Scorecard on Value Based Payments

By Clive Riddle, October 3, 2014

Catalyst for Payment Reform has just released their second annual National Scorecard and California Scorecard on value based payments and payment reform made to providers by purchasers, funded by The Commonwealth Fund and the California HealthCare Foundation.

The universe they utilized to track and measure provider payments was based on the National Business Coalition on Health’s eValue8 health plan survey platform, in partnership with NBCH and these business coalitions: the Colorado Business Group on Health, HealthCare 21, the Memphis Business Group on Health, the Mid-Atlantic Business Group on Health, the Northeast Business Group on Health, the Pacific Business Group on Health, and the Washington Health Alliance.

What meets their definition of value oriented payments? They say they are in-network payments that are “either tied to performance or designed to cut waste” and that 40% of commercial payments meet this definition. What makes up the other 60%? They say payment types without quality incentives that include “traditional feefor-service (FFS), bundled, capitated and partially capitated payments.”

What comprises the 40% that is value oriented? Quality incentive driven Bundled Payments (0.1%) + Non FFS Shared Savings (0.2%) + Non FFA Non-Visit Payments (0.6%) + Shared Risk (1.0%) + Partial or Condition Specific Capitation (1.6%) + FFS and Shared Savings (2.0%) + FFS Based Pay and P4P (12.8%) + Full Capitation (15.0%) + All Other (6.7%) = 40.0%.

Here’s more of the numbers shared in this year’s scorecard:

• 53% of value-oriented payments put providers at some financial risk if they fail to improve care or spend over budget
• 38% of payments to hospitals are value-oriented,
• 10% of payments to specialists and 24% of payments to primary care physicians are value oriented
• Of these value-oriented payments to physicians, 71% of the total goes to specialists, and 29% to PCPs
• 15% of participating health plans’ patient members are formally “attributed” to a provider participating in a payment reform contract

Humana Study on Workplace Wellness: It’s not just ROI

By Clive Riddle, September 19, 2014 

Humana has just published a 22 page report Measuring wellness: From data to insights which based on their study conducted by the Economist Intelligence Unit, examining “why companies implement workplace wellness, how data influences these programs and identifies obstacles that inhibit program participation.” The study surveyed 225 U.S.-based executives and 630 full-time employees from organizations with workplace wellness programs. 

Beth Bierbower, President of Humana’s Employer Group Segment, tells us “It’s interesting to validate that employers now view ROI as an important, but not exclusive or even primary measure of a wellness program’s success. Employers are now seeing that employee health is important beyond health care costs, it has profound impacts on productivity, retention, workplace engagement and morale.” The report states that instead of asking about ROI, “perhaps the question should be, ‘do we improve health at a reasonable price’ as opposed to ‘do we save money by doing so.’” 

Here are some key findings highlighted from the study:

• Nearly 70 percent of executives consider their organization’s wellness program to be cost effective, even though not all of the outcomes are measurable.
• While 86 percent of executives say improving employee health as an indirect driver of productivity, morale and engagement is their top reason for implementing a wellness program, cost factors are still important, including reducing employee health care costs (66 percent) and controlling medical claims (48 percent).
• About 30 percent of employees rate subsidized gym memberships, onsite health and wellness facilities, and budgeted wellness activity time during business hours, as the three most important services that would motivate participation.          
• 64 percent of employees have used fitness devices to monitor health and capture data, but only 19 percent use them regularly.         
• Two-thirds of executives feel data collection and interpretation is the biggest challenge confronting effective workplace wellness.         
• 53% of survey respondents say their organization collects health-related employee data as part of its wellness program
• The biggest disconnects between executives and employees regarding their perceptions of obstacles to employee participation in wellness programs, were in regards to the statements: “Employees don’t perceive health and wellness as a high priority” (30% of executives agreed vs. 2% of employees); “Employees are concerned that personal information will not remain confidential (43% of executives agreed vs. 27% of employees); and “Employees distrust employer motives” (24% of executives agreed vs. 11% of employees.)     

Clinicians Embracing mHealth – but not so much if patients are involved

By Clive Riddle, September 12, 2014 

Although lagging behind many other service sectors, healthcare clinicians do continue to their march towards the inevitable professional embrace of mobile apps, social media and other web applications – typically as long as that embrace falls short of interacting with their patients. 

