Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Prescription Drug Spending Varies by Private, Public Payers

Total prescription drug spending reached $333 million in 2017, but the way that lump sum was divided among Medicare, Medicaid, and employer-sponsored health plans may reveal differences between the populations each payer covers, according to a May analysis from the Kaiser Family Foundation (KFF).

HealthPayer Intelligence

Thursday, May 30, 2019

Executive order may leave out disclosure of negotiated rates

After intense opposition from health care stakeholders, sources say language calling for disclosure of rates negotiated between insurers and health care providers could be dropped from the final version of a Trump administration executive order on health care price transparency that is expected to be announced by mid-June.

Washington Post

Thursday, May 30, 2019

Report from The Leapfrog Group Finds Only 1 in 5 U.S. Hospitals Fully Meet Payor Standards for Maternity Care

The Leapfrog Group, a national watchdog organization of employers and other purchasers focused on health care safety and quality, today released its 2019 Maternity Care Report.

The Leapfrog Group

Wednesday, May 29, 2019

5 names to know at Facebook: the people behind its push into health care

When it comes to building out a health business, Facebook is often seen as having much more modest ambitions than its Big Tech competitors.

Stat News

Wednesday, May 29, 2019

J&J's Greed Helped Spawn Opioid Epidemic Oklahoma’s AG Argues

Johnson & Johnson’s greed for more sales of its addictive opioid painkillers helped create a deadly epidemic in Oklahoma that claimed thousands of lives, and the company should pay billions of dollars as compensation, the state’s top law-enforcement officer told a judge.

Bloomberg

Wednesday, May 29, 2019

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

‘Pharma Bro’ Shkreli Is In Prison, But Daraprim’s Price Is Still High 

It was 2015 when Martin Shkreli, then CEO of Turing Pharmaceuticals and the notorious “pharma bro,” jacked up the cost of the lifesaving drug Daraprim by 5,000 percent. Overnight, its price tag skyrocketed from $13.50 a pill to $750.

Kaiser Health News

Friday, May 4, 2018

Health Insurers Had Their Best Quarter in Years, Despite the Flu

U.S. health insurers just posted their best financial results in years, shrugging off worries that the worst flu season in recent history would hurt profits.

Bloomberg

Thursday, May 3, 2018

CVS ‘Moving Forward’ With Aetna Deal, Profit Tops Estimates

CVS ‘Moving Forward’ With Aetna Deal, Profit Tops Estimates CVS Health Corp. said it’s making “good progress” on getting regulatory approval for its $68 billion deal to buy health insurer Aetna Inc. -- one of two megamergers in the health-care industry that are under antitrust scrutiny.

Bloomberg

Wednesday, May 2, 2018

HHS Secretary Alex Azar to Supreme Court: Time to rule on Medicare case that affects $4 billion

Health and Human Services Secretary Alex Azar asked the U.S. Supreme Court to review an appeals court case won by numerous hospitals over disproportionate share hospital payments.

Healthcare Finance News

Wednesday, May 2, 2018

Bill Gates got President Trump fired up about a universal flu vaccine

Bill Gates was talking to President Trump in the Oval Office last month when the conversation turned to the notion of a universal flu vaccine — probably, as Gates recalled in an interview, “the longest conversation about universal flu vaccine that the president’s ever had.”

Stat News

Monday, April 30, 2018

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Fighting Healthcare fraud and over-prescriptions with predictive analytics

By Claire Thayer, October 31, 2017

Earlier this summer, the U.S. Department of Justice announced the largest ever health care fraud enforcement action, involving over 412 individuals across 41 federal districts, including 115 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes. Of those charged, over 120 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Adoption of prescription drug monitoring programs is one way to hold health care providers accountable for overprescribing practices. Use of sophisticated claims analytic tools can help detect suspicious practice patterns as well. A health plan in the Midwest recently uncovered the case of an overprescribing neurologist using peer-to-peer analysis for comparison of practice patterns.

This recent edition of the MCOL Infographic, co-sponsored by LexisNexis, provides highlights from this case study:

The State of Provider Directory Accuracy

By Claire Thayer, December 13, 2016

Despite a federal mandate for all plans in the health insurance marketplace be required to have current and accurate provider directories, many health plan enrollees are finding that when it comes time to call a provider for their specialty visit or find a new primary care physician willing to take new patients, the information in the directory is often out of date or missing vital information.

