Five Years On: Successes and Challenges of US-VISIT

Saw this article on SHRM. Would be interesting to see how US-VISIT will be expanded in the future: technically and politically.

2/18/2009 Since becoming operational in 2004, more than 130 million people have been screened biometrically upon entering the United States, netting the capture of thousands of criminals and the elimination of scores of fraudulent travel documents, according to the U.S. Department of Homeland Security (DHS).

“When US-VISIT was created, our primary emphasis was to roll out biometric technology to the air, land and sea ports of entry, all across the United States and consular offices abroad,” said Steve Yonkers, deputy assistant director, Business Policy and Planning, DHS. “Our challenge was to get information into the hands of decision-makers immediately … to verify who [the visa applicant] is, are they wanted for something, is there some reason this person should not receive a visa, and not become admissible to the U.S.,” he said.

The DHS’ US-VISIT (U.S. Visitor and Immigrant Status Indicator Technology) program is an immigration and identity management system used at visa-issuing posts and ports of entry to verify entrants’ identities when visiting the United States. The system involves collecting and analyzing travelers’ biometric data—digital fingerprints and photograph—usually at an overseas visa-issuing post, and checking the data against a watch list of wanted criminals and suspected terrorists. Upon arrival in the United States, the traveler’s biometric data is collected again, to ensure that the entrant is the same individual that received the visa.

Since Jan. 18, 2009, virtually all non-U.S. citizens are required to provide biometric data through US-VISIT, including lawful permanent residents of the United States, refugees and asylees seeking admission, persons paroled into the United States, persons applying for admission under the Guam Visa Waiver Program, and Canadian citizens currently required to obtain a Form I-94.

“US-VISIT has been a success,” Yonkers told those in attendance at the 2nd Annual Biometrics for National Security and Defense conference sponsored by the Institute for Defense and Government Advancement in suburban Washington, D.C., Feb. 11, 2009. “It has enabled us to more or less eliminate the fraudulent use of travel documents and literally catch thousands of criminals seeking to enter the United States, while facilitating travel and trade, [protecting] privacy, and [making] sure information is properly used and safeguarded,” he said.

Criticisms of the program include its cost, effectiveness and the potential for invasion of privacy.

‘Two-to-10’

“Going from ‘two-to-10’ [the fingerprinting of only the index fingers to fingerprinting all 10 digits] has been a major upgrade to the system,” Yonkers said. The upgrade has increased efficiency-of-use of the massive 100 million fingerprint database and increased interoperability with the FBI and other security agencies, by being able to identify latent prints from crime scenes and battle sites better. The two-to-10 upgrade has been implemented at all major U.S. ports of entry.

Exit Collection

US-VISIT is not just about entering the United States. Exit data collection and the ability to identify persons overstaying their visas have always been a part of its aim. An exit data collection system is currently being devised, with information being gathered from pilot programs and with the assistance of the airline industry and the Department of Commerce in order to embed exit collection as naturally as possible into routine exit procedures.

“We’re also looking beyond air and sea, to land exits,” said Yonkers. This presents special difficulties as most people exiting by land travel “at-speed,”—not stopping as they leave—and “we don’t want to disrupt travel and trade,” he said.

Future Tech

The future of biometric identification is mobile and multimodal.

“Obviously fingerprints are the cornerstone of our program, but we realize that in terms of moving forward, we have to become multimodal—that means iris and facial,” Yonkers said. The obstacles to this upgrade are technological and practical in nature, with database storage, system speed and operability, and agency necessity among issues to be worked out.

Yonkers cited the U.S. Coast Guard’s use of mobile biometric readers patched in to the DHS database when confronting people from the Dominican Republic attempting to reach Puerto Rico by ship illegally as an upgrade that has “resulted in a dramatic uptick in prosecutions and served as a real deterrent to an illegal and dangerous action.” DHS will continue to use mobile biometric technology to “bring the tech to where the mission is being done.”

