Positive Trends in the Land of Retail and Workplace Clinics

By Clive Riddle, May 29, 2015

Last month, the Robert Wood Johnson Foundation commissioned Manatt Health to issue an excellent 25 page report:  The Value Proposition of Retail Clinics, in which they remind us that “since first emerging on the health care landscape more than 15 years ago, retail clinics are now a common feature, with 10.5 million visits occurring annually at more than 1,800 retail clinics.

The report emphasizes the potential for current and future collaborations between retail clinic organizations and health care systems, noting “to date, more than 100 partnerships between retail clinics and health systems have been formed, linking care between retail sites and primary care medical homes, expanding after-hours care options and enabling health systems to provide patients with alternatives to emergency departments (EDs). In fact, one study estimated that up to 27 percent of ED visits could be handled appropriately at retail clinics and urgent care centers…”

With respect to the growth and scope of the retail clinic market, just this month CVS  Health’s MinuteClinic announced they  “will open more than 100 new clinics this year and anticipates surpassing 1,500 clinics by 2017,” and they have reached  the cumulative “25 Million Patient Visit Milestone.“

With respect to partnerships during the past month, California Healthline discussed: ”Kaiser-Target Partnership Sign of Times” and CVS Health announced clinical affiliations with Ochsner Health System in Louisiana and the University of Mississippi Medical Center, including their Center for Telehealth.

Meanwhile, on the workplace onsite clinic front, Towers Watson this week released their 2015 Employer-Sponsored Health Care Centers Survey report, which polled  137 U.S. employers in which 105 currently offer employer-sponsored health centers, and 15 are planning to offer by 2018, and represent 4.6 million employees.

Here’s some highlights of Towers Watson’s onsite clinic findings:

• 38% of large U.S. employers with onsite health facilities plan to add new centers over the next two years,
• 66% expect to expand or enhance the already broad services they offer by 2018
• Wellness programs are already available at 86% of the centers
• Lifestyle coaching to promote and reinforce behavior changes is currently offered at 63% of the centers
• Half of employer-sponsored health centers now offer some type of pharmacy services, up from 38% in 2012
• 35% offer telemedicine services, with another 12% planning to in the next two years.
• 40% have two to five centers
• 56% have had onsite health centers for over five years
• 55% are open before 8:00 a.m.; 32% are open after 5:00 p.m., and 16% are open on weekends
• 64% outsource managing staffing and services at the health centers
• 23% run the centers themselves
• 18% use local or regional provider groups or health systems
• 75% employers with onsite health centers calculate their ROI, up from 47% in 2012

One free resource for those monitoring activities in this sector, the Workplace & Retail Clinic Bulletin, offering free twice monthly e-newsletters.

Patient Reported Outcomes

By Clive Riddle, May 15, 2015

The National Quality Forum defines Patient-Reported Outcomes (PROs) as "any report of the status of a patient's health condition that comes directly from the patient, without interpretation of the patient's response by a clinician or anyone else." They elaborate that “in other words, PRO tools measure what patients are able to do and how they feel by asking questions. These tools enable assessment of patient–reported health status for physical, mental, and social well–being.”

The concept is obviously not new, but has certainly been overlooked at times. In an era with tremendous advances and emphasis in patient engagement, mobile health technologies, patient-centered care, we need to continue to see application of PROs receive the attention they deserve.

Dr. Bruce Feinberg, vice president and chief medical officer of Cardinal Health Specialty Solutions, tells us "As our healthcare system moves toward a value-based care model, the role of the patient is becoming increasingly important. We need to reframe the way we think about care to include not only the cost and clinical effectiveness of the treatment, but also the burden of disease and therapy on the patient's perceived sense of well-being. Patient-reported outcomes (PRO) are key to this equation, particularly for patients being treated for high-cost, complex diseases such as cancer or rheumatoid arthritis (RA)."

Dr. Feinberg’s organization is presenting a series of new clinical studies demonstrating the potential role of PRO research in improving the quality and reduce the costs of treatment provided to patients with complex diseases, at the International Society of Pharmacoeconomic and Outcomes Research (ISPOR) annual meeting.

Here's an overview of some of the key findings they will be presenting:

• One study used PRO to demonstrate that rheumatologists significantly underestimated the negative impact of RA disease burden and treatment on their patients' sense of well-being. Understanding this disparity in perceptions can help physicians make effective treatment decisions that lessen the burden on patients – and can sometimes also reduce the costs of their care.
• Another study showed that PRO can be critical to identifying and managing medication access and adherence challenges for high-cost specialty drugs.
• Of a total of 239 oncology and rheumatology patients who were contacted at the time of their initial prescription to provide patient reported outcomes, 28% were identified as having problems that either restricted access or adherence to the drug.
• Armed with this information, interventions and support services were provided to address those challenges. With the support of these interventions, a medication possession ration exceeding 95% was achieved – enabling nearly all patients to initiate or continue treatment.
• A third study  proved the feasibility of collecting PRO at the point of care. In the clinical study involving 3,185 RA patients, PRO data was captured during 90% of physician visits. The participating physicians were then able to utilize the data to inform real-time treatment decisions at the point of care.

Annual Global Oncology Medicine Spending Tops $100 Billion

by Clive Riddle, May 7, 2015 

The IMS Institute for Healthcare Informatics has just released a new report:  Developments in Cancer Treatments, Market Dynamics, Patient Access and Value: Global Oncology Trend Report 2015 which tells us “total global spending on oncology medicines – including therapeutic treatments and supportive care – reached the $100 billion threshold in 2014, even as the share of total medicine spending of oncologics increased only modestly.” 

The report found that “growth in global spending on cancer drugs – measured using ex-manufacturer prices and not reflecting off-invoice discounts, rebates or patient access programs – increased at a compound annual growth rate (CAGR) of 6.5 percent on a constant-dollar basis during the past five years. Oncology spending remains concentrated among the U.S. and five largest European countries, which together account for 66 percent of the total market, while the rising prevalence of cancer and greater patient access to treatments in pharmerging nations continues to grow and now accounts for 13 percent of the market” 

Murray Aitken, IMS Health senior vice president and executive director of the IMS Institute for Healthcare Informatics tells us“the increased prevalence of most cancers, earlier treatment initiation, new medicines and improved outcomes are all contributing to the greater demand for oncology therapeutics around the world. Innovative therapeutic classes, combination therapies and the use of biomarkers will change the landscape over the next several years, holding out the promise of substantial improvements in survival with lower toxicity for cancer patients.” 

Findings shared in the report include: 

• Growth in the U.S. has risen more slowly at 5.3 percent CAGR, reaching $42.4 billion in 2014, representing 11.3 percent of total drug spending compared to 10.7 percent in 2010.
• in the EU5 countries oncology now represents 14.7 percent of total drug spending, up from 13.3 percent in 2010.
• Targeted therapies now account for nearly 50 percent of total spending and have been growing at 14.6 percent CAGR since 2009.
• Within the U.S., two-thirds of Americans diagnosed with cancer now live at least five years, compared to just over half in 1990.
• The availability of new oncology medicines varies widely across the major developed countries, with patients in Japan, Spain and South Korea having access in 2014 to fewer than half of the new cancer drugs launched globally in the prior five years.
• Average therapy treatment costs per month have increased 39 percent in the U.S. over the past ten years in inflation-adjusted terms. Over the same period, patient response rates have improved by 42 percent and treatment duration has increased 45 percent, reflecting improved survival rates.
• Within the U.S., patient out-of-pocket costs have risen sharply for intravenous cancer drugs, increasing 71 percent from 2012 to 2013, reflecting changes in plan designs and increased outpatient facility costs. 

An interactive version of the full report is available via iTunes, but requires am iPad for viewing. Pdf versions of exhibits can be downloaded here. 

What are the implications of the upward spiral occurring in the specialty drug cost trend?

By Clive Riddle, May 1, 2015 

What are the implications of the upward spiral occurring in the specialty drug cost trend?" That was the question asked of experts in the current issue in MCOL’s ThoughtLeaders. A running theme in their responses was that this will further drive the value-based payment movement. Our ThoughtLeader Dr.  Peter Kongstvedt also takes us a “wonk on the wild side: predicting policy implications including more legislation. 

