The document summarizes a presentation on health reform from a contrarian perspective. It begins by stating that true health reform will continue independently of federal efforts. It then outlines five contrarian perspectives on health reform: 1) the US will not adopt single-payer healthcare, 2) actual reform occurs outside of policy debates, 3) Americans are willing to pay for services used not insurance, 4) the uninsured are a permanent but changing group, and 5) individuals not corporations will drive future reform. It concludes by suggesting areas where self-funded plans and individuals could better align financial interests.

1. Health Reform:
A Contrarian’s Perspective
Presented by:
Si Nahra, Ph.D., President
February 28, 2012

2. Pioneering Specialists in Group Health Care
Post-Payment Administration for 25 Years
Unblemished track record – no HIPAA violations or employee issues
• First with 100% claim audits
• Introduced the use of claim audits for recovery
• Originated linking of enrollment reconciliation with claim audits
• Started dependent eligibility audits 15 years ago
• Revolutionized data intake with payer-defined data – always successful
• Re-defining competitive bidding
• Extending control of data to self-funded plans of all sizes
• Putting meaning into fiduciary oversight via Routine Plan Monitoring
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Health Decisions, Inc.

3. Why You Are Here
Health reform in America has little to do with the Affordable Care
Act (AKA “ObamaCare”). This effort, like so many before it, will
leave behind layers of new rules and regulations. But true health
reform will continue in spite of and not because of federal efforts.
This webinar will attempt to put US health reform into perspective
by exploring its contradictions and by examining how we have
reformed – and are reforming still -- our definitions of “need” and
“risk” without government dictates.
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Health Decisions, Inc.

4. Approach
• Five Contrarian Couplets
• Brief Histories of Need and Risk
• NOT trying to convince anyone.
• Just trying to broaden the discussion.
• Lack of Q&A a blessing and a curse.
• Follow-up discussions welcomed.
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Health Decisions, Inc.

5. Five Contrarian Couplets
• Written before Obama even ran for president.
• Changed very little over time.
• Each Couplet could be its own webinar.
• Here, they provide an orientation.
– One and Two eliminate distractions
– Three and Four offer an alternative orientation
– Five hazards a guess at where reform is going
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Health Decisions, Inc.

6. Contrarian Couplet #1
• The US should adopt a single-payer, National
Health Insurance (NHI) system.
• No one alive today will live to see the US
adopt a single-payer, NHI system.
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Health Decisions, Inc.

7. Contrarian Couplet #2
• Public policy debate about health reform will
continue to rise and fade producing
incremental reforms that further complicate
an already complex health system.
• Actual reform will continue unabated, outside
the public policy arena, adapting and
assimilating any pubic policy initiatives.
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Health Decisions, Inc.

8. Contrarian Couplet #3
• Americans are not willing to pay premiums for
health insurance they may not use.
• Americans are willing to pay a fair price for
health services they use.
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Health Decisions, Inc.

9. Contrarian Couplet #4
• Uninsured persons are now a permanent (but
ever changing) part of the US health system.
• The terms “uninsured” and “underinsured” are
obsolete and should be replaced by the
concept of the “self-funded individual” which
encompasses all Americans.
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Health Decisions, Inc.

10. Contrarian Couplet #5
• Collective actions by corporate interests have
led to the US health system we have today.
• Collective actions of organized individuals will
truly reform the US health system of
tomorrow.
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Health Decisions, Inc.

11. A Brief History of Reform
Period Need Risk
Post WWII - 1960 How much more do we Rise of BCBS and
need? (Hill-Burton) community rating
1960’s – 1980’s What do we really need? Underwriting/HMO/ self-
(CON and “H S A”) funded groups
1980’s – 2000’s What do we need to pay Risk shifting
for? (Medicare) Higher cost sharing
2000’s – Current Do YOU really need that? Self-funded individual
(personal responsibility)
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Health Decisions, Inc.

12. The Future?
• Self-funded plans will focus on individual
enrollees not employees and their families.
• Self-funded plans can facilitate individual
communication and action.
• Areas where self-funded plans and individual
financial interests align:
– Improper use of Emergency Rooms
– Chronic care management
– Prescription drug costs
– Others?
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Health Decisions, Inc.

13. Past Webinars Available
Recordings of past webinars are available upon request, or through
Si’s Library (www.healthdecisions.com/library) including:
• December, 2011 – 2012: What Does it Hold for Self-funded Health Plans?
• November, 2011 – Overpayment Collection
• October, 2011 – Finding Provider Fraud
• September, 2011 – Complete Enrollment Validation
• August, 2011 – New HIPAA Accounting Requirements
• July, 2011 – Dos and Don’ts of Competitive Bidding
• June, 2011 – You’ve Done a Dependent Audit. Now What?
• May, 2011 – Two Dozen Reasons for Claim Payment Error
• April, 2011 – How Does Your Plan Compare?
• March, 2011 – How Medicare Can Help Employer Health Plans
• February, 2011 – Administrative Fee Inflation
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Health Decisions, Inc.

14. For More Information
Contact
si@healthdecisions.com
734-451-2230
Connect with me on LinkedIn
Add me to your circles on Google+
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Health Decisions, Inc.