From my America Out Loud Pulse podcast with Joel Strom, DDS and Kenneth Schell, D.Pharm. – https://www.americaoutloud.news/the-down-and-dirty-business-of-medical-care-joel-strom-dds-and-kenneth-schell-d-pharm/
The world of medicine encompasses so many ins and outs that patients never see. As costs go up, patients need to be aware of the reasons, and hopefully do something to keep those costs down for themselves—even if the politicians won’t do it.
Almost everyone in U.S. (92 percent) has health insurance whether private or government-financed, yet half have trouble with costs and 41 percent report have medical debt. Thirty-five percent of adults have delayed dental care due to costs. Our teeth are more important than many think they are, but dental care is the most common service to go. Prescription medicines are another culprit. Twenty-five percent of adults either skipped a dose or cut pills in half to save money.
The down and dirty business of medical care is starting to make the news as much as the end result: high costs. Five insurance companies control half the market. Now there is a proposed merger between two of them: Cigna and Humana. Cigna has Express Scripts, the second largest pharmacy benefit manager. Humana has Humana Pharmacy Solutions, the fourth largest PBM. This would significant consolidate the PBM market. Humana is big in the Medicare Advantage market. Medicare Advantage is the HMO with fixed rates for medical care Medicare beneficiaries.
We also have private equity firms buying up medical practices and consolidating them into one large group. The Federal Trade Commission is cracking down because these purchases have led to higher prices. For example, prices charged by anesthesiology groups increased 26 percent after they were acquired by private equity firms. (The most commonly represented medical groups included anesthesiology (19.4%), multispecialty (19.4%), emergency medicine (12.1%), family practice (11.0%), and dermatology (9.9%) From 2015 to 2016, there was also an increase in the number of acquired cardiology, ophthalmology, radiology, and obstetrics/gynecology practices.)
Do buy-outs and mergers help or hurt patients? My guests deal with patients and health policy. We are going to discuss the good, the bad, and the ugly of what is under the surface of medical care.
Bio
Dr. Joel Strom has practiced general dentistry for more than 40 years and is a former President of the California State Dental Board. He has extensive leadership experience in all aspects of the dental profession including education, regulation, professional leadership, clinical practice and as an expert witness. He is an Adjunct Professor at the Forsyth Institute in Boston, Massachusetts, former Chairman of Ethics in the Practice of Dentistry at USC, And Dr. Strom had a 12-year tenure on the California Science Center Board of Directors. Dr. Strom founded the Dr. Joseph Warren Institute, a 501c4 non-profit designed to educate and motivate health care professionals to become leaders in the political and public policy debate on health care reform.
Bio
Kenneth H Schell, Pharm.D earned his Doctorate in Pharmacy from the University of California, San Francisco. He has almost 40 years’ experience in clinical pharmacology and pharmaceutical science, including overseeing pharmacy operations in managed care, pediatric and adult hospitals, medical groups, home infusion, hospice and mail order organizations. Dr. Schell served as president of the California State Board of Pharmacy and on the Board of Directors and as Presidential Officer of the California Society of Health System Pharmacists. He is also lectures at the Skaggs UCSD School of Pharmacy and Pharmaceutical Sciences where he teaches Pharmacy Law and Ethics. He currently serves on the Sharp Healthcare Institutional Review Board for research projects. He also served in compliance and privacy as Chief Compliance and Privacy Officer at a major Pharmacy Benefit Manager (PBM).
Dr. Schell also serves on several other Boards including Disability Rights Now, which champions disabled individuals seeking to become attorneys and ACTG Biopharma, an organization seeking to support novel therapies for individuals with brain injuries.
