I wrote a piece on St. Luke's Center for Health Innovation that is being run by Sun Valley resident, Bill Boeger. The article was published in the leading technology publication (TechCrunch) which also gets published on the Washington Post site. Here's the article introduction...


Fifteen years ago the Internet was revolutionizing global communications and computing so companies were looking for the most advanced markets to test their technologies. Locales such as Korea and Singapore portended the future. Today, no less than reinvention of healthcare is taking place. A key question is which locales will provide a similar testbed for healthtech. It’s not always the obvious places.

Healthcare providers such as the Mayo Clinic have been at the vanguard of adopting new technologies and approaches. However, this remains a provider-centric approach and the Mayo Clinic has far more resources than a community hospital or clinic. Ultimately, a broader community-focused effort can demonstrate how new approaches can scale nationally across a wide array of settings. That is, an approach that spans all income and demographic sectors as well as a range from urban to rural settings.

Click to read the rest of Healthcare Field of Dreams In Idaho: Health System Opens Innovation Center

Thursdays, June 30 and Aug 18

The beaver has been called the most intelligent animal, aside from humans, for the ways in which it alters its surroundings.  During our evening, we will learn more about this amazing animal, and—with a little luck—see them in action!  Get to know the largest rodent in North America!  ERC Members free; suggested donation $10 individuals/$25 family for non-members.  Registration requested; call 208.726.4333.

The June walk will take place from 6:30 – 8:30 at the Greenhorn trailhead.  You may meet us there at 6:30, or meet at the ERC office at 6pm promptly to create carpools to drive to the trailhead.  August time and location will be determined as summer progresses (the same sites are not always active, so we scout locations in advance, closer to the time).

Get your family out into nature and enjoy our beautiful valley, but call soon!  The first one is Thursday June 30!  

The insurance middleman has taken a toll on the family doctor. New practice models plan to change that. Physicians in Seattle, Silicon Valley and Boston are proving what the rest of the world already knows. When you have a high function primary care system, there’s less money spent and better health outcomes.

Before House, M.D., there was Marcus Welby, M.D. who epitomized the glory days of healthcare. Dr. Welby knew every one of his patients. If you got sick, he took care of you right away, always spending whatever time necessary.

Unfortunately, there’s a radically differently model today that can only be described as a Gordian Knot designed by Rube Goldberg. 

Consider the following scenario:

It can take a patient days to get in for an appointment, they arrive for an appointment, wait 45 minutes in the crowded waiting room, wait again in the exam room, and then get 10 minutes with their doctor, 15 if they’re lucky. Of course, it’s difficult for him to remember much except for those few notes he scribbled last time. How much can anyone remember about 2,000-4,000 people? If a doctor doesn’t see 30 patients over the course of the day, he’s likely going to be penalized for not hitting insurance-driven productivity goals. In a typical 10 minute appointment, there’s often no time to go beyond the presenting symptoms and then give the patient a prescription as a way of closing the appointment. Does this sound familiar?

What happened to the old family doctor so wonderfully represented by Marcus Welby? Insurance killed him.

Today’s insurance reimbursement process severely impedes the delivery of affordable, patient-centered primary care. Whether a doctor is using a paper-based or electronic medical record, much of their time is spent ensuring they properly code billing forms. In many, many cases, those claims will be denied and the process starts all over again. That doesn’t address a patient needing tests or prescriptions.  Is it any wonder that more than 50% of primary care physicians say they would leave practice if they could?

Having spent years in Patient Accounting departments as a consultant, it was easy to see why there’s a 40% “insurance bureaucracy tax.” That is money not being spent on care itself. It also doesn’t take into account time and frustration by the patient who is ultimately responsible for care as they have to wade through Explanation of Benefits and other forms mere mortals have difficulty interpreting (perhaps by design).

Benjamin Franklin was right. An ounce of prevention is worth a pound of cure. The savings demonstrated in direct primary models extend to the public sector. By having a proactive primary care physician relationship coupled with a pharmacist, a group of Medicaid patients in Ohio with diabetes met monthly with their doctor monthly to monitor blood pressure, cholesterol and blood-sugar levels. They have found that having a proactive relationship with their primary care physician is resulting in an average savings of $5,500 per year. If this is extrapolated to Ohio’s entire Medicaid population that has Diabetes, that would account for $500MM in savings. In these budget constrained times, there’s not a state out there that wouldn’t benefit from these kinds of savings.