Here’s some excerpts from their responses in ThoughtLeaders: 

Vicky Parikh,  MD, MPH, (Executive Director, Reliance Health and Executive Director, Mid-Atlantic Medical Research Centers) frames the discussion, and points to further cost-sharing as the consequence – “Specialty drugs can cost more than $600 per treatment, $4,000 or more a month and can reach expenditures up to $100,000 a year. By 2020 the overall spending for specialty drugs could potentially reach $400 billion, or 9.1% of national health spending. In 2009, .12 cents out of every dollar spent went to specialty drugs. Now, that amount has risen to .32 cents out of every dollar. But what does the increase of prices for specialty drugs have to do with anything, when most individuals have a health plan that pay for medical expenditures? Employer based health plans could cause employees to see a change of benefits, increasing deductibles and overall shifting of the more expensive bills being passed towards the employee.” 

Jeremy Nobel,  MD, MPH, (Northeast Business Group on Health,  Executive Director, NEBGH's Solutions & Innovations Center and Faculty, Center for Primary Care, Harvard Medical School)  sees the trend hastening value-based purchasing – “The upward spiral on Specialty Pharma costs will likely accelerate the pace at which patient-centered care will reshape the healthcare marketplace from ‘volume-based’ to ‘value-based.’ Facilitated by highly personalized care coordination, back-stopped by advanced analytics, and rewarded with a host of outcomes-based payment mechanisms, providers and systems that can adjust to that ‘new normal’ will become dominant players. From a purchaser perspective, the traditional focus on reducing costs of "components of care" and managing unit price through volume discounts for everything from drugs to hospital days, to office visits and diagnostic tests, needs to move rapidly and comprehensively towards a focus on ‘total cost of care’ with a payment model that rewards cost reduction as long as quality benchmarks are maintained. And with the inevitable market entry of new medications like the PCSK9 class of drugs targeting extremely common conditions like hypercholesterolemia, the current Rx cost/value management mechanisms for Specialty Pharma will ‘fall short’ quickly.”  

Cyndy Natyer, President, CyndyNayer.com and Founder/CEO of Center of Health Engagement) also looks to value – “My goal is to shift the conversation to what is the value of the drug, and if it can prevent high cost conditions from becoming higher costs, then a higher priced drug may well be worth the negotiated spend…On the other hand, some of the drugs in the specialty arena are going thru yearly increases of thousands of dollars without new technology or formulations. In this case, the price escalation without better outcomes must be considered when negotiating the price of the drugs. We are even seeing many-hundred-percent increases in some common drugs, not specialty, for common chronic illnesses, again with little or no attribution to new technology in the drugs. In each case, I'd like to think that we will not simply deny a drug to a patient because of the cost, and that we would not waste valuable time demanding that folks fail on the drugs we know will not suit them because they are cheaper.” 

Constance A. Wilkinson (Member of the Firm, Epstein Becker & Green, P.C.) and Alan J. Arville (Member of the Firm, Epstein Becker & Green, P.C.) also go down the value-based path – “Manufacturers (and payors) will continue to pursue a value-based purchasing strategy, such as an outcomes-based approach, to support the value proposition of the drug. Such arrangements build in financial incentives or penalties for manufacturers that are contingent upon negotiated performance standards (typically based on quality or health outcomes). There are particular challenges in implementing this approach for federal health care program beneficiaries due to the potential implications to manufacturer drug price reporting under those programs, and the attendant financial consequences.” 

Peter R. Kongstvedt, MD, FACP (Principal, P.R. Kongstvedt Company, LLC) sees policy implications - “The two most significant long-term implications of rising specialty pharmacy drug costs are to create the pressure for another round of "health reform" and on international trade policy. These are obvious choices, I know, but let's look closer and take a wonk on the wild side ("...and the wonks go doo, da-doo, da-doo, da-doo doodoo, doo, da-doo, da-doo, da-doo doodoo..." *). [* Apologies to the late and sorely missed Lou Reed.] 

Peter explains that “there are really two broad types of specialty pharmacy though: manufactured drugs that are one or perhaps two molecules, regardless of how they are manufactured or delivered; and compounding pharmacy drugs. Compounding accounts for a surprising amount of the specialty pharmacy cost increase, but because it uses drugs manufactured by others, it can be managed with through tough negotiations, the use of a single compounding pharmacy, strict adherence to medical guidelines, preauthorization, a closed formulary, and benefits design. That leaves us with the manufactured molecules that have the long term implications.”

Peter sees the trend accelerating cost-sharing, which in turn will accelerate legislative reform of cost-sharing, and even pricing. “We will bypass all but one of the short term implications related to the existing approaches to managing costs such as preauthorization, drug utilization review, step therapy, formulary control and the like, as well as the counter-measures used by the manufacturers. But one of the most common approaches is increased cost-sharing, and that's the one that could get us to another round of health reform. Increased cost-sharing for specialty pharmacy is not quite the same as upping the PCP office visit copay by $10. It now often includes separate deductibles and coinsurance being applied only to specialty pharmacy coverage, which for a lot of people is both good news and bad news. The good news is that cost-sharing goes away when they hit their annual out-of-pocket maximum, which may occur in the second month of coverage; the bad news is they are slowly going bankrupt because most people don't have $6,600.00 (2015 single) / $13,200.00 (2015 Family) of spare cash every year in their savings or under the couch cushions. This brings us to Health Reform II: The Next Act…..Multiple states are now considering "cap the copay" bills that would require state licensed insurers and HMOs to markedly limit cost-sharing; for example, one Oregon bill under consideration would cap cost-sharing at $100 per month.”

Peter warns that “’Cap the copay’ and similar laws are like mowing the lawn to get rid of dandelions - it only appears to solve a problem that is actually growing. Specialty pharmacy costs, and really all healthcare costs related to pricing, in reality grow faster when richer coverage is required. Eventually those very real and ever-rising costs will force us as a society to once again grapple with national health policy about how we finance health care goods and services. Payers were first in the reform barrel. Pricing is likely to be next, though it may be confined to one sector, and specialty pharmacy or drug manufacturers overall seems to have raised its collective hand to be called on next.”

Vormetric Report: 48% of Healthcare organizations Had Data Breach or Failed Compliance Audit in Past Year

By Clive Riddle, April 16, 2015

Given the Anthem health plan hack in February, and other healthcare organizations that have fallen victim to breaches as of late, surveys offering threat assessments are certainly of interest. Vormetric just released the twenty-page 2015 Vormetric Insider Threat Report, which includes healthcare industry specific data.

How does Vormetric define Insider Threats? "Insider threats are caused by a wide range of offenders who either maliciously or accidentally do things that put an organization and its data at risk. The insider threat landscape is becoming more difficult to deal with as the range of miscreants moves beyond employees and privileged IT staff. It now includes outsiders who have stolen valid user credentials; business partners, suppliers, and contractors with inappropriate access rights; and third-party service providers with excessive admin privileges. Unless properly controlled, all of these groups have the opportunity to reach inside corporate networks and steal unprotected data."

Vormetric's 2015 Insider Threat Report was conducted online by Harris Poll during fall 2014, with 818 global respondents who work full-time as an IT professional with major influence in decision making for their company’s IT. In the U.S., 408 ITDMs were surveyed among companies with at least $200 million in revenue with 102 from the health care industries, 102 from financial industries, 102 from retail industries and 102 from other industries.

Vormetric reminds us that hacker attraction to healthcare is fueled by black market “healthcare records selling for tens to hundreds of dollars, while U.S. credit card records sell for 50 cents or less.” Alan Kessler, Vormetric tells us "healthcare data has become one of the most desirable commodities for sale on black market sites, yet U.S. healthcare organizations are failing to secure that data. An overreliance on compliance requirements and a cursory nod to data protection point to systemic failures that are putting patient data at risk. What's needed is for healthcare organization to realize that compliance is not enough, and to implement the controls and policies required to put the security of their data first."

Among healthcare organization respondents to their survey, 48% encountered a data breach or failed a compliance audit in the last year. 26% of healthcare respondents reported that their organization had previously experienced a data breach. 54% reported compliance requirements as the top reason for protecting sensitive data, and 68% rated compliance as very or extremely effective at stopping insider threats and data breaches.