We’ve posted a couple of infographics on this topic, one on the Accuracy of Health Provider Directories which outlined data points that CMS requires health plans to monitor and maintain on a monthly basis and the State of Provider Directory Accuracy Across the U.S. which outlined provider penalties that could be incurred for inaccuracies.

Last week, The New York Times published an in-depth article, Insurers’ Flawed Directories Leave Patients Scrambling for In-Network Doctors, highlighting from the consumer perspective just how frustrating the experience can be when you’re the patient shopping for health coverage and trying to find a physician willing to accept new patients.

While health plans participating in the health insurance marketplaces were to be subjected to penalties for directory inaccuracies starting in 2016, research by the New York Times found that while many directories are still incomplete, inaccurate or missing information, so far no plans have been fined or kicked off the enrollment sites for having poor doctor directories, said Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, which would enforce the rules. A Health and Human Services Department survey of Medicare plans for those 65 and older that was released in October found errors in nearly half of the listings in doctor directories .

Last week, the MCOL Infographoid, co-sponsored by LexisNexis Health Care, offered a deeper look at the provider directory requirements on a state by state basis in the State of Provider Directory Accuracy, highlighted below:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Changing the conversation from wellness to total wellbeing

By Claire Thayer, November 10, 2016

This week, Robin Bouvier from Aon’s Health Transformation Team, spoke in a HealthcareWebSummit webinar, co-sponsored by WebMD Health Services, on More than Meets the ROI: The Value of Investing in a Healthy Workforce.   Today’s forward thinking companies are moving towards a culture of health and changing the conversation about employee wellness from a ‘benefit’ to instead looking at health as a business imperative that’s integrated across all aspects of the organization.

Robin shares some perspective on general health of the workforce and somewhat surprisingly, the younger generations are not necessarily healthier:

	Baby Boomers (1946-1964)	Generation X (1965 -1978)	Millennials (1979-1996)
Tobacco Use	18%	21.1%	26.5%
Obesity	33.3%	32.8%	30.9%
Depression	16%	16%	20%
Debt	$29,317	$30,039	$23,332

Robin tells us that wellness is evolving to an all encompassing, total wellbeing approach: “Wellbeing means having the appropriate resources, opportunities and commitment needed to achieve optimal function, health and performance for the individual and the organization.” Total wellbeing interconnects:

• Emotional – attitudes and everyday living

• Physical – energy to complete daily living tasks

• Financial – confidently manage everyday and future finances

• Social – connections to others

Robin cited recent study findings of the impact of total wellbeing:

• 81% less like to seek out new employer in next year

• 41% less work missed because of poor health

• 69% of consumers say wellbeing programs health them get or stay healthy

• 22% more profitable as organizations

• 10% higher customer ratings

• ½ point higher performance rating by supervisor

From the new Aon Hewitt 2016 Financial Mindset Study, Robin identifies employee needs by financial stage as:

• Security: 30%

• Foundation: 25%

• Growth: 36%

• Freedom: 9%

It’s Complicated – Navigating Health Care Integrated Delivery Networks

By Claire Thayer, October 7, 2016

Integrated delivery networks (IDNs) are vast and complex. In the U.S. alone, there are more the 626 IDNs operating at 44,000 sites, employing over 412,000 health care providers.  Some IDNs are groups of hospitals, some are regional, some have facilities scattered throughout the country and even internationally – think Kaiser Permanente and the Mayo Clinic – both long standing traditional IDNs. More and more health systems are taking on risk management for their patient populations and in doing so, are looking for ways to collaborate with health plans and providers and related entities to align efficiencies in overall patient care management.  In the not to distant future, expect to see most provider organizations involved at some level with an IDN. 

Navigating IDNs and understanding the scope of their reach is the focus of a recent MCOL infographoid, co-sponsored by LexisNexis Health Care, highlighted below:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

What Health Plans Should Know About Marketing Costs

By Claire Thayer, September 29, 2016

Getting your message in front of the right audience sounds easy enough, but can be quite complicated for health plans during open enrollment season as well as throughout the year for member outreach.  A recent study of administrative expenses for Blue Cross Blue Shield finds that the 26.5% of total PMPM expenses is attributed directly to sales and marketing activities.  Being judicious and figuring out best practices for member engagement, when to contact members, identifying the healthcare CEO of the household, what language members speak at home, etc. requires marketing tools with intelligence capabilities to optimize campaign initiatives.