How it works

By forming a direct financial and professional relationship with each patient—as in the days before insurance—direct primary care models takes the 40 cents of each dollar that would have otherwise gone into insurance reimbursement processes and puts it into more medical providers, longer office hours, the latest diagnostic equipment, and lower fees. No insurance is required or accepted. No complicated billing forms for the typical day-to-day stuff that comes up for your health or even for managing a chronic condition.The practice offers members same – or next – day appointments seven days a week, plus 24/7 phone access to a physician. Visits are typically scheduled for an unhurried 30 minutes so that health-care providers can spend the necessary time and conduct the necessary tests to accurately diagnose an illness or provide appropriate wellness counseling. Comprehensive physical exams, included in the monthly fee, typically last an hour or more. When I visited Qliance’s clinic, the waiting room was an oxymoron — no one was waiting most of the time. The only person waiting during the 90 minutes I was there was a person waiting while their family member was having an appointment. 

Qliance members choose a personal care team of both a physician and a nurse practitioner who get to know each patient very well, since they see only one-fourth the patients that a typical insurance-based physician does. Members pay only $49 to $89 per month for as much primary and preventive care as they need. On-site digital X-rays, first fill pharmacy and many common lab tests are included in the monthly care fee. MedLion has a roughly similar model charging $49 per month regardless of age and just $10 per visit. It’s so affordable it’s being extended to a farming community with many migrant workers who have difficulty obtaining insurance.

The goal of direct primary care practices is to make the highest quality primary and preventive care affordable and accessible to all, rich or poor, insured or uninsured. Unlike insurance, they do not prescreen members on the basis of health.

Direct Primary Care practices do recommend health insurance to its patients—but not traditional low-deductible insurance. “Insurance should be used for catastrophic illnesses, not routine care,” explains internist Dr. Garrison Bliss, a national pioneer in direct primary-care practices and Qliance’s cofounder. “A high-deductible health-insurance plan combined with Qliance can save 30 percent to 50 percent off the total cost of comprehensive care. It provides better access and service at the primary-care level while maintaining financial protection for serious illnesses.”

At Qliance’s launch event, Washington State Governor Christine Gregoire told an audience of patients and others: “I see someone like Dr. Bliss and I say many of our physicians in this country and in this state went to school because they wanted to practice medicine, not because they wanted to deal with insurance. Not because they wanted to deal with bureaucracy. In fact, they don’t want to deal with any of that; they want to deal with their patients and that’s what they are really good at. And what Qliance has as a vision and a model is to allow doctors to do what they love and what they feel passionate about, to give patients… what they so richly deserve at an affordable cost and with high quality. It is patient safety. It is driving down costs… This is exactly what we and the patients in the state of Washington need.”

Marcus Welby had it right. Primary care physicians are at their best when their primary focus is their patient. Unfortunately, immense amounts of time dealing with insurance burdens have essentially eliminated the Marcus Welby model but modern day Marcus Welbys are fighting back and having great success. It’s exciting to see the spark return to the primary care physicians I’ve met who’ve removed the insurance yoke and are practicing the way they know is best for their patients (and themselves). You might call it “Do it Yourself Health Reform” driven not by politicos but by physicians.

Dave Chase is CEO of Avado.com and previously founded Microsoft’s Health business and was a senior consultant with Accenture’s Healthcare Practice.  He can be found on Twitter @chasedave.

Earlier I have written pieces on the opportunity for the valley for economic development related to what I call "Do it yourself health reform." You can read those articles on health reform if you want more background for the piece below.

The excerpt below is from a TechCrunch (the leading tech site that AOL purchased recently for ~$100MM) article on how small business and startups can help level the playing field while doing their part to drive a market shift that will save them money and lead to healthier employees. It’s part of what I call the Do it Yourself Health Reform movement that I think is at least as important as what is coming out of DC. The full piece is here.

The talent wars that were common back in the late 90′s appear to have returned whether it’s using LOLCats or cheeseburgers to recruit talent. While I love the creativity, when it comes down to making a decision to join a new company, the lumbering tech giants (Google, Microsoft, Amazon, Zynga, Facebook) which startups compete against for talent have one giant ace up their sleeve — great healthcare benefits.