63 percent of healthcare IT decision makers report that their organizations are planning to increase spending to offset data threats, which was the highest of any segment or region measured in the report.

When asked about the most important reasons for securing sensitive data, the top three responses from the healthcare sector were compliance (55%), implementing best practices (44%) and reputational protection (41%). In comparison to other business sectors the compliance response was 5 percentage points above other industry averages.

Accenture Pegs 2015 Private Exchange Enrollment at 6 Million

By Clive Riddle, April 10, 2015

Accenture has released a new report on private exchange enrollment: Private Health Insurance Exchange Enrollment Doubled from 2014 to 2015, which pegs 2015 total private exhange enrollment at 6 million, up from 3 million in 2014.

Accenture forecasts that enrollment in private health insurance exchanges will grow to 12 million in 2016 and 22 million in 2017. They have gone on record projecting "total enrollment in private exchanges to ultimately surpass state and federally funded exchanges, reaching 40 million by 2018."

Here’s more on Accenture’s findings from their report:

• Accenture concludes that midsize employers, defined as companies with 100 to 2,500 employees, contributed most to the adoption of private health exchanges increase.
• 76 percent of consumers with employer-sponsored coverage see health insurance as a primary factor for continuing to work at their current employer
• Accenture points out that this limits some employers’ ability to drop or defund health coverage.
• Accenture postulates that for such employers, "private exchanges will emerge for some as a compelling model to reduce costs and administrative burden"
• Accenture notes that private exchange enrollment is expected to accelerate in 2017 due to looming penalties for “Cadillac” Plans.
• Accenture  also notes that market funding is growing, citing  Aetna’s bswift acquisition of bswift and Mercer’s equity investment in Benefitfocus
• Accenture further postulates that Accenture expects that "increased compliance requirements .. will drive employers to adopt new models for managing benefits administration."

Healthcare Startups Capitalizing on the Sharing Economy and More

By Clive Riddle, April 1, 2015

These five healthcare lists – courtesy of healthsprocket - should be of great interest today –addressing the sharing economy; King v Burwell; upcoming M&A transactions; headlines you might have missed; and hot innovation initiatives:

Healthcare Startups Capitalizing on the Sharing Economy and More

1. Uberlance - provide on-demand ambulance services with your SUV
2. Airpital - rent out your spare rooms for hospital services
3. PatientGrades - site for doctors to rate their patients
4. TeleCrowd - crowdsourcing telemedicine - vote on patient's diagnosis & treatment
5. AirRx - Start a Mail Order Pharmacy with your unused prescriptions

Five Possible Outcomes for SCOTUS King v Burwell Decision

1. To avoid split tie decision, Scalia and Ginsberg thumb wrestle to settle matter
2. Court disallows federal funding in states using healthcare.gov, with farmer exemption allowing combined corn/healthplan subsidy
3. Court strikes down Obamacare - Congress passes emergency band-aid bill providing monthly lottery tickets and band-aids to uninsured
4. Court rules federal subsidies may continue, but not via healthcare.gov - strict interpretation requires actual physical marketplace with pop-up tents
5. Court keeps Obamacare intact - Congress authorizes funding of time travel - terminator cyborg to go back to 2010 and prevent passage of ACA

Four Upcoming Blockbuster Healthcare M&A Transactions to Watch For

1. UnitedHealthcare acquires states of Florida and Arizona to increase Medicare marketshare
2. J&J acquires actual cloud covering east coast for cloud-based pharma initiatives - relocates cloud to reduce future employee snow days
3. Company formerly known as WellPoint acquires copyright to Star Spangled Banner as part of re-branding company as "National Anthem"
4. HCA acquires Carnival Cruise Lines to create new medical tourism fleet

Important Healthcare Headlines You Might Have Missed

1. German government delays renown U.S. Clinic's expansion to Hamburg and Frankfurt - puts Mayo on hold
2. In nod to digital age, doctor offices now feature e-versions of past magazines in patient lobbies using refurbished Apple Newton tablets
3. Red Cross licenses use of name to Blue Cross Blue Shield plans wishing to re-brand insurance products in Republican states
4. Concerns mount with new obesity management procedure converting unused part of brain to second stomach
5. GAO investigation uncovers missing "M" in Centers for Medicare & Medicaid Services acronym

Hot Healthcare Innovation Initiatives

1. Implantable chip sends you text message letting you know when your knee hurts
2. McDonalds / CMS partnership pairing choice of Value Meal with each Value-Based payment
3. Exercise treadmills installed in fast food line queues
4. StubHub-like app to auction your doctor appointment time
5. Starbucks Pharmacies dispensing your daily prescription with your latte

The lists provided in Healthsprocket’s annual April 1st edition of the SprocketRocket newsletter. If you’d like to check out similar lists from previous April 1st editions, click here

PwC’s Health Research Institute Gives Us Five

By Clive Riddle, March 20, 2015

Many institutions are pausing to write and reflect on the ACA at this five-year anniversary mark, underneath the pall of the SCOTUS’ King vs. Burwell shadow. PwC’s Health Research Institute has just weighed in with a nice 22-page report : Healthcare reform: Five trends to watch as the Affordable Care Act turns five.

The report lays five key trends on us that they contend the ACA has fueled after five years:

1. Risk Shift: Raising the stakes for all healthcare players. The ACA added force to new payment models that reward outcomes and penalize poor performance such as high rates of readmission and hospital-acquired conditions.
   
2. Primary care: Back to basics. Experimentation in new payment models and expansion of insurance coverage are making primary care once again the critical touch point.
   
3. New entrants: Innovators in the New Health Economy. New entrants are rushing into the market to meet the demand for lower-cost, consumer-oriented care options in the post-ACA era. More than 90 new companies have been created since 2010, according to HRI analysis.
   
4. Health insurance: From wholesale to retail. Rapid enrollment in the ACA's public exchanges has demonstrated the potential of retail-style health insurance and spawned renewed interest in private exchanges.
   
5. States: Reform's pivotal stage. States have emerged as key players in the reconfigured healthcare landscape, as the ACA gave states notable discretion in how the law could be implemented.
   

Ceci Connolly, managing director of PwC's Health Research Institute, tells us "the five trends have led to the creation of more than 90 new companies that have entered the sector since 2010. The ACA has opened gates for savvy investors and start-ups to take a piece of the $2.9 trillion industry."

And if that isn’t enough, they give us these five takeaways on what stakeholder should consider going forward:

1. Revisiting strategies to emphasize saving over spending and quality over quantity, to serve more consumers effectively and demonstrate affordability.
   
2. Watching closely as the reimbursement pendulum swings from fee-for-service to accountable care.
   
3. Innovating to meet the demands of the new healthcare consumer.
   
4. Pursuing opportunities to enhance consumer choice and engagement in selecting health benefits.
   
5. Working with states as they continue to shape the future landscape.
   

Prescription Costs Returning to the Wild

By Clive Riddle, March 13, 2015

Numerous studies have been warning that prescription cost increases, domesticated and docile for some time now, have returned to the wild - resurging and rearing their unpleasant head.

During last fall, Evaluate published a new 18-page report , "Budget-busters: The Shift to High-Priced Innovator Drugs in the USA." that addresses the growth of high-end prescription drugs. Evaluate tells us that "the median price of the Top 100 drugs has skyrocketed from $1,260 in 2010 to $9,400 in 2014, representing a seven-fold increase," and that "the average patient population size served by a Top 100 drug in 2014 was 146,000 down from 690,000 in 2010. The number of treatments costing in excess of $100,000 per patient per year rose to seven in 2014 versus four in 2010."

When Segal released their 2015 Segal Health Plan Cost Trend Survey, they stated “Health benefit plan cost trend rates for 2015 are forecast to drop slightly for some coverage, but to increase substantially for prescription drug coverage...…The increase in the cost of prescription drug carve-out coverage for actives and retirees under age 65 is expected to jump to nearly 9 percent. Prescription drug trend for retirees age 65 and older is expected to rise to 7.5 percent, more than twice the rate of retiree medical cost trends. The projected specialty drug/biotech trend rate for 2015 is an exceptionally high 19.4 percent.”

