NHS & Simon Stevens----Sell or Sail?

Dr No:

Is this the sound of music for the NHS? Steven’s plans for the NHS are a big shake up for the NHS, but this time executed at a micro rather than macro level. His clear call for real extra public funding for a national health service – efficiency savings alone will not fill the black hole - will rattle politicians’ cages, but at the same he has a history of travelling on the other bus, including time at the giant American private health firm UnitedHealth, not to mention bowling from the pavilion end when advising the then Labour government about health in the early noughties. His answers this morning on the Today programme on the question of greater private sector involvement in health service delivery made up in broadness what they lacked in depth

My Take a while back.

The Cockroach Catcher was privileged to be having dinner with his good friend.

He covered the bottle when he served his favourite red wine.

"See what you think."

"Fully of blackberry and long with good tannin that has softened."

"1996 and the tannin will keep it going for another 5 years."

"Of all the recent great wines that you have served and that included the second wines of Lafite and Margaux, this is the most impressive. Just like our NHS!"

"But now you have one of the most impressive guys running it."

"Selling it, you mean!"

"I did not want to upset you."

"So you know about Simon Stevens. Not just wines then."

"You need to know that Britain is responsible for producing all the great doctors in the old commonwealth. My cardiologist was trained there. Look at Singapore, Australia & New Zealand, generations of doctors were all trained in the UK and in turn the next generations.

Why do you think that UnitedHealth paid so much to get one of the top UK guys to add a new perspective?

UnitedHealth is based in Minnesota, home of the famous Mayo Clinic and Simon Stevens is married to an American and they have school age children. As you well know, it is not easy for Americans to adjust to British life."

"So you think he is not going to last that long?"

"He has a very natural excuse!"

"Family!"

"Lets see what Bloomberg say:"

BRITISH EXPERIENCE

UnitedHealth followed up on June 30 with another report for lawmakers pinpointing $332 billion in savings through better use of technology and administrative simplification. If enacted, those changes would potentially benefit UnitedHealth's Ingenix data-crunching unit. Ingenix, with annual revenue of $1.6 billion, is poised to establish a national digital clearinghouse to ensure the accuracy of medical payments and provide a centralized service for checking the credentials of physicians.

Stevens, an Oxford-educated executive vice-president at UnitedHealth, once served as an adviser to former British Prime Minister Tony Blair. In that capacity, Stevens tried to fine-tune the U.K.'s nationally run health system. Today he tells lawmakers that theU.S. need not follow Britain's example. Concessions already offered by the U.S. insurance industry—such as accepting all applicants, regardless of age or medical history—make a government-run competitor unnecessary, he argues. "We don't think reform should come crashing down because of [resistance to] a public plan," Stevens says. Many congressional Democrats have come to the same conclusion.

UnitedHealth has traveled an unlikely path to becoming a Washington powerhouse. Its last chairman and chief executive, William W. McGuire, cultivated a corporate profile as an industry insurgent little concerned with goings-on in the capital. From its Minnetonka(Minn.) headquarters, the company grew swiftly by acquisition. McGuire absorbed both rival carriers and companies that analyze data and write software. Diversification turned UnitedHealth into the largest U.S. health insurer in terms of revenue. In 2008 it reported operating profit of $5.3 billion on revenue of $81.2 billion. It employs more than 75,000 people. 

Stevens argues that while UnitedHealth will likely benefit financially from health reform, the company will also aid the cause of reducing costs. He cites what he says is its record of "bending the cost curve" for major employers. 

During a media presentation in May in Washington, Stevens said medical costs incurred by UnitedHealth's corporate clients were rising only 4% annually, less than the industry average of 6% to 8%. But that claim seemed to conflict with statements company executives made just a month earlier during a conference call with investors. On that quarterly earnings call, UnitedHealth CEO Hemsley conceded that medical costs on commercial plans would increase 8% this year. 

Asked about the discrepancy, Stevens says the lower figure he is using in Washington represents the experience of a subset of employer clients who fully deployed UnitedHealth's cost-saving techniques, including oversight of the chronically ill. "These employers stuck at it for several years," he says. "We are putting forward positive ideas based on our experience of what works."

"Wow!"

"So there is not reason for him to leave UnitedHealth! They love him. The best of British & of Oxford!"

"Perhaps he has not left UnitedHealth!"

"So perhaps a sort of UnitedNHS then!"

"Well despite what people say about Obamacare, even Stevens concede that:

.....the U.S. insurance industry—accepting all applicants, regardless of age or medical history—make a government-run competitor unnecessary, he argues.

"NHS as such was the most serious competitor to the Health Insurance Industry. It is serious because there is not even any co-pay!"

"And quality is the same as the actual specialist doctor on either side are the same."

"Only the coffee is better!"

"Whatever Stevens plan to do is not something most of us can begin to guess but my suspicion is that it would not be to anyone's liking..."