When I left Microsoft 8 years ago, my wife expressed only one concern — losing health benefits. At the time, I told her that it’s just a matter of paying those costs directly. The reality has been that it’s been a significant hassle and cost that we’d rather not deal with.  The excitement of working with startups has outweighed that hassle, but even to this day it remains a burr in the saddle. Periodically, I will get an offer to join some company and her first question is “how are their health benefits?” Startups have repeatedly shown an ability to outmaneuver the behemoths we compete with but this is one area where the behemoths still have an edge.  It’s time to turn the tables with what I call Do-it-Yourself (DIY) Healthcare Reform.

While the behemoths stick to the old health payment model, which is a Gordian Knot designed by Rube Goldberg, there’s a better way. The big companies can stick with a model that has led to health costs increasing 274x in my lifetime (compared to 8x for all other consumer goods and services). What’s better is that startups are beginning to offer key parts of the solution.

Full article here.

The article Top Business, Health, Political Leaders in Sun Valley to Discuss Healthcare's Future discussed the future economic and health benefits of the Wood River Valley taking the lead in what I call Do-it-Yourself Health Reform. One of the frequent criticisms of the new Health law is that it only addressed the access issue, not the massive cost issue crushing personal, business and government budgets.

Turn to page 621 of the Senate version, the section entitled “Transforming the Health Care Delivery System,” and start reading. Does the bill end medicine’s destructive piecemeal payment system? Does it replace paying for quantity with paying for quality? Does it institute nationwide structural changes that curb costs and raise quality? It does not. Instead, what it offers is . . . pilot programs.

This has provided a soft target for critics. “Two thousand seventy-four pages and trillions of dollars later,” Mitch McConnell, the Senate Minority Leader, said recently, “this bill doesn’t even meet the basic goal that the American people had in mind and what they thought this debate was all about: to lower costs.”

The country faced a similar situation over 100 years ago when food took up 40% of a family's budget and it took 50% of our workforce (and we think 18% of our GDP spent on healthcare is bad!). In well written article by Atul Gawande, he asks "The healthcare bill has no master plan for curbing costs. Is that a bad thing?" 

The strategy seems hopelessly inadequate to solve a problem of this magnitude. And yet—here’s the interesting thing—history suggests otherwise.

Gawande explains how the tests catalyzed by the USDA in 1903 to improve farm production had a remarkable effect. Seaman Knapp, the first USDA employee charged with influencing local farming practices, started small making a few simple innovations on a portion (70 acres) of one farm. It proved effective and expanded from there. 

"What a man hears he may doubt, what he sees he may possibly doubt, but we he does for himself he cannot doubt."

By 1930, food accounted for 24% of family spending and 20% of the workforce. Today, food accounts for 8% of household income and 2% of the labor force. While one could argue that the Farm Bills of today have become counterproductive, it is impressive to see that shift in a 100 year time frame.

Gawande emphasizes a point that I believe is the core problem of our health system -- the Fee-for-Service system.

Our fee-for-service system, doling out separate payments for everything and everyone involved in a patient’s care, has all the wrong incentives: it rewards doing more over doing right, it increases paperwork and the duplication of efforts, and it discourages clinicians from working together for the best possible results.

We have a great disease care system. It's the health care system that falls short. 

But, in the end, it contains a test of almost every approach that leading health-care experts have suggested. (The only one missing is malpractice reform. This is where the Republicans could be helpful.) None of this is as satisfying as a master plan. But there can’t be a master plan. That’s a crucial lesson of our agricultural experience. 

The vision laid out in the Top Business, Health, Political Leaders in Sun Valley to Discuss Healthcare's Future piece is just such an example of expanding upon a pilot of a promising approach. Why not Sun Valley? Why not now? 

Read the full "Testing, testing" article. I've been critical of the new health law for not doing enough about costs. Other than leaving out malpractice reform, the approach they took makes more sense than I originally thought. Gawande does a nice job of shedding light as both a great writer and practicing physician.

Follow Dave Chase on Twitter @chasedave

July 6, 2012, 9:15 a.m. MDT

SUN VALLEY, IDAHO (AP)

The attendees of the Health Next Summit in Sun Valley came to advance the best ideas for designing a replacement for what a Sun Valley local dubbed "The Gordian Knot designed by Rube Golberg" when describing the health payment system. While cognizant of state and federal level health policy, the guiding principle of the Health Next Summit was to focus on non-legislative health reform and  focus on legislation when it was blocking innovation. 