Challenges

Challenges to the continued operation of US-VISIT include concerns over data privacy protection, enhanced interoperability with other agencies, the development of common standards, cracking down on the “spoofing of the system,” and the need to complete the exit collection function. A major future initiative of the program is to be the biometrics identification service provider for all DHS agencies, including the U.S. Coast Guard, the Federal Emergency Management Agency and the U.S. Secret Service, Yonkers said.

-J|S

Daschle Out. (Ugh. And I Bought His Book Already)

Breaking News- February 3, 2009. Tom Daschle has officially withdrawn his name from nomination for the post of Health and Human Services secretary.

Follow the Developing Story at CNN.

Tom Daschle has withdrawn his name from nomination for the post of Health and Human Services secretary. That word comes directly from Daschle himself, via a statement the White House just released.

In that statement, the Democrat and former senate majority leader says he does not want to be "a distraction. The focus of Congress should be on the urgent business of moving the president's economic agenda forward."

Daschle's nomination ran into trouble over the weekend when it was revealed that he had failed to pay taxes on the value of a car and driver he used for several years -- errors that led to him paying about $140,000 in back taxes and interest.

More to Follow. . .

Btw, I was always leary of those red glasses of his.

Concierge Medicine: A Natural Outgrowth of Consumerism in Health Care

January 28, 2009 – There was an interesting article posted on the World at Work Site today about concierge medicine.

There are several names for this practice; some call it “retainer medicine” or “boutique medicine,” while others call it “concierge medicine”. Whatever the name, it appears to be increasing in prevalence. Virtually unknown 10 years ago, it is a growing niche business.

For a fixed annual fee, medical practitioners offer a limited number of patients the opportunity to pay a fixed annual fee in exchange for "premium services and amenities." These services may include priority/same-day/guaranteed next-day appointments; extended or Saturday appointments; access to the doctor 24/7, with access to the physician's pager, cell phone, and home phone numbers; house calls; telephone and e-mail consultations; and other services.

The growth of concierge medicine has really come from two things: One is a revenue stream for physicians whose income is being reduced in many ways from lower third-party reimbursements, higher costs and the like, while others would like to return to the past when medical care was more personalized.

Some doctors who have gone this way have decided to no longer contract with Medicare and other private insurers, and the main selling point to potential patients is that they supposedly get better and more immediate access to, and more undivided attention from, their doctor.

The cost for such memberships can run as low as $1,000 per year on up to $20,000 or more per year. The most recent ones I have come across have been in the $1,500 to $2,000 per year range. It all depends on a variety of factors, including what services are actually provided.

Some fear that concierge care will result in a two-tiered medical system based upon economics. Concierge physicians would not be satisfying their ethical duties to provide some indigent care.

David R. Donnersberger, MD, JD offers an interesting perspective about Concierge Medicine on the Health Care Blog.

January 24, 2009 – Concierge Medicine From A Doctor’s Perspective - Call it boutique medicine. Retainer medicine. Platinum care. Evoking the pastoral image of a sturdy black doctor’s bag and spectacles, concierge medicine is a small but growing trend among over-worked and over-booked physicians. The practice essentially offers a limited number of patients the opportunity to pay a fixed annual fee in exchange for premium services and attention. Fees can range anywhere from $1,000 to $20,000. Concierge medicine has been dubiously received while transition necessitates limiting a physician’s patient base significantly. Imagine receiving a letter from your doctor of 30 years demanding an annual fee on top of the cost of your normal visits. Hurry your check, and you may be one of the lucky ten percent the practice will keep. Thousands of patients have been outraged to receive just this kind of letter from their family doctor.

I believe concierge medicine can indeed offer significant advantages if mixed with a dose of good, old-fashioned business practice. There exists a happy medium that allows physicians to spend increased time with patients without alienating long-term clients. In our practice, we demand no annual fee. We ask that Medicare patients pay out of pocket for their wellness visit; such payment is only covered when the patient turns 65. The patient can in turn be reimbursed on the insurance provider’s schedule.