A number of other studies cite similar concerns, and this week Express Scripts weighed in with their annual Drug Trend Report. They state “new hepatitis C therapies with high price tags and the exploitation of loopholes for compounded medications drove a 13.1 percent increase in U.S. drug spending in 2014 – a rate not seen in more than a decade.”

Here’s some key selections from Express Scripts findings:

“Hepatitis C and compounded medications are responsible for more than half of the increase in overall spending. Excluding those two therapy classes, 2014 drug trend (the year-over-year increase in per capita drug spending) was 6.4 percent.”

“Specialty medications – biologic and other high cost treatments for complex conditions, such as multiple sclerosis and cancer – accounted for more than 31 percent of total drug spending in 2014. As Express Scripts forecasted last year, specialty drug trend more than doubled in 2014, to 30.9 percent. Hepatitis C medications accounted for 45 percent of the total increase in specialty spend despite having the second lowest prescription volume among the top 10 specialty conditions. Medicare plans – required to follow Medicare Part D formulary guidelines – were the hardest hit, as their annual specialty drug spend increased 45.9 percent.”

“Spending on traditional classes of medications continues to rise as a result of compounded drugs, which emerged in the top 10 traditional therapy classes for the first time. Despite having the least number of prescriptions among the top 10 classes, compounded medications accounted for 35 percent of the increase in spending, the most of any traditional therapy class of drugs.”

“Drugmaker consolidation and drug shortages also led to increases in traditional drug trend, which rose to 6.4 percent in 2014. Diabetes remains the leading traditional therapy class for a fourth straight year based on total costs; Express Scripts expects double-digit increases in spend in this class over the next three years due to once-weekly oral and injectable drugs in the pipeline.  Cost for medications to treat pain increased 15.7 percent in 2014, due in part to new tamper-resistant formulations for opiates.”

Are the Health Coverage and Tax Credit Details for Filing 1040s Really That Complex?

By Clive Riddle, February 12, 2015

Much attention has been given this tax season to the new intricacies involved with filing health coverage and related tax credit information for individual 1040s. H&R Block and many other tax services have taken the opportunity to nationally advertise their expertise to support tax filers this season.

So the question begs, how complex are they? This month’s issue of Health Insurance Marketplace News tackles that issue in their February Thought Leaders Corner, asking the question: “ Are the tax credit and related health coverage filing details required for individual 1040s really that complex, and do you feel there is adequate IRS guidance?”

Here’s what some Health Insurance Marketplace News panelists had to say:

“If 2014 premiums based on 2012 incomes prove to be different from actual 2014 incomes and the government seeks to claw back what proved to be excessive subsidies and compensate for too-low subsidies, it will prove to be very complex in practice and generate much paperwork and frustration. Also, if people were covered for only part of the year, the filing will be complex. Better if the subsidies were fixed dollar amounts not subject to retroactive adjustment.” Alain C. Enthoven PhD, Marriner S. Eccles Professor of Public and Private Management (Emeritus), Knight Management Center, Stanford University, Stanford CA

“My initial response to the tax filing requirements in a Health Affairs blog was to express a concern that the filing requirements for the individual responsibility penalty and for premium tax credit reconciliation were very demanding and would probably require most tax filers who were affected by either issue to use the help of tax preparers. Since then, the IRS and CMS have taken a number of steps to help taxpayers -- allowing taxpayers in states that did not expand Medicaid with incomes not exceeding 138% of the poverty level to claim an exemption on their taxes, offering calculators at Healthcare.gov that will allow tax filers to determine the premiums of the lowest-cost Bronze plan and second-lowest-cost Silver plan that would have been available to them and offering free tax filing software to most tax filers. It is still not going to be easy, but this should be manageable for most tax filers.”  Timothy S. Jost Esq., Robert L. Willett Family Professorship of Law, Washington and Lee University School of Law, Lexington VA

“Tax filing details are often complex. Adding anything associated with the ACA won’t make it any easier. If filers receive ACA-related IRS guidance primarily through written documents versus from a knowledgeable professional or through another more ‘modern’ approach to communication and education, it may be a real challenge for many to fully understand and timely and properly complete the required information. This could be seen as an outstanding opportunity for the various parties close to the ACA that have observed so much about the importance of consumer-level communication and education to work together to assist the IRS in its endeavor. There are some useful resources available, but accessing and understanding those resources may continue to be a challenge that must be continuously addressed to ensure consumers are knowledgeable about, and compliant with, the law.”   Simeon Schindelman, CEO, Bloom Health, Minneapolis, MN

“Yes, most consumers will find it very confusing and yes, there is sufficient IRS guidance. Consumers will fall into two broad categories; either they received a tax credit for 2014 tax year or did not.

(1) Did not receive tax credit:  Form 1040EZ. Easiest to file with some restrictions (e.g., claim no dependents and do not want to claim any advance payments of the premium tax credit); and (2) Received and will claim advance payments of the premium tax credit:   Form 1040A. Has some restrictions (e.g., do not itemize deductions, claim standard deductions and taxable income or $100K or less);  Form 1040. Filed for taxable income of greater than $100K (e.g., can itemize deductions);      Form 8962 for premium tax credit, irs.gov/pub/irs-pdf/f8962.pdf; the 1095-A is required when filling out Form 8962 to claim premium tax credits. If consumers had private health insurance or had self-insured employer coverage or coverage through a government program (e.g., Medicaid or Medicare) they may receive a 1095-B. If consumers had health insurance through a large employer that had an employer-sponsored plan, they may receive a 1095-C. However, 1095-B and 1095-C are optional for 2014 tax year, which means it's unlikely most folks will receive one. Unfortunately, if consumers didn’t have or maintain coverage, they will have to get an exemption or make a payment with their federal income tax return.”  Peter B. Nichol, Director, IT/Head of IT , Access Health CT , Hartford, CT

Analysis of Managed Care Organization CEO Turnover Rates

By Clive Riddle, February 6, 2015

MCOL has just conducted an analysis of managed care organization CEO turnover during the past ten years, and found the turnover rates to be surprisingly high, given the importance of management stability and continuity for most organizations. One-fourth of managed care organization CEOs turned over during the past year,  one-third turned over during the past two years, one-half turned over during the past three years, two-thirds during the past five years and only one in seven remain from ten years ago.

That doesn’t mean that all turnover is attributed to firings or resignations.  More than half of the organizations analyzed are part of chain or system in which upward mobility within the organization is often the cause.

The analysis is based upon data from MCOL’s HealthQuest Publishers National Managed Care Leadership Directory, which lists health plans, provider networks, administrative organizations, PBMs, and specialty benefit organizations involved with managed care. The 2015 Directory was recently released. HealthQuest Publishershas released the annual directory since 1994. MCOL acquired HealthQuest Publishers in 2000.

Managed Care Organization CEO Turnover Percentage Compared to 2015 Incumbent

While 926 organizations are listed in the 2015 directory, only organizations also listed in applicable prior years were included in the analysis. Organizations are added or dropped in the directory over time based upon mergers & acquisitions, closures, consolidations and expansions.

The turnover rate percentage for each year, compared to the 2015 incumbent, for the MCOs that were also listed in each applicable year are indicated below. The number of applicable MCOs that are still listed in 2015 of course drops over time due to the factors listed above.

Year	CEO Turnover	Applicable MCOs
2014	25%	741
2013	36%	709
2012	52%	704
2011	61%	658
2010	68%	633
2005	86%	416

While the cause of turnover was not measured in the analysis, and upward mobility or other transfers within the same organization is undoubtedly a significant factor, disruption at the CEO level presents significant challenges for managed care organizations during this disruptive era of healthcare reform, regardless of the reasons for the change.

Ranking the Seahawk’s Seattle vs. the Patriot’s Boston in the Health Care Bowl

By Clive Riddle, January 30, 2015

Given that the contest between the Seattle Seahawks  vs. the New England Patriots in Super Bowl XLIX is a product of listing and ranking NFL teams (by wins and losses), perhaps some irrelevant insights into the outcome of that contest can be gleaned by comparing how the two cities rank in various healthcare lists.

Of course the immediate challenge is to assign a city to the Patriots. Foxboro- the site of their stadium? The entire New England region and all metro areas within? We’ll deflate their claim to a multi-state region, and go with just Boston.