Helping health plans to keep their marketing costs down is the focus of a recent MCOL infographoid, co-sponsored by LexisNexis Health Care, highlighted below:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Workplace family monthly health premiums rise to $1,512; deductibles up 12% in 2016

By Claire Thayer, September 15, 2016

In 2016, employer-sponsored health insurance covered half of the non-elderly population.  For the 18th year in a row,  the Kaiser Family Foundation & Health Research & Educational Trust (HRET) published findings from its annual survey of employers reflecting trends of employer sponsored health benefits on premiums, employee cost-sharing, wellness programs and employer opinions in the 2016 Employer Health Benefits Survey.  Here are a few highlights:

• The average premium for single coverage in 2016 is $536 per month, or $6,435 per year.
• The average premium for family coverage is $1,512 per month or $18,142 per year
• The $18,142 average family premium in 2016 is 20% higher than the average family premium in 2011 and 58% higher than the average family premium in 2006
• Among those with a general annual deductible for family coverage, the percentages of covered workers with an average aggregate general annual deductible are 61% for workers in HMOs, 64% for workers in PPOs, and 77% for workers in POS plans
• The share of covered workers in plans with a general annual deductible has increased significantly over time: from 55% in 2006, to 74% in 2011, to 83% in 2016, as have the average deductible amounts for covered workers in plans with deductibles: from $584 in 2006, to $991 in 2011, to $1,478 in 2016
• Eighty-three percent of firms offering health benefits in 2016 offer only one type of health plan. Large firms are more likely to offer more than one plan type than small firms (53% vs. 16%)
• Enrollment remains highest in PPO plans, covering just under half of covered workers, followed by HDHP/SOs, HMO plans, POS plans, and conventional plans.
• Forty-eight percent of covered workers are enrolled in PPOs, followed by HDHP/SOs (29%), HMOs (15%), POS plans (9%), and conventional plans (< 1%)
• Nearly all (more than 99%) covered workers work at a firm that provides prescription drug coverage in their largest health plan.
• Sixty-one percent of covered workers are in a self-funded health plan.
• Twenty-four percent of large firms (200 or more workers) that offer health benefits to their employees offer retiree coverage in 2016, similar to recent years.
• Among large firms that have a health risk assessment, 54% offer an incentive to employees to complete the assessment

Says KFF President and CEO Drew Altman, “We’re seeing premiums rising at historically slow rates, which helps workers and employers alike, but it’s made possible in part by the more rapid rise in the deductibles workers must pay.”

 

More info:

• Summary of findings is here
• Entire report with over 200 exhibits in 14 different sections is here
• News release is here
• Health Affairs article is here

High Drug Prices, Complexity of Drug Development and What the Market Will Bear

By Claire Thayer, August 30, 2016

The escalating cost of prescription drugs is of concern for all of us and impact stakeholders all across the health continuum: patients, payers, providers, as well as policy makers.   A recent Consumer Reports study, Is There a Cure for High Drug Prices?, offers these 5 reasons drug costs are ballooning:

• Reason #1: Drug Companies Can Charge Whatever Price They Want
• Reason #2: Insurance Companies Are Also Charging You More
• Reason #3: Old Drugs Are Reformulated as Costly ‘New’ Drugs
• Reason #4: Generic Drug Shortages Can Trigger Massive Price Increases
• Reason #5: Specialty Drugs Are Costing All of Us

This week, the Journal of the American Medical Association (JAMA) released an in-depth article, The High Cost of Prescription Drugs in the United States, which explores literature from January 2005 to July 2016 for sources of drug prices in the U.S., justification and consequences of high prices and possible solutions.  The authors conclude that “high drug prices are the result of the increasing cost and complexity of drug development but also arise in large part from the approach the United States has taken to the granting of government-protected monopolies to drug manufacturers, combined with restriction of price negotiation at a level not observed in other industrialized nations.”

Among overall study findings:

• In 2013, per capita spending on prescription drugs was $858 compared with an average of $400 for 19 other industrialized nations.
• In the United States, prescription medications now comprise an estimated 17% of overall personal health care services.
• The most important factor that allows manufacturers to set high drug prices is market exclusivity, protected by monopoly rights awarded upon Food and Drug Administration approval and by patents.
• The availability of generic drugs after this exclusivity period is the main means of reducing prices in the United States, but access to them may be delayed by numerous business and legal strategies.
• The primary counterweight against excessive pricing during market exclusivity is the negotiating power of the payer, which is currently constrained by several factors, including the requirement that most government drug payment plans cover nearly all products.
• Another key contributor to drug spending is physician prescribing choices when comparable alternatives are available at different costs.
• Although prices are often justified by the high cost of drug development, there is no evidence of an association between research and development costs and prices; rather, prescription drugs are priced in the United States primarily on the basis of what the market will bear.

