Jaan Siderov
Jaan Sidorov is the Population Health Blog

by Jaan Sidorov

First posted on Disease Management Care Blog 1/15/2014

Dr. Jaan Sidorov, host of Disease Management Care Blog
Dr. Jaan Sidorov, host of Disease Management Care Blog

Quick: if you had to chose a limited number of measures to gauge success of the Affordable Care Act, what would you choose?  Would it be the number of persons who haveenrolled in healthcare.gov? The number of persons who havepaid for their insurance and have coverage?  The number ofyoung people with coverage?  The degree of spin used by the White House?

Naturally, the quizzical Disease Management Care Blog proposes a different metric:

The percent of persons with either 1) “silver” or 2) “bronze” plans who have gone two or more months without paying their insurance premium.

Why, you ask?

1) The silver and bronze plans, because their monthly premium is lower, will attract a disproportionate number of persons who were previously unable to afford health insurance and are now newly insured;

2) According to this just published JAMA article, even if their monthly premiums are fully or partially subsidized, these lower-cost insurance plans cover only up to 60% to 70% of medical expenses. That means cost sharing that can be excess of $6000 and $12,000 for individuals and families, respectively.

As these newly insured persons begin to access health care, high out-of-pocket expenses can lead to two scenarios:

1) Those with subsidized insurance will resent paying anything for a plan that stretches the very definition of “health insurance,” or

2) Those with partially subsidized or unsubsidized insurance, because of their mounting bills, won’t be able to pay the premium

Either drop-out scenario is very possible.  The DMCB isn’t aware of any data that describes the normal drop-out rate in low-premium/high out of pocket health insurance plans, but that number exists somewhere.  If Obamacare has a higher than expected rate of of drop-outs, that could spell trouble.  If the drop-out rate is low, things are going well.

CODA: The image above is an example of an enterprise data dashboard, which is intended to help companies track real time success in achieving specified targets.  It’s arguably a best management practice and it shouldn’t be too much to expect the White House to post an ACA “healthcare” dashboard on their web site.  Why not?

Image from Wikipedia

Jaan Sidorov, MD
Jaan Sidorov MD is the Host of the Disease Management Care Blog where he shares his knowledge and insights about medical home, disease management, population-based health care and managed care. He is a primary care internist and former Medical Director at Geisinger Health Plan with over 20 years experience in primary care, disease management and population-based care coordination. He is primary care by training, managed care by experience and population-based care strategies by disposition. The contents of his blog reflect only his opinions and should not be interpreted to have anything to do with any current or past employers, clients, customers, friends, acquaintances or enemies, personal, professional, foreign or domestic.



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