Looking to healthsprocket, the site for healthcare lists, we find these eight lists posted during the past year, which include mention of Seattle or Boston.  The result is basically a tie, based on mentions – unless you deflate the Patriot’s claim to Springfield and Worcester, in which case Seattle might prevail in a sqeaker.

There is a list claiming overall healthcare rankings – that puts Boston at #2 with Seattle whiffing:

Ranking Of The Best Healthcare Cities In The U.S. (Source: iVantage Health Analytics)

1. Washington, DC
2. Boston
3. Minneapolis
4. Portland, OR
5. Chicago
6. Charlotte
7. Philadelphia
8. Atlanta
9. New York
10. St. Louis

On the other hand, Boston makes the Most Expense Healthcare Cities list (#9), unlike Seattle:

10 Most Expensive Cities for Healthcare (Source: Castlight Health)

1. Sacramento, CA
2. San Francisco, CA
3. Dallas, TX
4. St. Louis, MO
5. Kansas City, MO
6. Charlotte, NC
7. Denver, CO
8. Miami, FL
9. Boston, MA
10. Portland, OR

Seattle makes this list of lowest cost bronze plans (at #18) in 2014 public exchanges, unlike Boston

2014 Lowest Cost Bronze Plan After Subsidies by Largest City in Each State For A Single 25 Year Old (Source: Kaiser Family Foundation)

1. Los Angeles, CA - $140
2. Denver, CO - $142
3. Hartford, CT - $117
4. Washington, DC - $124
5. Indianapolis, IN - $157
6. Baltimore, MD - $115
7. Portland, ME - $146
8. Billings, MT - $152
9. Omaha, NE - $135
10. Albuquerque, NM - $122
11. New York City, NY - $111
12. Cleveland, OH - $136
13. Portland, OR - $130
14. Providence, RI - $127
15. Sioux Falls, SD - $173
16. 16.Richmond, VA - $127
17. 17.Burlington, VT - $116
18. 18.Seattle, WA - $138

Seattle is also the place to be if you don’t like waiting for your doctor – ranked at #1, with Boston not mentioned

Top 10 Cities With The Shortest Average Wait Times To See The Doctor (Source: Vitals)

1. Seattle, WA- 16 minutes, 15 seconds
2. Milwaukee, WI- 16 minutes, 17 seconds
3. Denver, CO- 16 minutes, 25 seconds
4. Minneapolis, MN- 16 minutes, 42 seconds
5. Portland, OR- 17 minutes, 05 seconds
6. Omaha, NE- 17 minutes, 23 seconds
7. Charlotte, NC- 17 minutes, 26 seconds
8. Austin, TX- 17 minutes, 32 seconds
9. San Diego, CA- 17 minutes, 43 seconds
10. Raleigh, NC- 17 minutes, 48 seconds

Boston Children’s comes in #1 in this list of best Children’s hospitals, while Seattle is ignored:

Deborah Kotz: The Honor Roll of Best Children's Hospitals 2014-15 (Source: The Boston Globe)

1. Boston Children’s Hospital/ Children’s Hospital of Philadelphia (tied)
2. Cincinnati Children’s Hospital Medical Center
3. Texas Children’s Hospital, Houston
4. Children’s Hospital Los Angeles
5. Children’s Hospital Colorado, Aurora
6. Nationwide Children’s Hospital, Columbus, Ohio
7. Ann and Robert H. Lurie Children’s Hospital of Chicago
8. Children’s Hospital of Pittsburgh of UPMC
9. Johns Hopkins Children’s Center, Baltimore

If you use the Patriot’s inflated claim to the larger region, Springfield and and Worcester come in at #1, and #14 respectively  for best heart surgery hospitals, while Seattle has a hospital ranking #13, in the list:

Top 15 hospitals in U.S. for heart surgery (Source: Castlight Health)

1. Baystate Medical Center, Springfield, Mass.
2. Borgess Medical Center, Kalamazoo, Mich.
3. Cleveland Clinic, Cleveland
4. The Heart Hospital Baylor Plano, Plano, Texas
5. Kaiser Permanente Sunnyside Medical Center, Clackamas, Ore.
6. Kaleida Health (Gates Vascular Institute at Buffalo General Medical Center), Buffalo, N.Y.
7. Mother Frances Hospital-Tyler, Tyler, Texas
8. St. Joseph Mercy Hospital, Ypsilanti, Mich.
9. St. Joseph's Hospital Health Center, Syracuse, N.Y.
10. St. Vincent Heart Center of Indiana, Indianapolis
11. Sequoia Hospital, Redwood City, Calif.
12. Spectrum Health - Grand Rapids (Meijer Heart Center), Grand Rapids, Mich.
13. Swedish Medical Center-Cherry Hill Campus, Seattle
14. UMass Memorial Medical Center, Worcester, Mass.
15. Valley Hospital, Ridgewood, N.J.

Using an access benchmark, Boston ranks #5 while Seattle doesn’t make this list:

Top 10 Cities With The Highest Per-Capita Ratio Of Both Hospitals And Primary Care Physicians Per Resident (source: Vitals)

1. Cleveland
2. Minneapolis
3. Milwaukee
4. Kansas City
5. Boston
6. Omaha
7. Denver (tie)
8. Miami (tie)
9. Atlanta
10. Nashville

And finally, perhaps in a bit of a stretch, Seattle placing an Executive in the this Most Influential list, while Boston is ignored:

Modern Healthcare: 10 Most Influential Physician Executives And Leaders (source: Modern Healthcare)

1. Richard Gilfillan- President and CEO, CHE Trinity Health, Livonia, Michigan
2. John Noseworthy- President and CEO, Mayo Clinic, Rochester, Minnesota
3. Gary Kaplan- Chairman and CEO, Virginia Mason Health System, Seattle, Washington
4. Margaret Hamburg- Commissioner, Food and Drug Administration, Washington
5. Ardis Dee Hoven- President, American Medical Association, Chicago, Illinois
6. Patrick Conway- Deputy Administrator for Innovation and Quality, CMO, CMS, Baltimore, Maryland
7. John Kitzhaber- Governor of Oregon
8. Glen Steele Jr.- President and CEO, Geisinger Health System, Danville, Pennsylvania
9. Jonathan Perlin- President, Clinical Services CMO, HCA, Nashville Chairman-elect, American Hospital Association, Nashville, Tennessee
10. Toby Cosgrove- CEO, Cleveland Clinic, Cleveland, Ohio

What exactly is Qliance?

By Clive Riddle, January 16, 2015

Qliance, recently discussed in Time Magazine as they are quick to tell you, just issued a news release  that their New Primary Care Model Delivers 20 Percent Lower Overall Healthcare Costs, Increases Patient Satisfaction and Delivers Better Care.

Qliance conducted a study "of insurance claims data from 2013 and 2014 for approximately 4,000 Qliance patients covered by employer benefit plans, and compared the cost of their care to that of non-Qliance patients who worked for the same employers. The results revealed a savings of $679,000 per 1,000 Qliance patients on total claims –19.6 percent less than the total claims for non-Qliance patients during the same period."

Here’s data from a table they provided:

	Incidents Per 1,000 Qliance patients	Incidents Per 1,000 Non-Qliance patients
ER Visits	81	94
Inpatient (days)	100	250
Specialist Visits	7,497	8,674
Advanced Radiology	310	434
Primary Care Visits	3,109	1,965

Impressive enough data, albeit its hard to know how much is apples to apples in the comparison. But the bigger question from examining this, is what is Qliance, what the heck is a Direct Primary Care model, and how is it different from other, more familiar models?

The first question is how exactly does one pronounce Qliance? The website FAQs didn’t have an answer for that question – like “clients” one would assume.

The next question would be, is Qliance a form of health coverage? The answer would be yes and no. Yes – you can contract to receive their medical services for a fee, but no – they are not an insurance plan.  One might think so when first arriving at their website – the navigation menu  refers to Members, Clients, Locations, etc, so one might assume Qliance is an integrated health plan.