Health Benefit Costs for Large Employers – Up 6% again in 2017

By Claire Thayer, August 12, 2016

This week, the National Business Group on Health released their Large Employers’ 2017 Health Plan Design Survey, with the ‘good’ news that the overall health benefit costs were only expected to increase 6%.  Says Brian Marcotte, president and CEO of the National Business Group on Health, “interestingly, current estimates have health insurance premiums for the average public exchange plan increasing by at least 10%, about twice what large employers are projecting for next year. This is a clear indication that the employer-based health care model continues to be the most effective way to provide health insurance coverage to employees and their families.”

Spending on pharmaceuticals and specialty drugs are contributing factors in the overall growth of health care benefit costs.  The survey reports that overall, 80% of employers placed specialty pharmacy as one of the top three highest cost drivers, followed by high cost claimants (73%) and specific diseases and conditions (61%).

The survey offers highlights of what employees will see during their upcoming open enrollment:

• Telehealth services on the rise: Nine in 10 employers (90%) will make telehealth services available to employees in states where it is allowed next year, a sharp increase from 70% this year.
• Consumer-Directed Health Plans (CDHPs) increase slightly: Overall, 84% of employers will offer a CDHP in 2017, up from 83% this year. In addition, more than one-third of employers (35%) will only offer CDHPs to employees in 2017, a slight increase from 33% this year.
• Spousal surcharges leveling off: One in three employers (33%) will have surcharges in place for spouses who can obtain coverage through their own employer, roughly the same as this year. A few employers will exclude spouses when other coverage is available through an employer.
• Expanded options at Centers of Excellence grow. The use of Centers of Excellence will grow from 79% this year to 85% in 2017. The largest increases will be for bariatric surgery (up 15 percentage points), transplants and fertility treatments, both up 8 percentage points.
• Tools to manage care: Eight in 10 respondents (80%) plan to offer nurse coaching for care and condition management while 72% will offer nurse coaching for lifestyle management. Nearly two-thirds (65%) will provide employees with self-service decision-making tools to help them become better health care consumers.

Connecting individuals to complex health care fraud schemes

By Claire Thayer, July 25, 2016

The U.S. Department of Justice has been busy in tracking down and convicting criminals in health care fraud related crimes.  This week, the U.S. Department of Justice announced its largest criminal healthcare fraud case against individuals in $1billion Medicare fraud scheme. This follows U.S. Department of Justice news on June 22, 2016, of an unprecedented nationwide sweep led by the Medicare Fraud Strike Force in 36 federal districts, resulting in criminal and civil charges against 301 individuals, including 61 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $900 million in false billings.  In addition, the HHS Centers for Medicare & Medicaid Services (CMS) is suspending payment to a number of providers using its suspension authority provided in the Affordable Care Act.  This coordinated takedown is the largest in history, both in terms of the number of defendants charged and loss amount. 

An OIG report published earlier this year found that in FY 2015, FBI efforts resulted in over 625 operational disruptions of criminal fraud organizations and the dismantlement of the criminal hierarchy of more than 144 health care fraud enterprises.  These and other findings are the focus of a recent MCOL infographoid, co-sponsored by LexisNexis Health Care, highlighted below:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Cost of a data breach in health care reaches $355

By Claire Thayer, July 19, 2016

The Ponemon Institute released a few new reports this summer on the cost of data breaches as well as ability of companies to adequately mitigate online incidents and cyber attacks. While the reports cross all major industries, noted below are a couple of important highlights pertaining to healthcare.

In terms of analyzing external threats that arise outside the company’s traditional security perimeter, and use of online channels – email, social media, mobile apps, or domains, as primary attack vehicles, a July 2016 Ponemon Institute report finds that only 29 percent of respondents in health and pharma believe they indeed have the necessary tools and resources to mitigate external threats:

In addition to concerns on how best to mitigate external threats, the Ponemon Institute’s  2016 Cost of a Data Breach Study finds that the average global cost of a data breach per lost or stolen record reached $355 for healthcare, compared to $158 for all industries. 