Local leaders recognized that they had unique advantages by virtue of being a remote, mountain community. While Sun Valley's remoteness presented some challenges for tourism, it also created opportunities for what they have called "Do it Yourself Health Reform." As a popular resort destination, the area has attracted successful doctors and clinicians drawn to its lifestyle and the opportunity to setup their own practice or be a part of the local health system. It also served as a testbed for the local hospital that was a part of a larger health system as they planned for their future.

The local leaders recognized two other big factors working in their favor to pursue Do it Yourself Health Reform. First, while not everyone is a world class athlete, Blaine County (the county where Sun Valley is located) has the 2nd lowest average Body Mass Index (BMI) of any county in the country. Visitors often comment on the "fountain of youth" with locals such Charlie French, the octogenarian triathlete and Nordic marathon competitor, Carl Manus, a 79-year-old snowboarding phenom was featured in a BlueCross ad and Dr. Del Pletcher who at 66 out-skis top level Nordic skiers 1/3 his age. While they do have many fit people, they also have a broad cross section of people of all ages and a significant immigrant population so the leaders recognized they could not only solve the local challenge but offer lessons to the country as a whole. 

Second, like many communities, local businesses had encouraged people to "shop local" to help stimulate the local economy by recycling money in their valley. While Sun Valley's citizens had received most of their healthcare services locally, it was only when they took a closer look that they realized that they were, in fact, sending a third of their healthcare dollars outside of their community never to return again due to the fact that all the health insurance companies reside outside their area. Even with a small population of 20,000 people, they estimated that was potentially $50,000,000 that could otherwise be re-circulated in their community providing a much-needed boost to the local economy. 

Where did that rough estimate come from? They took the average per capita spend on healthcare and realized that nearly 80% of one's healthcare premium goes for what would be considered predictable, day-to-day healthcare needs with the remaining 20% going for catastrophic coverage. Of that 80% going to day-to-day healthcare (the equivalent of getting your car tuned up which you'd never consider pulling out your insurance card for), they recognized that there was a 40% "tax" going to insurance bureaucracy (at the provider and insurer, not to mention the time individuals spent with billing hassles) and company profits.

The Solution

As is done in much of the world, the Sun Valley health providers now have a transparent price sheet that offers a dramatic savings if one pays cash rather than going through the insurance rigmarole. This saves both the patient and the health system money. St. Luke's realized that their negotiated insurance agreements typically only paid them 60 cents on the dollar and this was after a long payment delay and billing costs. Thus, offering a cash price was a win-win for the health system and their clientele alike. Further, many in Sun Valley realized that coupling a high-deductible catastrophic health insurance plan with a Health Savings Account (HSA) was another way to stretch their healthcare dollars another 20-30% (due to the tax benefit). When those accounts were opened at local banks, that was additional money that could potentially be recycled via small business loans.

The hospital was also a leader in the emerging Direct Primary Care (DPC) that organizations such as the Michael Dell and Jeff Bezos backed Qliance had pioneered. The hospital leaders took note of a little-noticed facet of the new health law that had received bipartisan support. That is, the new health insurance exchanges allowed for DPC practices such as Qliance and the local providers offering a DPC model to be a part of the health exchanges when coupled with a high deductible "wrap around" policy even though the DPC practices themselves weren't an insurance offering. For a monthly fee averaging under $100 (e.g., $69 for a 40 year old), a member receives unlimited primary and urgent care. With organizations such as Qliance, the only additional costs are the fees associated with lab tests (usually $12-20) and X-rays ($17 a body part). This made it very appealing for businesses, non-profits and individuals who decided to join this new membership model.

Local health providers began offering this model after they reviewed that it was financially successful to deliver primary and urgent care in this manner. In addition, they learned Qliance was garnering Google/Apple level customer satisfaction and recommendation ratings by delivering care in this manner. Even more exciting was Qliance had shown that their patients (despite having higher-than-normal utilization) had seen reductions in the 50-70% range for ER, surgical and specialist visits. At least two key items had driven that reduction. First, simply being available 24x7 via phone/email reduced many unnecessary ER visits. In the traditional fee-for-service model where a healthcare provider doesn't get paid for an email/phone consult, naturally they urge people to come to their office where they can bill insurance. In contrast, the direct primary care provider has already received the monthly payment and realizes it saves everyone time and money for the many interactions that don't require an immediate, in-person visit. The second big factor was the old health inspired adage "an ounce of prevention is worth a pound of cure". That is, addressing many conditions early prevents the condition from getting worse (and more expensive). An additional pleasant finding was that Primary Care Physicians who are in increasing short supply and have become unhappy with their lot in the healthcare system, were much happier in the DPC model because they were able to return to practicing medicine the way they were trained.