If the patient is unable to pay, we will still provide the visit. In considering a concierge practice, physicians should continue to accept patients with Medicare or other third-party payers, but may ask for payment directly before the patient files their own claim. The benefits of a direct payment structure to physicians means a less bureaucratic or “quota”-driven practice. The benefits to patients include same-day appointments, complete and continuous physician access via cell phone, on-site laboratories in clinics, and no anonymous hospitalists in the event of a stay.

Increased attention for patients leads to a much higher rate of satisfaction and comfort.
Concierge medicine, from a doctor’s perspective, is a more gratifying and fulfilling way to practice medicine. Today’s doctors take on patient loads of up to 2,500 to 3,500 patients annually. Longer appointments with concierge physicians means a thorough discussion of patient questions and concerns. More time also translates into a real ability to monitor wellness screens such as mammograms and colonoscopies.

There exists the fear that concierge care will result in a two-tiered medical system based upon economics. In the beginning, this may have in fact been true. But as the practice has evolved over the past decade, so have individualized billing plans. Ideally, physicians should maintain long-standing relationships with patients regardless of their ability to pay out of pocket. About 250 concierge physicians exist in the United States today. Participating physicians report more time to devote to patient care and advocacy, as well as continuing medical education and family life. The result is a revolution in preventative care and a return to a more personal relationship between doctor and patient.

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In keeping with the theme of Consumerism, the emergence of concierge medicine is a natural outgrowth of health care economics. It’s also echoed in Obama’s “you can keep what you have” Health care policy stance. For the very wealthy, perhaps the extra expense is not cost-prohibitive. For the rest of the economic classes, a cost-benefit analysis must be performed to determine it’s true value.

-JS

The Sad Truth. And Who Reads, "Yachting" Anyway?

JS

Card is from Jessica's Indexed site.

Health Insurance Reform in 2009: The Raison D'tere for Insurance Scoop

I refuse to be the next person to wax philosophical about how Obama's inauguration promises America the hope of change. Rather, I'd like to focus on one particular issue he has promised to address: Health Care Reform.

I was listening to the radio this morning and one of the news outlets (NYT, I believe) counted the number of campaign promises Obama made during his campaign. As a reference point, in the 2004 election Bush was quoted as making upwards of 198 different campaign promises. Obama came in at 515. But again, let's just concentrate on the one that matters to me personally, and also the impetus for this blog.

Health Care reform promises to take center stage as one of the most important issues of Obama's Presidency. To keep pace, the focus of this blog will compare and contrast every idea, proposal, white paper, and policy that offers an idea on how to reform the system. Once I've assimilated the information, I will strive to contribute my own ideas to the discussion taking shape. And why not? It's my blog ;)

Two recent posts of mine deal with various proposals to reform the HC System:

• Perhaps, a Ray of "Sunshine?" Health Insurance Policy Paper from the CBO Released Today (january 8, 2009)
• The Stage is Set for Health Care Reform (january 15, 2009)

I also recently cited the release of Tom Daschle's Book: Critical: What We Can Do About the Health-Care Crisis.

In the coming months I will be piecing together a policy paper of my own that deals with the competing proposals, from the establishment of a Federal Health Exchange to the proposed Employer HC Subsidy. The paper will be published here and be written in lay terms.

In the meantime, I wanted to share another reference source with you. The Rand Corporation publicly released it's Health Care Policy Reform comparison tool, aptly entitled: COMPARE.

According to the site, "The RAND Corporation's COMPARE (they love CAPS) initiative provides information and tools to help policymakers, the media, and other interested parties understand, design, and evaluate health policies."

Here are the four basic objectives of COMPARE:

• Synthesize what is known about the current health care system.
  
• Describe policy options that have been proposed to address one or more existing challenges.
• Analyze the effects of different health care policy options on multiple dimensions of health system performance.
• Identify gaps in our knowledge about the effects of policy changes.

Rather than constructing specific policy proposals, COMPARE offers objective analyses of policy options currently being used, considered, or discussed by public and private policymaker. Goodie.

Truth be told, I haven't had time to fully explore the site and their metrics, but on the surface it looks great. Lucky for you, I will sift though all the data and analysis and translate it all for you here. Ideally, I would like separate entries here to deal with each competing idea.