But it is not.  As their FAQs will inform you, they are NOT insurance.  Instead they charge a monthly fee to provide primary care, with no fee for service charges.  Here’s what they say:  “We work directly for our patients to provide direct primary care. Your monthly care fee pays for our primary and preventive care services. Qliance does not bill any insurance carrier for our services, and Qliance monthly care fees are not reimbursable by any health insurance company, and may not be applied to any insurance plan deductible. Your insurance plan may be billed by others for services such as emergency, hospital, specialty care, laboratory tests, diagnostic imaging, prescription drugs or other goods and services that are ordered by your Qliance health care provider but are not performed or provided in our offices.”

So with or without health insurance, you can pay Qliance a monthly fee, and receive all the coordinated direct primary care services you want. But you or your health insurance, and not Qliance, will pay for any healthcare services Qliance does not provide. And depending on the type of managed care plan you have. your health insurance won’t pay for outside services ordered or prescribed by your Qliance doctor.

Sounds like a major stumbling block. Except that Qliance also works with self-insured employers to integrate with their health benefits.  Again, quoting from Qliance FAQs:  “We can work with any type of insurance plan. Most employers that incorporate Qliance into their benefits plans save 10% or more, with some employers saving over 40%”

Reading up on all the bells and whistles of Qliance – they seem to be a hybrid of a patient-centered medical home, concierge care, retail/urgent care clinic, with some purchaser-like capabilities. So the question is, in an age where integrated care holds much potential promise – why not keep moving bit by bit down the spectrum towards the purchaser end of the bar?

Perhaps first Qliance will just need to keep moving – to some additional locations. Right now you’ll just find them in the Seattle – Tacoma metro area of Washington.

Your Healthcare Lexicon for 2015 from A to Z

by Clive Riddle, January 9, 2015

Accountable Care Arrangements in Medicare, Commercial and Medicaid flavors

Big Data in healthcare parsed with Analytics

Collaboration between providers and purchasers

Deductibles loom large with continually increased consumer cost sharing

Engagement by purchasers with consumers and with providers

Federally Facilitated Marketplaces may or may not be able to provide future subsidies (see “K” & “S”)

Generic Drug prices are on the rise

Health Insurance Exchanges (Marketplaces) both public and private

Innovation Officers abound in health systems trying to transform how they do business

June is when we should find out what SCOTUS has to say about the next item (see “K”)

King vs. Burwell looms large on the Supreme Court docket

Long Term Care continues to be largely ignored while boomers age away

mHealth technology advances on all fronts

Narrow Networks are being deployed in Exchanges and elsewhere

Obamacare somehow remains the politically charged umbrella term for all things Affordable Care Act

Population Health Management has been embraced in the mainstream of plans and health systems

Quality Measures are being transformed with advances in analytics and reporting capabilities

Republican control of Congress ensures continued chipping away at the Affordable Care Act

Subsidies for public exchange enrollment are threatened (see “F”, “K” and “R”)

Tax Filings now require healthcare coverage information,

Uninsured are the topic of conversations of health plan marketing departments and political pundits

Value Based Purchasing is being sought by almost every purchaser

Wellness Programs for employers are being significantly scrutinized for effectiveness

X-Prizes in healthcare are on the rise with Innovation initiatives (see “I”)

Young Invincibles reluctant to signup for healthcare coverage (see “U”)

Zebras – may be easier to find in healthcare with advances in Big Data and analytics (see “B”)

What’s In a Name?

By Clive Riddle, December 3, 2014

Wellpoint is now Anthem. The re-titling of the national health benefits company was publicly announced months ago, the new corporate website has been designated as www.antheminc.com, and the change from the New York Stock Exchange ticker from WLP to ANTM became effective today.  

WellPoint Health Networks and Anthem merged in 2004, with WellPoint assuming the corporate name of the merged company. Why the name change back to Anthem ten years later? It’s mostly about branding. Joseph Swedish, Anthem’s President and CEO tells us “the change to Anthem will help us better communicate our values and simplify the way we connect with our associates, consumers, investors, and the communities we call home.” Simply put, the company has lots of products around the nation branded as Anthem. They have none branded as WellPoint.

So why did they take the WellPoint name in the first place? Branding may have been less the issue at the time than negotiations between two large BBCBS for-profit corporations. The corporate headquarters went to Anthem’s Indianapolis, but with the WellPoint name. WellPoint’s Leonard Schaeffer got the title Chairman of the Board; Anthem’s Larry Glasscock took the title President and CEO. A telling sign of the shifts in competing corporate cultures and recognition of the branding issue would have been in 2009 when the flagship from the WellPoint camp, Blue Cross of California, assumed the trade name Anthem Blue Cross.

The era of corporate names that are independent of the subsidiary divisions and products seems to have faded as branding is deemed more essential.

As we dig around through the graveyard of bygone healthcare names, the branding issue is forever complicated by mergers, acquisitions, spinoffs and scandals. 

Humana once was a hospital company that developed a health plan division, back when corporate integration of healthcare was in vogue in the 1980’s, before falling out of favor in the 1990’s and re-discovered this decade. Humana’s hospital division was spun off as Galen Healthcare, which was acquired by Columbia, which merged with HCA to become Columbia/HCA, and finally just HCA (Hospital Corporation of America), partially to simplify branding, and perhaps more to re-brand away from the Columbia identity after a Medicare fraud scandal in 1997.

Tenet was once National Medical Enterprises, becoming Tenet in 1995 partly to re-brand after large acquisitions, but motivated to distance from the NME name after scandals with NME’s Psychiatric hospitals division.

In New York, Group Health Inc. and Health Insurance Plan of New York merged in 2006, under the corporate name EmblemHealth. Eventually, the corporate name became branded as a product name. Such strategies - to deploy the corporate name in branding - have become much more prevalent during this decade.

But then there is Regence, the Pacific Northwest BCBS company who in 2011 announced their new corporate name would be Cambia Health Solutions, while the health plan products are still branded Regence.  So what’s in a name – and in 2024 will Cambia pull a WellPoint and re-title themselves as Regence?

Lung Cancer Misperceptions: The “Any One Any Lung” Survey

By Clive Riddle, November 21, 2014

Misperception surrounding a disease can impact treatment, care, funding, and more. So it would seem is the case with lung cancer, as just highlighted in a new survey “Any One Any Lung” Survey sponsored by Novartis Oncology. The online survey was conducted by Harris Poll involving 10,111 adults from 10 countries including the U.S., 84% responding that they know little or nothing about lung cancer. The stated goal of the campaign surrounding the survey is to “to raise global awareness of lung cancer as a complex disease that can affect anyone, regardless of gender, age or smoking history.”

Stefania Vallone from the organization, Women Against Lung Cancer in Europe, has this to say in conjunction with the survey: “While patient advocates around the world have played an important role in raising lung cancer awareness, misinformation continues to surround this disease, creating barriers to treatment and patient care and often generating negative attitudes towards patients affected by this disease. We are calling on the general public to help correct misperceptions around lung cancer and highlight the disease for what it truly is, a complex and heterogeneous disease with many causes that can affect anyone, regardless of age, gender or smoking history, and that over the past 30 years has doubled in incidence and mortality rates, especially among women."

Here’s results from the survey that Novartis shared to make their case regarding misperceptions:

• 59% didn't realize that lung cancer causes the most cancer deaths worldwide
• 55% of adults feel that people with lung cancer are mostly or fully responsible for causing their cancer, compared to the levels perceiving the same about people diagnosed with prostate (12%), colon (14%) or breast (11%) cancer.
• 17% believe that all people who are diagnosed with lung cancer are current or former smokers
• 75% immediately think smoking is the cause when they hear someone has lung cancer (approximately 10 – 15% with the disease have never smoked)
• 40% say there is little support or compassion for people with lung cancer in their country
• Only 23% recognize changes in genetic makeup as a cause of lung cancer
• 6% believe no one under the age of 40 can get lung cancer
• 19%) recognize that therapies targeted to a specific change in genetic makeup can be used to treat lung cancer, significantly less than mention chemotherapy delivered directly to into the blood, (68%), radiation (66%), surgery (61%) and therapies that help the body's immune system fight cancer (52%)

Healthcare Innovation Models and Accelerators

By Clive Riddle, November 7, 2014

Intermountain Healthcare and Healthbox just announced an interesting healthcare innovation collaboration, with their Innovation at Intermountain Healthcare Initiative. Intermountain is the Utah-based health system non-profit juggernaut with 22 hospitals, 185 clinics, 1,100 employed physicians, and the SelectHealth health plan.