Wolters Kluwer Health just released survey results on nurse practitioner use of mobile health, social media and the web. The survey was conducted on their behalf by Lippincott Solutions. 

The survey found that 65% of nurses currently use a mobile device at work for professional purposes at least 30 minutes per day, and 95% of healthcare organizations allow them to consult websites and other online resources for clinical information at work. 

The survey findings also indicated:

• 83% of nurses perceive that their organization's policy allows patient care staff access to web sites, including social media, to access general health information regarding patient conditions
• 48% of respondents that access health information say their organization encourages nurses to access online resources; while 41% allow for occasional use; and 5% only as a last resort
• 89% of healthcare organizations allow nurses to use online search engines at work
• 60% of respondents say they use social media to follow healthcare issues at work
• 86% say they follow healthcare issues on social media outside of work
• 20% of nurses use mobile health apps for two hours or more per day
• Among those who use mobile devices at work, Nurse Managers, at 77%, are more likely to use them than Staff Nurses, at 58% 

But their report notes that “73% of healthcare respondents say that organizational policies strictly prohibit direct patient care staff to have social interaction with patients on social media and social sites, compared to 51% say that organizational policies prohibit direct patient care staff to have access to their organizations’ own social media pages.” 

A Walters Kluwer survey of physicians last year found that 21% of doctors didn’t use smartphones in their practice, 46% used them less than 25% of the day, and 33% used them more than 25% of the day. Regarding use of tablets, 39% of doctors didn’t use tablets in their practice, 37% used them less than 25% of the day, and 24% used them more than 25% of the day. Of those who did use mobile devices at work,  24% use mhealth apps; while 33% used their smartphones to communicate with patients, and  17% used their tablets for patient communication. 

While many integrated systems like Kaiser have structured electronic interaction with patients into their system, basic impediments for many continue to be a lack of reimbursement, as well as legal concerns about doing so. 

Yet it is exactly that interaction that their customers are asking for.  For example, Harris Poll results just released for a survey commissioned by Wellocracy found that 66% of those who have used a wearable mhealth tracker or app in the past 12 months ndicated that they would be interested in receiving personalized feedback on their health data from a trusted health expert, such as a doctor, nutritionist, fitness trainer or licensed lifestyle coach, and of those respondents: 75% would be willing to pay for personalized feedback and coaching from a doctor, and 73% from a nutritionist, nurse or dietician.

Healthcare (Health Care) in a word (or two)

By Clive Riddle, September 5, 2014

MCOL has launched a survey, albeit a little tongue-in-cheek, on solving a great question for the ages:  do we spell it healthcare (one word) or health care (two words)? You can click here to take the survey, and see real-time results, or click here to check out a one-minute video on the topic.

Early results from the survey to-date indicate a slight preference for one word: 44.7% have said one word; 31.6% have said two words; 13.2% have responded that it depends on the context; and 10.5% have answered that either is fine. Remember though, respondents work within this industry (more on that to follow.)

How have others weighed-in on this conundrum?  Major news organization, medical journals and the AP consistently use “health care” in two words.  Many major blogs have taken the same position, such as The Incidental Economist (Feb 2013) and Archelle On Health (May 2011).

But many  either take the position of one word, while lamenting the times they are a-changing, or they argue the both uses are acceptable, depending upon the context.

One of the most quoted blogs regarding this topic comes from Michael Millenson’s The Doctor Weighs In, in his August 2010 post - “Healthcare” vs. “Health Care”: The Definitive Word(s) .  Millenson makes the case that learned authorities use two words, but goes on to say: “So why isn’t that the end of the issue? Because conventions are not set in concrete. For example, at the time the Internet first became popular, the AP preferred the term “Web site” over “website” because the World Wide Web is a proper name. “ and acknowledges one word use is on the way up: “However, I think a tipping point for fusing “health” and “care” was reached with the federal legislation setting up the Agency for Healthcare Research and Quality at the end of 1999.”

Are the times a-changing? Certainly a review of Google search results placing both terms within quotations, indicates two words is the clear winner:  109 million results versus 47.8 million – a ratio of 2.28 to one.  When the results are filtered to only display content created in the past twelve months, two words still easily wins: 15 million results versus 9.4 million, but the ratio reduces to 1.6 to one.  The times it would seem are changing – but not at the rate of Bob Dylan record sales in Greenwich Village in 1961.

