Why home care costs too much – Paul Osterman

MIT Sloan Prof. Paul Osterman

MIT Sloan Prof. Paul Osterman

From the Wall Street Journal

As baby boomers age into long-term care facilities, Medicaid costs will go through the roof. Americans already spend – counting both public and private money – more than $310 billion a year on long-term support services, excluding medical care, for the elderly and the disabled. Medicaid accounts for about 50% of that, according to a 2015 report from the Kaiser Commission on Medicaid and the Uninsured. Other public programs cover an additional 20%.

Yet in another decade or so these figures may look small. In 2015 around 14 million Americans needed long-term care. That number is expected to hit 22 million by 2030. There’s an urgent need to find ways of providing good long-term care at a lower cost. One fix would be to deregulate important aspects of home care.

There are two million home health aides in the U.S. They spend more time with the elderly and disabled than anyone else, and their skills are essential to their clients’ quality of life. Yet these aides are poorly trained, and their national median wage is only a smidgen more than $10 an hour.

The reason? State regulations – in particular, Nurse Practice Acts – require registered nurses to perform even routine home-care tasks like administering eyedrops. That duty might not require a nursing degree, but defenders of the current system say aides lack the proper training. “What if they put in the cat’s eyedrops instead?’ a healthcare consultant asked me. In another conversation, the CEO of a managed-care insurance company wrote off home-care aides as “minimum wage people.”

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Translating a Biologic Revolution into an Organizational Overhaul — Retsef Levi

Retsef Levi

MIT Sloan Prof. Retsef Levi

From NEJM Catalyst

Thanks to the revolution in biologic therapy, the annual number of intravenous infusions at the Massachusetts General Hospital (MGH) rheumatology clinic’s small (two-chair) infusion center increased from 1,247 to 1,856 between 2009 and 2014. Related billings skyrocketed from nearly $16 million to more than $40 million. To understand this major shift, one must pause briefly to appreciate the medical history that led to it and then to examine how MGH is redesigning its care processes to bring these novel therapies to patients. Central to the plan is a collaboration with academic partners at the MIT Sloan School of Management.

The Medical Backstory

In 1980, a rheumatoid arthritis (RA) patient at the MGH rheumatology clinic would have received a weekly in-clinic infusion of gold salts and, occasionally, undergone laboratory monitoring.

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A way forward toward affordable, quality healthcare — Joseph Doyle

MIT Sloan Assoc. Prof. Joseph Doyle

MIT Sloan Assoc. Prof. Joseph Doyle

From The Hill

Most discussions about the state of the U.S. healthcare system start with the problem of unsustainable cost growth. One reason costs have been rising is that we (as a society and as consumers) find enormous value in health improvements and are willing to pay for them. The real question is how to identify value vs. waste in healthcare so we can increase efficiency to bring costs down.

Over the years, we’ve seen many attempts to revamp the healthcare system, but they have been insufficient to be transformative. A good example is the HMO model in the 80s and 90s, which was notorious for restricting access to care. During the healthcare reform debate, voters balked at the U.S. government coming anywhere near restraining spending on healthcare. Read More »

Join Senior Lecturer Bob Pozen for Twitter Chat on Underfunded Retiree Healthcare

MIT Sloan Senior Lecturer Robert Pozen

MIT Sloan Senior Lecturer Robert Pozen

Underfunded/unfunded retiree healthcare is a topic that gets little attention in the finance media. All the attention has been paid to pension funds, but retiree healthcare is in worse shape. For example, if a pension fund is only 70 percent funded, it is considered extremely underfunded. And yet retiree healthcare plans are on average only four percent funded.

The question is, why?

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Americans forced to work through their retirement are missing out on an “encore adulthood” — Lotte Bailyn

MIT Sloan Professor of Management, Emerita Lotte Bailyn

MIT Sloan Professor of Management, Emerita Lotte Bailyn

From Quartz

How do today’s Baby Boomers—many of whom are still healthy and active—view their retirement? The traditional image of these so-called Golden Years involves leisure and freedom: mornings on the golf course, afternoons puttering in the garden, perhaps with some globetrotting and grandchildren thrown in for good measure. (Of course this option is only open to those who through pension plans or savings have the means for it.

In recent years, a second image of retirement, known as “aging in work,” has emerged. This model, borne in response to the economic need to protect Social Security and retain experienced workers’ knowledge, keeps retirement-age employees working in part-time or contract positions. It’s sold as win-win: Companies and the country benefit financially, but employees benefit, too, because it keeps their brains active and their social networks strong. The assumption is that continuing to work, though under better, more flexible conditions, is what makes people happy. The mainstream media back the model. Why Working Longer Is Good For Your Health and Get back to work! Working past “retirement age” is beneficial are just a few recent headlines.

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