A physical structure in Salt Lake City is being constructed next to Intermountain’s flagship medical center to house the initiative, which includes three components:

1. The Intermountain Foundry which they state “provides a structured framework for help high-potential employee ideas and near-market concepts become commercial businesses.”
2. Strategic Investments that “will source companies from the broader healthcare ecosystem and develop partnerships that include investment and potential customer relationships.”
3. The Healthbox Salt Lake City Accelerator, which launched in September in partnership with Health Equity, Zion’s Bank and BD.

Healthbox sees themselves as a “preeminent source of healthcare innovation and drives actionable collaboration between inventors, entrepreneurs and the healthcare industry.” They have operations in five key markets across the U.S., in addition to London and Tel Aviv, and a portfolio of more than 80 active companies and strategic partnerships with more than 30 healthcare organizations.

Speaking of Accelerators, the just released November issue of Healthcare Innovation News addresses the question “how can healthcare accelerators ensure success in their quest to nurture entrepreneurs and support their startup ventures?” in their Thought Leaders’ Corner. Below are three selected responses to this question from their Thought Leader panel.

Tom Olenzak, Director, Innovation at Independence Blue Cross in Philadelphia says “we believe that the key issue facing healthcare innovators is access to customers. The investment of time, expertise and resources by potential customers is critical to help startups turn their innovative ideas into sustainable businesses and products. That’s why we participate in healthcare accelerator programs, such as DreamIt Health Philadelphia. DreamIt Health puts a focus not only on providing funding, but also on the mentorship and access needed to nurture the startups.  I’ve seen firsthand how access to a customer’s point of view, along with business knowledge and data, can have a direct impact on the success of startups. Last year we provided anonymous claims data to the startup Grand Round Table and these data helped the company to solidify its value proposition, helping doctors find appropriate diagnoses faster and reducing the number of unnecessary tests and treatments. The healthcare industry, as we know it, is experiencing dramatic change, and the future of the industry relies on innovative thinking to overcome our biggest challenges. Healthcare accelerators that establish the perfect blend of entrepreneurial coaching and corporate support are the ones that will be successful in developing ventures that push the envelope, and deliver solutions that provide high-quality, affordable care that patients deserve. The future of our industry depends upon innovation, but the opportunities are endless when you embrace partnership and have the right mix of bright minds. Most accelerators help companies grow, but those that provide access to customers and other decision makers breed startups that develop sustainable and scalable solutions to the most pressing challenges.”

Scott Shreeve, CEO at Crossover Health in California says he believes “the challenge for health accelerators is to nurture disruptive ideas and companies yet remain connected to the needs of healthcare providers and payers. Accelerators are good at incubating consumer-focused, digital health innovations. Exciting for sure, but we don’t always see how these isolated innovations bridge the ongoing divide between consumers and providers, and the realities of our current third-party payer system. This is critical in our view because transforming the costs and quality of care won’t be consumer, provider or payer led, but a powerful mix of all three. Crossover Health works with leading employers to deliver primary care services directly to employees via worksite, near-site and virtual care models. We focus on delivering an exceptional patient experience, which not only develops deep patient/provider relationships but also inspires people to take ownership of their health. Innovative provider-led, care delivery and new direct payment models support our experience-centered approach. And, critical to its success are our discovery and adoption of digital health technologies that create new channels of communication, enable population health analytics and facilitate chronic health management in new and different ways. Accelerators can help ensure the success of their startups by making a strong effort to collaborate with equally disruptive providers, who are working with payers that are willing to think differently about health. It’s the responsibility of the accelerator to match different key players together to yield the greatest opportunities and results. By creating a mutual selection process, accelerators can show the power and values of true technology and market disruption.”    

Jason Wainstein, Principal at Deloitte Consulting in Philadelphia shares that “ensuring success is a lofty quest given the nature of accelerators. Not all ideas will pan out. So it’s not about batting 1000; its about providing the best environment to foster the maturation of concept into a viable business. Four dimensions that are critical for accelerator success are: Maintain the right temperature. Many start-ups are focused on building their product/service offering and can benefit from enhanced structure and commercialization cadence, as well as lessons learned from prior startups. Providing a playbook allows the thought leaders to stay focused on building the business. Perfect the role of super connector. One of the greatest values of an accelerator is connecting startups with industry leaders, potential investors and target distribution channels. The top accelerators work relentlessly at building their networks and actively connecting their portfolio companies to these relationships. Be a talent agent. With top talent in high demand, having a network of highly skilled resources that can be brought to bear on short notice can make the difference between success and failure given how aggressively startups must move. Know the white space. There is no shortage of ventures that pop up to capitalize on the hype of the moment, for example, analytics, patient engagement, chronic disease and remote monitoring—like moths to a light. Knowing the white space within these areas and guiding startups to differentiated positions are critical. Otherwise, young companies risk becoming noise in an overcrowded system. Accelerators must treat each startup as a customer, focus on the four dimensions above and be selective in which ideas are brought into the fold based on cultural and content fit.”

Derek Newell, CEO of Jiff in Palo Alto says that “accelerators, by definition, exist to help develop very early stage companies. At this stage, entrepreneurs must transition their companies from a concept phase to a delivery phase. In order to do this effectively, they need to clearly define their value proposition, product and business model. There are two key ways accelerators can support entrepreneurs in facilitating this process.

First, accelerators should connect entrepreneurs to potential customers. Customers validate the product and let companies know they have a commercially viable concept. Talking to customers is the most important thing a startup can do to refine its value proposition. In addition, customers provide critical feedback on product. For the first time, the venture will understand the problem and their target customer’s’ needs at the level of detail necessary to create a meaningful solution for it. Finally, accelerators can help startups figure out their business models early. Many entrepreneurs coming into the healthcare space lack a deep understanding of the complexities and nuances of the industry. Unless the venture is developing a new technology, there is probably a good reason that the solution doesn’t already exist. Within an accelerator, industry experts can help the entrepreneur identify and understand the stakeholders, existing systems and barriers to entry. The forces inhibiting the adoption of the company’s solution could include technology, regulation, operations and/or sunk costs, just to name a few.

By introducing entrepreneurs to potential customers and helping them better understand the healthcare industry, accelerators can help startups navigate this space and support them as they refine their value proposition, business model and product.”

Top Ten Medical Innovations for 2015

By Clive Riddle, October 31st, 2014

The Cleveland Clinic annually announces their take on the Top Ten Medical Innovations that are likely to have major impact on improving patient care in the coming year. They have just released their ninth annual version of this list, selected by a panel of 110 Cleveland Clinic physicians and scientists. With no further adieu, here – verbatim – is their narrative on their compilation of the Top 10 Medical Innovations for 2015:

