qotd: Insurers shoving “advanced illness counselors” on us

Kaiser Health News
August 27, 2014
Operator? Business, Insurer Take On End-of-Life Issues By Phone
By Elana Gordon, WHYY

Kate Schleicher, 27, is a licensed clinical social worker, who knows
almost as little about you as you do about her. Except she knows your
phone number, your insurance provider and that you are pretty sick.

Schleicher is one of 50 social workers at a company called Vital
Decisions. After sending a letter (people rarely respond) counselors
essentially cold-call to offer what they describe as "nondirected"
end-of-life counseling.

The hope of this program, she says, is to build a relationship over the
phone, so (the patient) might be comfortable discussing his situation
and his goals. Then he'll be empowered to communicate those things with
others, including his family and his doctors. He could also choose to
allow the counselor to talk to his doctors or family directly. It's paid
for by insurers and federal privacy rules permit this for business purposes.

And when these conversations do happen, there's can be another
byproduct: reduced costs. Research is finding that when patients fully
understand aggressive care, many choose less of it.

But some people are wary of the company's approach. Dr. Lauris Kaldjian,
professor of bioethics at the University of Iowa, has concerns about the
social worker, patient and family never actually meeting. "Because if
you don't have enough knowledge about what's actually going on with the
patient, it would actually be irresponsible to pretend to have
discussion that depends upon such knowledge."

http://www.kaiserhealthnews.org/Stories/2014/August/27/insurers-new-business-end-of-life-conversations.aspx

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Vital Decisions

Vital Decisions is an innovative organization that assists patients and
families dealing with advanced illness. We help patients clarify their
values and preferences and then communicate with their family and care
team to actualize those preferences. Our clients include several leading
national, regional, and local health care plans which offer our service
free of charge to appropriate individuals within their member populations.

We are a privately held company located in the Metropark business
complex in Edison, NJ. The Company is profitable, and cash
flow-positive, and is a leader in the growing field of advanced illness
counseling.

The Company is a portfolio company of MTS Health Investors, the New
York-based healthcare private equity firm.

http://www.vitaldecisions.net/careers.asp

HHS.gov: Health Information Privacy: "Business Associates"
http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/businessassociates.html

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Comment by Don McCanne

When you are faced with advanced illness, perhaps nearing the end of
life, where would you want to turn for medical advice on how to get
through this difficult time? Your personal physician and health care
team? Private health insurers, always looking for more administrative
innovations to sell us, are now using high pressure tactics to force
"advanced illness counselors" into the management of your care.

Who are these counselors? In the example given, they are employees of
Vital Decisions, a private, for-profit corporation that sells its
services to private insurance companies. They use your confidential
medical diagnoses that have been provided to them by the private
insurers to market to you an advisory service on negotiating the health
care system. After an introductory letter that is routinely ignored, the
counselors cold-call to try to convince you to accept their end-of-life
counseling. Of course, this is "at no cost to you" since your insurer
pays for this service. The services are provided over the phone from
offices in New Jersey - a definition of personal care that only the
insurers can understand. The clients of Vital Decisions are the private
insurers, not the patients, nor the physicians, nor any other members of
the health care team.

With today's emphasis on privacy, how could unrelated business entities
gain enough information about you to make a contact? In another
concession to the private insurers, HHS allows them to share this
confidential information with "business associates" - basically any
business entity that might interact with the insurer as the insurer
carries out its business functions. It is the private insurers that sic
on you these end-of-life-care marketeers just at a time that you do not
want any more extrinsic intrusions since you are suffering enough already.

Although the insurers say that they are paying for these services, they
are actually paid by plan enrollees in the form of higher premiums. What
is worse, these services are classified as health care related services
and can be included in the insurers' medical loss ratios. They do not
apply to the 15% or 20% limit on administrative costs. In fact, since
they are counted as medical losses, it allows the insurers even more
leeway in adding on yet more administrative services. Since the
percentages are fixed, more medical losses allow more administrative
services - the primary product that the private insurers are selling us.

As a portfolio company of MTS Health Investors, the New York-based
healthcare private equity firm, Vital Decisions is taking very good care
of Wall Street, while intruding in our most difficult time of life and
then walking away with our health care dollars.

Regular readers know what a single payer national health program would
do with these parasites. They'd be out the door, right now.