Many different policymakers, including President Clinton have tried to reform the system. All of them have failed.

But, things have changed.

The recession has placed downward pressure on HC GDP. Consumerism is now creating economies of scale that are finally starting to enact price constraints. New technology avails more data at both the provider and subscriber levels. That same technology now allows systems of managed competition amongst insurers to flourish where none previously existed. Disease management and wellness have become more sophisticated. Patents on top 100 drugs are beginning to expire in scores. And public and social awareness of the problem has never been higher. In 1998, when the average family was paying around $6,200 for annual coverage, there were bigger issue with which to deal. In 2009, that figure has doubled, and then some. It's now at the top of everyone's list.

The ideas are out there. We need only to make sense of them. And in order for any one idea to work, it must be unilaterally accepted as viable for all socioeconomic strata.

We all welcome the hope for change. But what kind of change, is not up to Obama. It's up to us.

-J|S

Yes, Another Study Demonstrating That HC Costs are Still on the Rise

Towers Perrin, an HR consulting Firm just released their annual HC Cost Survey for 2009. And while it seems that there is a similar study released every week, all of them telling us what we already know, the Towers HC Cost Report is widely used and respected in the industry.





The new data suggests that employers will pay, on average, $9,552 per employee for health benefits in 2009, a jump of 6% from 2008. Yet some employers will buck the trend because they proactively manage their benefit programs.

One interesting nugget of data reveals that "high-performing companies," or those organizations that rigorously track their health benefit objectives, will spend on average, 12% less in annual health care premiums in 2009, compared to low-performing companies. For example, high-performing firms report health benefits costs $8,904 per employee, compared to $10,104 for low-performing companies. The cost fell even lower (to $7,032) at high-performing companies utilizing consumer-driven health plans with health savings accounts. (Still not convinced about CDHP?)

The survey defined high performers as companies that not only had a strong commitment to improving employee health and engagement, but also aggressively managed their health plans and the delivery process.

Other Findings Within The Study:

• Large employers are experiencing health care cost increases of 6% on average, or $532 per employee per year. Although this year's average percentage increase is similar to last year's, employers are paying 29% more today than they spent five years ago for health care.


• In flat dollar terms, the employee share in 2009 will average $80 per month ($960 annually) for employee-only coverage and $273 per month ($3,276 annually) for family coverage - a significant cost for many employees.


• Pre-65 retirees will contribute approximately 51% of the premium for retiree-only coverage, and 54% for family coverage.


• Retirees age 65 and older will pay an average of $148 per month (or $1,776 annually) for retiree-only coverage and $309 per month (or $3,708 annually) to add coverage for one dependent.

Follow the link above to read the study for yourself.

-JS

What is "Trend?" And How Much of It is Price Margin?

One of the major components of premium or rates that insurers use on commercial accounts is called Medical Trend. Loosely defined, Annual Medical Trend is the historical or projected average change per year in an insurers medical, capitation, and pharmacy costs. In the last quarter of 2008, average HMO and PPO annual trends ran between 10-12%. On different cases that I've brokered I've seen trend as high as 17%.

Certainly there is justification for trend increases year over year. New technology and infrastructure in the HC system, pharmacy costs, aging workforce, Medicare reimbursement rates, so on and so forth. But new data shows that the Medical CPI is actually leveling off, and in some cases, declining.

I really have to learn how to upload better graphs from Excel sheets, but the graph below displays the Medical CPI for the last ten years. (Trust me, the data is in there.) Year Over Year (YOY) Medical CPI appears to be flat or declining. I have the rest of the data that shows that this is relevant across inpatient, outpatient and medical services. However, the Producer Price Index ( PPI ) which is the carrier's premium pricing in aggregate is going up 7bps over November and close to 3/4% YOY. It suggests that while the insurance carriers affordability efforts are containing trend, the increased trends that groups are receiving are more an effort for the carrier's margin expansion than it is a legitimate effort to price to a rising trend.

Admittedly, less than a percent is not a lot, but compounded YOY it can be.

-JS