Only a year into the process of Do it Yourself Health Reform, Sun Valley is energized by how they are coming up with solutions not only for their community but the country as a whole. Since word leaked of their experiment, they have been visited by business and political leaders from around the country providing a stimulus all its own. Since its founding as the first destination ski resort in the U.S., the most prominent leaders in the business, media and political communities have frequented Sun Valley.  Local leaders have been excited to build off that unique asset and facilitate a national discussion. Prominent politicians such as John Kerry and virtually every prominent media, venture capital and technology company come to observe the innovation taking place in Sun Valley when they visit. For example, the business, media and political leaders in town for the annual Allen & Company gathering have had sessions discussing the success they've had. This living laboratory of Do it Yourself Health Reform has provided a financial and moral boost few could have imagined just a year earlier.

********************

This is the headline and story is waiting to be written. Will we seize the opportunity? Even if the potential to recapture $50,000,000 for the local community is only 1/5 of that, that is still a $10,000,000 annual infusion into the local economy. Why not Sun Valley? Why not now? 

I wrote this article as though it was being published in summer of 2012 and the steps had been taken implied in this future AP story. The hope would be to catalyze local leaders to take steps in conjunction with local healthcare providers to realize this vision. This should spur some thought on what could be a major opportunity for the community. I thought this could be a way to open the discussion.

The main point is that Sun Valley (by that, I mean the entire valley) can and should be a living laboratory of a better model of healthcare. It's obvious DC won't fix things anytime soon. Not only could it be the beacon for the country, it could be the Davos/Aspen Institute like meeting space where leading thinkers gather to advance the best new models of care/payment (payment is the big issue, in my opinion, as it dictates how care is delivered unfortunately).

Earlier I wrote about Health Insurance's Bunker/Budget Buster and Do it Yourself Health Reform if you are interested in more background.

Follow Dave Chase on Twitter @chasedave

[This is part of an ongoing series on the dramatic implications of the new Health law on individuals and small businesses.]

In an earlier post entitled Health Insurances Bunker/Budget Buster, I detailed how an obscure health insurance term - "medical loss ratio" - was incorporated into the new Health law. I predicted the dramatic effect it would have on health insurance premiums (some are saying a 50% increase is likely in the Fall unless you work for a large employer). The NY Times had an editorial on the gaming of the definition of "medical" is being investigated by Sen. Rockefeller's committee (i.e., classifying questionable items as "medical expenses".

Few Americans know what a “medical loss ratio” is, but a fierce struggle over how to calculate it under the new health care reform law will determine how much insurers must spend on patient care and how much they can retain for administration and profits. This is but one of many battles that will emerge as federal and state regulators develop regulations to implement reform.

Continue reading the rest here.

In looking at the great disparity in the Medical Loss Ratio between those on large employer plans versus small employers, I come to the conclusion that small businesses (and individuals) are essentially subsidizing the large employer health insurance marketplace as they don't have the same negotiating clout as the large players. This is yet another example of Rube Goldbergian mess that our health payment system is today due mainly to insurance being used for day to day things unlike all other forms of insurance where it is used for rare things (car accidents, house fires, etc.). This is why organizations such as Qliance are growing in places such as Seattle. More to come on those models in future posts.

[This is part of an ongoing series in SVO's Health & Wellness section on the impacts of the new Health law and related issues such as economic development in our valley. The Sustain Blaine study being put into action by the Sun Valley Economic Development Corporation identified Health & Wellness as an area where the Wood River Valley could shine.]

Harvard Medical Community reports on an organization in Seattle (Qliance) that is "reforming" healthcare on its own though it did need dispensation from the state government to ensure it wasn't regulated as health insurance. Qliance's model is more akin to a health club membership where you can use your primary care services as much as you'd like. Rather than a model that tries to keep you away, they encourage you to visit before things get worse (and more expensive).

According to an article in Money Magazine, Blaine County had the 2nd lowest Body Mass Index in the country which is correlated with health. With the fitness-mindedness of our valley, it would seem our valley would be ripe for this model. People here realize that being proactive about your health is the best way to go.