"Except the Health Insurance Industry."

"So, he will not follow the US example of insurance industry accepting all applicants, regardless of age or medical history."

"No way!"

"You see, UnitedHealth has decided to leave California because of that."

"Not profitable!"

"If Insurers need to cover everything in England, they would think twice and most likely do a California thing."

"And Stevens can go back to America then!"

"So what is the wine?"

"Big Sail Boat!"                                                              

"Big Sail Boat?"

That the logo might have helped to sell a wine is unthinkable if the wine is no good. Ch. Beychevelle was fortunate enough to have a boat on its label and the Chinese just embrace it now that Lynch Bages hit the roof and there are too many fake 1982 Lafites around.

When my friend stock up on his Beychevelle, it was he told me, just a third of the price right now.

"It will be the next Lynch Bages."

"That is why 50% has been sold to the Japanese!"

"Wow!"             

So will Simon sell or sail? Or sell then sail!

Forbes:

I recently learned that this month a class-action lawsuit has been filed against California United Behavioral Health (UBH), along with United Healthcare Insurance Company and US Behavioral Plan, alleging these companies improperly denied coverage for mental health care.

According to the class action lawsuit, United Behavioral Health violated California’s Mental Health Parity Act, which requires insurers to provide treatment for mental-health diagnosis according to “the same terms and conditions” applied to medical conditions. Specifically, the insurer is accused of denying and improperly limiting mental health coverage by conducting concurrent and prospective reviews of routine outpatient mental health treatments when no such reviews are conducted for routine outpatient treatments for other medical conditions. 

New York:

Pomerantz Law Firm has filed a Class Action Against UnitedHealth Group, Inc. 
for Violations of Federal and State Mental Health Parity Laws - UNH

NEW YORK, March 12, 2013 (GLOBENEWSWIRE) Pomerantz Grossman Hufford Dahlstrom & Gross LLP has filed a class action lawsuit against UnitedHealth Group Inc. (“UnitedHealth” or the “Company”)(NYSE: UNH) and various subsidiaries, including United Behavioral Health.  The class action was filed in the U.S. District Court, Southern District of New York, and docketed under 13 CV 1599, alleging violations of federal and state mental health parity laws and other related statutes. The action has been brought on behalf of three beneficiaries who are insured by health care plans issued or administered by United and whose coverage for mental health claims has been denied or curtailed. These plaintiffs seek to represent a nationwide class of similarly situated subscribers. In addition, the action was filed on behalf of the New York State Psychiatric Association, Inc. (“NYSPA”), a division of the American Psychiatric Association, seeking injunctive relief in a representational capacity on behalf of its members and their patients.

California regulators seek up to $9.9 billion in fines from PacifiCare

The health insurer violated state law nearly 1 million times from 2006 to 2008 after it was bought by UnitedHealth Group, the Department of Insurance says. The fine, if there is one, is likely to be much less than the maximum allowed.'

UNITED HEALTHCARE INSURANCE AGREES TO PAY U.S.
$3.5 MILLION TO SETTLE FRAUD CHARGES

WASHINGTON, D.C. - United Healthcare Insurance Company has agreed to pay the United States $3.5 million to settle allegations that the company defrauded the Medicare program, the Justice Department announced today.

The government alleges that beginning in or about 1996 and continuing through 2000, United Healthcare's telephone response unit knowingly mishandled certain phone inquiries received from Medicare beneficiaries and providers and then falsely reported its performance information to the Centers for Medicare and Medicaid Services (CMS) concerning the company's handling of those calls. CMS is the federal agency charged with administering the Medicare program.

From October 2, 1995 to October 1, 2000, United Healthcare acted under contract with CMS as a Durable Medical Equipment Regional Carrier. Under that contract, United Healthcare processed Medicare Part B claims for durable medical equipment submitted to it by Medicare beneficiaries, physicians, and other health care providers and suppliers located in the northeastern United States.

"This settlement demonstrates our continuing commitment to pursue vigorously allegations of fraud and abuse in Medicare," said Peter Keisler, Assistant Attorney General for the Department's Civil Division. "Medicare contractors, along with other health care providers, can and will be held accountable for their billing practices. This settlement demonstrates our unwavering pursuit of fraud and abuse."

The allegations of improper conduct were brought to the attention of the government by a former United Healthcare employee, who filed suit under seal in November 2001 under the qui tam or whistleblower provisions of the federal False Claims Act. The United States recently intervened in the whistleblower suit.

As a result of today’s settlement, the whistleblower will receive $647,500 of the settlement amount. United Healthcare did not admit any of the allegations in the complaint in connection with the settlement. Under the False Claims Act, private citizens can bring suit on behalf of the government and share in any awards that are obtained through that legal action.

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UnitedHealth & Simon Stevens: Your NHS! Your Money!

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