1. Mobile Stroke Unit
   Time lost is brain lost. High-tech ambulances bring the emergency department straight to the patient with stroke symptoms. Using telemedicine, in-hospital stroke neurologists interpret symptoms via broadband video link, while an onboard paramedic, critical care nurse and CT technologist perform neurological evaluation and administer t-PA after stroke detection, providing faster, effective treatment for the affected patient.
2. Dengue Fever Vaccine
   One mosquito bite is all it takes. More than 50 to 100 million people in more than 100 countries contract the dengue virus each year. The world's first vaccine has been developed and tested, and is expected to be submitted to regulatory groups in 2015, with commercialization expected later that year.
3. Cost-effective, Fast, Painless Blood-Testing
   Have the days of needles and vials come to an end? The new art of blood collection uses a drop of blood drawn from the fingertip in a virtually painless procedure. Test results are available within hours of the original draw and are estimated to cost as little as 10% of the traditional Medicare reimbursement.
4. PCSK9 Inhibitors for Cholesterol Reduction
   Effective statin medications have been used to reduce cholesterol in heart disease patients for over two decades, but some people are intolerant and cannot benefit from them. Several PCSK9 inhibitors, or injectable cholesterol lowering drugs, are in development for those who don't benefit from statins. The FDA is expected to approve the first PCSK9 in 2015 for its ability to significantly lower LDL cholesterol to levels never seen before.
5. Antibody-Drug Conjugates
   Chemotherapy, the only form of treatment available for treating some cancers, destroys cancer cells and harms healthy cells at the same time. A promising new approach for advanced cancer selectively delivers cytotoxic agents to tumor cells while avoiding normal, healthy tissue.
6. Checkpoint Inhibitors
   Cancer kills approximately 8 million people annually and is difficult to treat, let alone cure. Immune checkpoint inhibitors have allowed physicians to make significantly more progress against advanced cancer than they've achieved in decades. Combined with traditional chemotherapy and radiation treatment, the novel drugs boost the immune system and offer significant, long-term cancer remissions for patients with metastatic melanoma, and there is increasing evidence that they can work on other types of malignancies.
7. Leadless Cardiac Pacemaker
   Since 1958, the technology involved in cardiac pacemakers hasn't changed much. A silver-dollar-sized pulse generator and a thin wire, or lead, inserted through the vein kept the heart beating at a steady pace. Leads, though, can break and crack, and become infection sites in 2 percent of cases. Vitamin-sized wireless cardiac pacemakers can be implanted directly in the heart without surgery and eliminate malfunction complications and restriction on daily physical activities.
8. New Drugs for Idiopathic Pulmonary Fibrosis
   Nearly 80,000 American adults with idiopathic pulmonary fibrosis may breathe easier in 2015 with the recent FDA-approval of two new experimental drugs. Pirfenidone and nintedanib slow the disease progress of the lethal lung disease, which causes scarring of the air sacs. Prior to these developments, there was no known treatment for IPF, in which life expectancy after diagnosis is just three to five years.
9. Single-Dose Intra-Operative Radiation Therapy for Breast Cancer
   Finding and treating breast cancer in its earliest stages can oftentimes lead to a cure. For most women with early-stage breast cancer, a lumpectomy is performed, followed by weeks of radiation therapy to reduce the likelihood of recurrence. Intra-operative radiation therapy, or IORT, focuses the radiation on the tumor during surgery as a single-dose, and has proven effective as whole breast radiation.
10. New Drug for Heart Failure
    Angiotensin-receptor neprilysin inhibitor, or ARNI, has been granted "fast-track status" by the FDA because of its impressive survival advantage over the ACE inhibitor enalapril, the current "gold standard" for treating patients with heart failure. The unique drug compound represents a paradigm shift in heart failure therapy.

Wondering what Cleveland Clinic proclaimed a year ago would be the top innovations for this year? Here was their top ten list from last year:

1. Retinal Prosthesis System – Early Stage Bionic Eye
2. Genome-Guided Solid Tumor Diagnostics
3. Responsive Neurostimulator For Intractable Epilepsy
4. Direct-Acting Antiviral Oral Hepatitis C Drugs
5. Perioperative Decision Support System
6. Fecal Microbiota Transplantation
7. Relaxin For Acute Heart Failure
8. Computer-Assisted Personalized Sedation System
9. TMAO: A Novel Biomarker For Heart Attack, Stroke Risk
10. B-Cell Receptor Pathway To Treat Blood Cancers

Surveying Physicians on Their Views of the ACA

By Clive Riddle, October 17, 2014

The Medicus Firm, a national healthcare recruiting firm has just released results regarding health reform, from their 11th annual Physician Practice Preference Survey. This year’s survey shows an uptick grades doctors give the Affordable Care Act, but a still overall negative review. 2,272 physicians and advanced practice providers from 19 specialties and all 50 states participated in this year’s survey.

When asked to give the ACA an overall grade, 8.6% awarded an “A”, up from 6.3% last year. Meanwhile, 22.35% graded the ACA an “F” this year, down from 30.2% a year ago.

The survey went on to ask doctors to rate the ACA on specific objectives, such as improving efficiency of healthcare, improving access to healthcare, improving quality of healthcare, and decreasing healthcare costs. Medicus reports that “the best and most improved grades were awarded for ‘improving access to healthcare’, with a resounding 23.4 percent giving the ACA an ‘A’ in this objective, up from 11.8 percent last year. Additionally, 27.11 percent of physicians gave the ACA a ‘B’ for improving healthcare access. Only 13.68 percent of respondents failed the ACA in this category, down from 23.6 percent who gave it an ‘F’ last year for this objective. The objective receiving the lowest grades was ‘improving efficiency of healthcare.’ However, even this category showed some improvement over last year. Only about 7 percent of physicians gave the ACA an ‘A’ for improving efficiency, which is up slightly from 5.6 percent last year. Furthermore, 29.73 percent of physicians gave the ACA an ‘F’ for improving efficiency, which is down from 35.4 percent who gave it a failing grade in this category last year.”

It should come as no surprise that from the onset, physicians would view the ACA negatively. Perhaps it should also not be surprising that some of them would view things more positively once the core of the Act was finally implemented. Jim Stone, President of The Medicus Firm, tells us "Physicians seem to have become slightly more positive about the ACA compared to last year's survey. As of last year's survey, the ACA had not yet been fully implemented, although many aspects of the legislation were already in motion. This year's survey was conducted after the ACA was in full effect for several months, and four years after its passage into law. Unfortunately, the grades on the whole are not very positive, so it's good that there is some improvement in physicians' perceptions of the effectiveness of the ACA."

The Medicus Firm isn’t the only organization surveying physicians on their views of the Affordable Care Act. Physicians Practice Magazine conducts the annual Great American Physician Survey, which this year had 1,311 respondents. Their results, announced in August, included this reform question:
“Which statement best describes your personal feelings about the Affordable Care Act, in terms of its effect on patient access to care: [A] I think it’s been great for Americans (18.9%); [B] I think it’s mostly good, but not all good; and [C] I think it has done a disservice to Americans (39.2%).”

Finally, The Physicians Foundation commissioned Merritt Hawkins, a physician search and consulting firm, to conduct a survey of 20,000 physicians, with the resulting report 2014 Survey of America’s Physicians: Practice Patterns and Perspectives released last month. The survey included a question similar to The Medicus Fund’s grading of the ACA, with Merritt Hawkins finding that “when asked about what grade physicians would give the Affordable Care Act (ACA), 46 percent give a D or F grade. Younger (ages 45 or lower), employed physicians were more inclined to give the ACA favorable marks than older (46 or higher), private practice owners. In fact, 63 percent of younger physicians (ages 45 or lower), would give the ACA a grade of C or above.”

Study on Health Plan Shopping – Reluctants, Premiums and Defaulters

By Clive Riddle, October 10, 2014

Vitals – who provide a consumer health information platform including doctor ratings and reviews, has released a study on health plan shoppers in open enrollment season, and lumping many of the shoppers into three categories: (1) The Reluctant; (2) The Premium; and (3) The Defaulter. Vitals study was based on their August online survey of 1,000 adults.

The big takeaways from their survey?

• 80 percent of respondents said they were not planning to switch their insurance this year.
• More than 1 in 5 are dissatisfied with their plan.
• Nearly one-third said they were unhappy with the value for cost of their plan.
• 27 percent were unhappy with customer support services
• 9 percent were unhappy with the lack of quality network doctors and hospitals

So what the heck are Vitals’ trio of Reluctants, Premiums and Defaulters?

Vitals classifies Reluctants as age 30-44 with no dependents and household income under $25k, who are satisfied with their plan provider network but not the plan value. Vitals says “the Reluctant doesn’t want to buy insurance and isn’t satisfied with their plan – if they even have one. They’re more likely to have an HMO to keep costs down, but still say they’re not getting a good value for cost. Over 1 in 4 will switch their health plan during open enrollment this year. Their main gripe: Cost. They index higher for cost increases over the past year and report being surprised more by health care costs this year, compared to last year.”

Vitals classifies Premiums as age 45-60 with dependents and household income over $100k, who also are happiest with the network and unhappiest with plan value. Vitals tells us “the Premium is most likely to have Cadillac-like coverage for their health care. They index higher for employer-provided health care and PPO-type plans, which offer the most flexibility. Premium shoppers are most likely to say they’re happy with their health insurance – only 5 percent will switch during open enrollment! And they uniformly agree they have adequate access to medical care.”

Finally, Vitals classifies Defaulters as any age adult (but often age 60+) with no dependents and household income of $50 - $99k. They define the Defaulter as someone “on cruise control and typically doesn’t review or change their plan from year to year.”