware. In that regard, MedAllies has put great effort into protecting the users of its network.

Here comes Obamacare

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Seventeen health insurance companies have stepped up and offered New Yorkers four levels of plans (plus an ominous-sounding “catastrophic” category) with standardized contract terms and product offerings. Consumers can now comparison-shop among them. Enrollments for New York’s health exchange marketplace, one of the most important early stages of the federal Affordable Care Act (Obamacare), will begin October 1, and coverage will become effective on the first day of 2014.

How much will eligible persons in the Hudson Valley pay for health insurance? According to the website, premiums for individual New Yorkers for the most comprehensive plan, “platinum,” will range depending on the vendor chosen from $446.25 to $994.34 monthly. Premiums for the plan with the lowest of the four levels of benefits, “bronze,” will be offered from $265.89 to $589.91 per month. Multiply those premiums by 1.70 for the inclusion of children, 2.00 for spouses and 2.85 for families. The rates approved are subject to final certification of the insurers’ participation in the exchange.

The new premium rates do not affect a majority of New Yorkers, who receive insurance through their employers, only those who must purchase it on their own, an article in the July 16 New York Times explained. Because the cost of individual coverage has soared, only 17,000 New Yorkers currently buy insurance on their own. About 2.6 million are uninsured in New York State. State officials estimate that as many as 615,000 individuals will buy health insurance on their own in the first few years the health law is in effect. In addition to lower premiums, about three-quarters of those people will be eligible for the subsidies available to lower-income individuals.

The marketplace has been a long time coming. Governor Andrew Cuomo attributed the expectation that the expensive private insurance rates for individuals will decrease at least half to the influence of the newly constructed competitive marketplace. “New York’s health benefits exchange will offer the type of real competition that helps drive down health-insurance costs for consumers and businesses,” said Cuomo.

Crain’s New York Business provided perhaps the most animated reaction. “When the Cuomo administration gave word last week that individual health-insurance premiums offered through the state exchange to launch in October would be at least 50 percent cheaper than what some New Yorkers pay now, it was like tossing food pellets into a pond of starving fish,” said a Crain’s editorial last Friday. “Groups supporting the Affordable Care Act celebrated the news in TV ads, seeking to beat back Republican efforts to repeal Obamacare. Critics of the law fought back, arguing that the numbers were deceiving or downright false.”

New York has required insurers to cover everyone regardless of pre-existing conditions, but did not require everyone to purchase insurance — a feature of the new health-care law — and did not offer subsidies so people could afford coverage. With no ability to persuade the young and the healthy to buy policies, the state’s premiums to individuals have long been among the highest in the nation.

The health of healthcare


New Paltz Chamber of Commerce President Michael A. Smith. (photo by Lauren Thomas)
New Paltz Chamber of Commerce President Michael A. Smith. (photo by Lauren Thomas)

The movement toward implementation of the federal Affordable Care Act will continue in 2013 as one of the very biggest issues in American society. It’s going to be as big an issue in 2014, and in 2015 as well. And every year beyond that for perhaps a decade. So we might as well be prepared to deal with it.

Health insurers and most provider organizations are better prepared than they were a couple of years ago. The provisions of the federal legislation require them to come to terms with the subsidized healthcare benefit exchanges scheduled to go into business in every state of the nation less than a year from now.

Other deadlines are looming, too. The players are scrambling to participate in a variety of experiments, figuring out how most effectively to find their niche in cooperation with other healthcare organizations. Most if not all are also wrestling with the implementation of electronic health records and other tools of information technology.

By October 31 of this year, health insurers will be competing for New York customers in the state-run health benefit exchange. This is no small enterprise. New York, one of the most aggressive states in setting up its state-run health benefit exchange, is getting tens of millions of dollars in the form of federal grants to fund implementation.

According to the 2009 American Community Survey, some 121,000 of the medically uninsured in the seven counties of the mid-Hudson region (Westchester, Putnam, Rockland, Dutchess, Orange, Sullivan and Ulster counties) will gain coverage as a result of the ACA. With the state health benefit exchange in place, the uninsured in the region will decrease from 15 per cent to nine per cent of the population.

Healthcare insurance expansion


Kingston Assemblyman Kevin Cahill, newly appointed chairman of the Assembly Insurance Committee. (photo by Dion Ogust)
Kingston Assemblyman Kevin Cahill, newly appointed chairman of the Assembly Insurance Committee. (photo by Dion Ogust)

In politics as in nature, it’s good to get close enough to the fire to get warm but not close enough to get burned. In both realms, the ideal distance is often reached through trial and error.

After four years as chairman of the Assembly Energy Committee, Kingston Assemblyman Kevin Cahill got a new job last week. He was appointed chairman of the Assembly Insurance Committee. He said he expected as steep a learning curve in his new chair’s job as he had experienced when he assumed his former chairmanship. Cahill remains a member of the Health, Economic Development, Ethics, Higher Education and Ways and Means committees.

Under a state executive order signed in April 2012, New York will begin implementing a state-established health benefit exchange (HBE) expected to provide largely subsidized health insurance to more than a million New Yorkers. The state Health Department will have responsibility over the administration of the HBE. But other state agencies, including the Insurance Department, will also be heavily involved. Under the federal Affordable Care Act (ACA), popularly known as Obamacare, private companies compete in the marketplace for health insurance.

Who goes without medical care?

The U.S. Census Bureau recently reported that working-age adults made an average of 3.9 visits to doctors, nurses or other medical providers in 2010, down from 4.8 visits in 2001. Among those with at least one visit, the average number of visits also declined, from 6.4 visits in 2001 to 5.4 visits in 2010.

Perhaps Americans are getting dramatically healthier. Or perhaps they can’t afford to go to the doctor.

“The decline of the use of medical services was widespread, taking place regardless of health status,” said Brett O’Hara of the Census Bureau.

But people lacking insurance were far less likely to go to doctors. Just 24 percent of the uninsured went to a doctor at least once in 2010, compared with 72 percent of the general population of working age adults, the census report found.

The census data contradicts the common-sense supposition that people in bad health would be more likely to avoid being uninsured. People under 65 whose health was poor, fair or good were more likely to be uninsured than those with very good or excellent health.

Spending a night in a hospital has become a rare event. The chances of spending no nights in a hospital ranged from 96 percent for children to 83 percent for people 65 or over.

Among people in poverty, 38.6 percent went without seeing a medical provider over the previous year, compared with 19.1 percent of people whose family income was greater than 400 percent of the poverty threshold.

Clearly, a lot of sick people don’t get government assistance — even when they can’t afford medical care. So they go without doctor visits, lab work and medications.

In an article, Ruth Fishbeck, director of the Health Initiative in Potsdam, recently described the serious health consequences of a lack of affordability in St. Lawrence County in the far northwestern corner of the Adirondacks. “People are dying,” she said. “We rank in health 58th or 59th out of 62 [New York counties], and that means premature death and sickness. And a lot of it is simply the lack of money to get adequate health care.”