Here's an excerpt from the article. Click below to read the entire article.

Many primary care physicians are now finding themselves in hot water. Declining reimbursement for evaluation and management has undercut the economics of providers who cannot also bill for a complement of procedures. Coordination of care remains difficult with high patient turnover and the absence of standardized personal health records. A lack of time for physicians to stay abreast of new clinical guidelines has contributed to a tendency toward lowering the threshold for specialist referrals.

Read the entire story on the Direct Primary Care model.

Compare the services Qliance offers as part of its direct primary care model paid with a simple monthly payment to the Gordian Knot of going through insurance. And that monthly payment is far less than one would pay for traditional health insurance even when Qliance is coupled with a high deductible major medical insurance program which is strongly advised. They price based on age. Even at the highest price $129/month (for those 65 and older), it is far less cost yet you get more. For younger people, the cost is around $50 per month.

Qliance's services include the following (note: these are pulled from Qliance's site linked to above):

• Appointments: Office visits, telephone consultation and email
• Wellness Care: In addition to primary care, your Qliance clinician also offers lifestyle and wellness care. Your visits may include extended consultations and personalized coaching to create positive lifestyle changes such as weight loss, smoking cessation and stress management.
• Chronic Disease Management
• Specialist Care Coordination
• Urgent Care
• Hospital Care Coordination (they offer two different levels)
• After Hours Coverage
• X-Ray Imaging ($17 per body part)
• Lab Test - Draws/collections are included and then lab costs are passed along at cost and they list the prices so no surprises
• Office Procedures: Qliance offers selected diagnostic and urgent care procedures in our office including but not limited to: blood draws, EKGs, casts, stitches, joint injections, skin biopsies, skin tag and wart removal, wound care, IUD insertion and spirometry and more. There is no additional fee for performing these procedures, however if a procedure requires laboratory testing, durable medical equipment or materials (e.g. crutches or a sling) it is charged at cost. As with all out-of-pocket expenses, their relevance to your care and their cost will be discussed with you beforehand.
• Vaccines: Free or at cost

One might wonder if this is economically possible and how they can offer this for the "average person" as compared to so-called "concierge medicine" which is similar but priced as high as $1000/month (naturally there are additional services above Qliance's). There's a long explanation but given that Michael Dell and Jeff Bezos (Amazon) are investors, you can imagine that they looked at the cost efficiencies that can be driven. Dell and Bezos both radically disrupted traditional models taking a different approach. Qliance is doing just that.

Update: As predicted last Spring, insurance rates have indeed increased dramatically. The NY Times reported on the effect of this in their piece entitled As Healthcare Costs Rise, GOP and Insurers Differ on the Cause. I followed up my piece below with some thoughts on how you could do Do it Yourself Health Reform.

I have yet to talk to a business/organization that has planned for the coming 50% rate increase coming shortly. Fortunately, as outlined in my piece in the Huffington Post, there's a way to avoid that increase but sticking with the status quo will virtually guarantee a 50% increase.

In the piece I wrote for Huffington Post, I touch on how the new health law sets the table for a new, better model for getting most of your healthcare needs addressed. A key part of my background was starting my career at what is now Accenture in their healthcare practice working on the interface between providers and payors. I later founded Microsoft's healthcare business. This gave me a perspective on just how crazy our existing model is. This shock to the system is going to create the conditions for a much needed change.

For an organization such as St. Luke's, this can be a big boon for them...or a threat. Knowing some of the fine folks over there, I am hopeful they take advantage of this terrific opportunity to get ahead of the curve while saving themselves and their patients precious resources. 

Here's an intro to that piece...

With my extensive health care background, many people have asked for my opinion during the health reform debate. My response has been that the only way to really "reform" the system is to blow it up and start over, which isn't politically feasible. After delving deeper into the current legislation, I believe that we are going to see something close to a "blow up" this fall; something that isn't being predicted by the pundits who know little of the inner-workings of health care.

Two portions of the Health legislation have received little attention yet will have a huge effect on bending the cost curve: 1. Medical Loss Ratio (MLR); 2. Direct Primary Care (aka "Medical Homes"). MLR requires that insurance companies spend at least 80 to 85 percent of their collected premiums on medical services, while the Direct Primary Care provision will offer an affordable alternative that by-passes insurance companies altogether. Taken together, these two provisions could have a long term effect that is likely to be devastating to traditional health insurance companies.