The complete Ponemon Institute 2016 Global Cost of a Data Breach Study includes:

• The average costs and consequences related to experiencing a data breach incident.
• Seven global mega trends in the cost of data breach research.
• The most common factors that influence and can limit the cost of a breach.

Factors attributed to medication non-adherence

By Claire Thayer, July 12, 2016

Medication non-adherence has a huge impact on overall public health. Isolating factors attributed to nonadherence presents opportunities for providers and pharma organizations to not only step up to improve patient health outcomes, but also eliminate wasted medications. An Express Scripts study on this topic found that 69% of medication nonadherence is due to behavioral issues, for a variety of reasons such as forgetfulness or procrastination, 16% of nonadherence was due to cost, and 15% say that medication side effects contributed to non-adherent behaviors.

These and other findings are the focus of a recent MCOL infographoid, co-sponsored by LexisNexis Health Care, highlighted below:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Insurance spending on behavioral health: Up for Mental Health / Down for Substance Use

By Claire Thayer, June 7, 2016

The June 2016 issue of Health Affairs takes a deep dive into behavioral health from several different vantage points, including public and private health spending, veteran’s mental health service use, quality measurement, mental illness and gun violence, drug monitoring, suicide prevention, along with trends in media coverage.

Here are a few highlights of several of the articles in the June 2016 issue:

On the health spending spectrum, a long-term longitudinal Health Affairs study finds a increase in the total mental health treatment expenditures financed by private insurance, Medicare, and Medicaid increased from 44 percent in 1986 to 68 percent in 2014. While the share of spending for substance use disorder treatment financed by private insurance, Medicare, and Medicaid showed almost no increase, was 45 percent in 1986 and 46 percent in 2014.

Another article in the June 2016 issue examines gun violence, gun-related suicide and violent crime in people with serious mental illnesses, and whether legal restrictions on firearm sales to people with a history of mental health adjudication are effective in preventing gun violence.

State prescription drug monitoring programs were reviewed based on findings from a national survey to assess the effects of these programs on the prescribing of opioid analgesics and other pain medications in ambulatory care settings. In this study overview, researchers found that the implementation of a prescription drug monitoring program was associated with more than a 30 percent reduction in the rate of prescribing of Schedule II opioids.

Blue Shield of California Releases Executive Pay Report

By Claire Thayer, May 31, 2016

This week, Blue Shield of California released its first report on executive pay, thanks in part to a state audit that raised questions on the amount of executive pay and large cash reserves, along with mounting public pressure to be more transparent on executive compensation.  It pays to meet incentive plan goals - the CEO’s compensation jumped 40% in less than two years in doing so. 

The report includes components of the executive compensation program –including base salary and incentives tied to short and long term goals. Compensation paid to their top ten executives is listed, details on the CEO's individual pay package, along with comparison of how their exec pay ranks compared to their peers (Centene, Aetna, United, Anthem, Humana and Kaiser).

For further reading:

Blue Shield of California 2015 Executive Compensation Summary [May 2016]

Blue Shield ‘Lifts The Veil’ On Executive Pay [Kaiser Health News, May 26, 2016]

Blue Shield reveals executive compensation [BenefitsPro, May 27, 2016]

How are health plans meeting behavioral health needs of members?

By Claire Thayer, May 23, 2016

There’s been a lot of awareness about mental health lately, especially during the month of May – officially recognized as Mental Health Month, via Mental Health America .  In the spirit of this awareness, AHIP recently released a new 28-page issue brief on behavioral health benefits and mental health coverage from collective case studies of 11 member health plans. This new issue brief, Ensuring Access to Quality Behavioral Health Care: Health Plan Examples, identifies innovative approaches to these key areas:

• Awareness and Education
• Identification and Outreach
• Timely access to care
• Quality measurement
• Evidence-based clinical criteria
• Care Coordination and integration
• Programs targeting opioid use

Health Plans profiled in the report include:

• Anthem
• Beacon Health Options
• Blue Shield of California
• CareFirst
• Cigna
• Health Care Service Corporation
• Health Partners
• Highmark
• Humana
• Kaiser Permanente
• Wellcare

To read this complete Issue Brief: Ensuring Access to Quality Behavioral Health Care: Health Plan Examples

Walgreens raising awareness on mental health with online screening tools and telehealth services

By Claire Thayer, May 10, 2016

Walgreens and Mental Health America have forged an ambitious initiative to screen 3 million people for mental issue, by the end of 2017. Walgreens is well positioned to step up to expand mental health services and treatment options and has announced it will offer access to 1,000 therapists and psychiatrists via MDLive’s subsidiary, Breakthrough.

Walgreens new dedicated mental health “answer center” is designed to help connect people to Mental Health American’s Online Screening Program— free, scientifically-based online screenings for a number of conditions including depression, anxiety, bipolar disorder, PTSD and others.

The National Alliance on Mental Illness reports that getting access to services for treatment of mental health illness continues to be a concern:

• Approximately 60 percent of adults, and almost 50% of youth ages 8 to 15 with a mental illness received no mental health services in the previous year.
• African American and Hispanic Americans used mental health services at about one-half the rate of whites in the past year and Asian Americans at about one-third the rate.
• One-half of all chronic mental illness begins by the age of 14; three-quarters by age 24.
• Despite effective treatment, there are long delays−sometimes decades−between the first appearance of symptoms and when people get help.

Further reading:

• Walgreens To Expand Mental Health Services [Forbes, May 10, 2016]
• Walgreens hopes to screen 3 million on mental health by next year [MedCity News, May 10, 2016]
• Mental Health America, Walgreens Team Up on Mental Health Screenings and Campaign
• National Alliance on Mental Illness: Facts and Numbers

Cyber attacks – a new reality for health care organizations

By Claire Thayer, April 20, 2016

The healthcare industry as a whole is at a critical juncture in its efforts to curb medical identity theft, data breaches and health care fraud. More than any other industry, health care is now leading the way for the highest number of records breached - 84.4 million alone in the first half of 2015. Hospitals, health plans, health systems and provider organizations are all doubling down on efforts to address vulnerabilities related to cyber attacks. And, the sooner the better – as consumers are starting to take notice - about 50% say they wouldn’t hesitate to find another healthcare provider if they were concerned about the security of their medical records.

Cyber threats now have the full attention of the c-suite. A recent HIMSS Cybersecurity Survey finds:

• 87% of healthcare leaders indicated that information security had become a critical business priority
• 66% of healthcare organizations experienced a significant security incident
• 57% of healthcare organizations have allocated a full-time resource to address cybersecurity
• 81% of respondents believe more innovative and advanced tools are needed to combat security threats

These and issues pertaining to identity management in health care are the focus of a recent MCOL infographoid, co-sponsored by LexisNexis Healthcare, highlighted below:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Health Systems Advised to Tread Carefully When Considering Provider-led Health Plans

By Claire Thayer, April 18, 2016

McKinsey & Co released an in-depth paper that explores both growth and evolution of provider-led health plans and offers key questions health systems should think about when evaluating their current plans or considering offering stepping into to provider-led plan market space. Here are some of the highlights gleaned from this paper.

The authors point out that overall, the growth in enrollment of provider led plans has increased 6% since 2010, growing from 12.4 million in enrollment to 15.3 million in 2014. While during this same time period, growth in the number of provider-led health plans was modest, increasing just 3% from 94 plans in 2010 to 106 in 2014. The enrollment growth was most pronounced in the Medicaid, Medicare Advantage and Individual Markets

The authors point to 4 important questions that are critical for health systems to consider when evaluating provider-led health plan (PLHP) offerings:

• How can consumerism benefit a PLHP
• When is growth through a PLHP most likely
• Is an alternative type of administrative infrastructure possible?
• What can be gained through granular analytics?

For further reading:

Article Summary: The market evolution of provider-led health plans [McKinsey & Company]

Full Article: The market evolution of provider-led health plans [McKinsey & Company]

52% of healthcare IT leaders evaluating cloud-based solutions for population health management

By Claire Thayer, April 12, 2016

A recent HIMSS Media survey of healthcare IT leaders identifies five key challenges in using connected health IT applications to support population health management:

• Care Coordination – 23.5%
• Financial investment in IT – 21.4%
• Data Management – 18.4%
• Patient Engagement & Adherence – 14.3%
• Cohort identification and risk stratification – 12.2%

With the growing consumer interest in all things mobile, it’s not a surprise to see that many of these health IT leaders are giving serious considerations to population health platforms that support telehealth systems with back-end integration services.  Notably, 52% are evaluating cloud-based solutions and more than half say they intend to adopt mobile wellness monitoring apps for their population health management needs.