Read the rest of the Health Insurance's Bunker Buster on the Huffington Post. Stay tuned as there'll be piece of what I believe to be the solution rolling out this summer.

--

Matt VanderNoot, GM

Papa Hemi's Hideaway
"Ketchum the way it used to be..."

At the Gateway to Ketchum

310 South Main St. (Hwy 75)

Ketchum, Idaho  83340

Papa Hemi’s Hideaway

Live Local Music

Schedule for January 2010

Wednesdays from 6-9pm   ♫♯♪♫   Fridays/Saturdays from 6:30-9:30pm

01/13  Wednesday – Mic Terra

Local guitarman, singer/songwriter Mic Terra plays folk, bluegrass and the in-between. Mic has toured with national bands and played alongside the late great Norton Buffalo.

01/15  Friday – The Mighty Shims

An eclectic mix of blues, folk and jazz with the superlative musicianship of Fletcher Brock (guitar, mandolin, banjo) and Jim Paisley (bass, guitar). Fletcher’s artisanship as a nationally acclaimed luthier is evident in the rich sound of his handcrafted instruments. Vocal harmonies and an entertaining blend of old and new.

01/16  Saturday – FourStroke Bus

Always a sensation here in the Valley, FourStroke Bus performs acoustic sets at Papa’s with a whole new sound that lets the clear vocals from lead singer Lisa Whitworth ring true. Usually performing with guitar, banjo, mandolin and hand drums – the usual is unusual with FourStroke Bus. Expect an upbeat mix of blues, folk, bluegrass and soul.

01/20  Wednesday – The J.Ward Band

Jason Ward (guitar, harmonica, kick drum, high hat) and Chris Ward (dejimbe hand drums) play a great mix of Americana, folk and alternative country. Jason is a founding member of the very popular alternative folk band, RYEBENDER, whose latest CD rose above the Top 40 in its category.

01/22  Friday – Freehand 

Sheryll Mae Grace (guitar),  Aaron Pugh (bass) and friends combine in their new band, Freehand, for natural Idaho acoustic singer/songwriter folk. A unique sound, excellent musicianship and Sheryll’s outstanding vocals promise another evening of fun for all.

01/23  Saturday – Bruce Innes & friends

Bruce Innes on acoustic folk guitar is one of the most accomplished musicians in the Valley. In his hit band of the 1970s and even today, Bruce makes frequent performance tours on the national and international scene. Rich musical tones and a resonant baritone voice are the highlights for an evening of outstanding musicianship. Playing classics, rarities and a medley of his own singer songwriter classics, don’t miss a rare evening with Bruce at Papa Hemi’s Hideaway.

01/27  Wednesday – Latin Jazz Duo

True Latin Jazz musicians through and through, Alejandro Rivas and Maria Laura Bustamante are recently arrived from South America where they share many years experience on the very competitive local club circuit. Classics and originals in their native Spanish and occasional English. Girl from Ipanema and much, much more. Do not miss the best Latin Jazz performance you’ll hear all year!

01/29  Friday – Spare Change

Chip Booth (guitar, banjo, mandolin) & Peter Boice (guitar) are each outstanding musicians in their own right. When they come together for a night of play, the harmonies of voice and musical instrument are truly exceptional. An eclectic Idaho mountain mix of bluegrass, jazz and folk with many harmonies – always a night of great fun and musical adventure.

01/30  Saturday – The Mighty Shims / The Toast Points

Fletcher Brock (mandolin, guitar), Jim Paisley (bass), and Chip Booth (banjo, guitar, mandolin) comprise 3 of the 4 members of the phenomenally popular Ketchum band, THE TOAST POINTS. Performing this evening as THE MIGHTY SHIMS, expect an evening of truly outstanding musicianship and a range of music from bluegrass, folk and Appalachian picking, to jazz & blues. Fletcher Brock is an accomplished luthier, and will be playing his own hand-crafted instruments.

02/03  Wednesday – Michael White

Michael White has a long and accomplished musical career on guitar and piano. Michael plays well to a crowd, with a deep and diverse repertoire of folk music spanning many generations. Michael is also the humble and ever genial organizer of Bellevue’s annual Big Wood Folk Festival (www.bigwoodfolk.com).