But what about context?

While many make the case that usage is driven by context, there isn’t agreement about what that context is.  Some say one word is used by those in the business when communicating to each other, and two words is for use with the general public. The Metropolitan Philadelphia Chapter of HFMA concluded in The Great Debate of Our Industry: Healthcare vs. Health care “so there still is no final answer here. Both health care and healthcare remain acceptable term.”  The author seems to go for the context route, stating” the single word healthcare may show you are an industry insider, and I save the term health care for those who write about our industry from the outside.”

In the March 2008 Medical Malprocess Blog post Health Care or Healthcare?, an often mentioned approach regarding context -  in which two words refers what a patient receives, and one word refers to a system:  “Health care as two words refers to what happens to a patient. …Healthcare as one word refers to a system or systems to offer, provide, and deliver health care (two words).”

Grammarist.com, in Healthcare vs. health care tells us the times are a-changing but context depends upon international use: “Healthcare is on its way to becoming a one-word noun throughout the English-speaking world. The change is well underway in British publications, where healthcare already appears about three times as often as health care and is used as both a noun and an adjective. Many American and Canadian publications resist the change, meanwhile, and health care remains the more common form in North American newswriting, as well as in government and scholarly texts. In many cases—such as on health-related U.S. government websites—health care is the noun (e.g., “your health care is important”) and healthcare is the adjective (e.g., “find a healthcare professional”), but this is not consistently borne out, and both forms are widely used both ways. Many publications and websites seem to have no policy on this at all. Short answer: Outside North America (Australia goes along with the U.K. on this one), use healthcare. In the U.S. and Canada, make it two words (unless you want to help speed the compounding process).”

What to make of all of this? Google search results, and purists would agree that two words is still king – for the general public, but eventually it would seem one word will take hold – although perhaps not as rapidly as some might think. During this transition – context will drive usage, and those in the business of healthcare might be more comfortable with one word with conversing with each other.

Towers Watson 2014 Employer Survey Results

By Clive Riddle, August 22, 2014

Towers Watson has just released results from their annual Health Care Changes Ahead Survey which “offers insights into the focus and timing of U.S. employers’ plans and perspectives related to their health benefits, and their efforts to better manage costs and employee engagement.”

Their headline takeaway? “U.S. employers expect a 4% increase in 2015 health care costs for active employees after plan design changes… If no adjustments are made, employers project a 5.2% growth rate.

Towers Watson’s Randall Abbott tells us “in the current economic climate, affordability and sustainability remain dominant influences on employers’ overall health care strategies. Expense management and worker productivity are equally critical to business results. While employers are committed to providing health care benefits for their active employees for the foreseeable future, persistent concerns about cost escalation, the excise tax and workforce health have led to comprehensive strategies focused on both year-over-year results and long-term viability for health care benefits and workforce health improvement. The emphasis is on achieving or maintaining a high-performance health plan. And CFOs are now focused on a new gold standard: managing health cost increases to the Consumer Price Index. This requires acute attention to improving program performance.”

Here’s some key employer responses from their survey findings:

• 73% of employers said they are somewhat or very concerned they will trigger the excise tax b
• 43% said avoiding the tax is the top priority for their health care strategies in 2015.
• 81% plan moderate to significant changes to their health care plans over the next three years
• Pharmacy-only cost trend is projected to be 5.3% after plan changes (6% before changes)
• 48% are considering tying incentives to reaching a specified health outcome such as biometric targets during the next three years ( 10% intend to adopt it in 2015)
• 37% are considering offering plans with a higher level of benefit based on the use of high-performance or narrow networks during the next three years (7% in 2015)
• 34% of employers are considering telemedicine during the next three years (15% in 2015)
• 33% are considering significantly reducing company subsidies for spouses and dependents during the next three years (10% have already done so; 9% intend to do so in 2015)
• 26% are considering spouse exclusions or surcharges if coverage is available elsewhere during the next three years; (30% already do so; 7% expect to add it in 2015)
• 30& are considering caps on health care coverage subsidies for active employees, using defined contribution approaches during the next three years (13% already have them; 3% are planning them for 2015)
• 50% are considering full-replacement ABHPs (Account Based Health Plans) during the next three years: (17% offer only an ABHP today; 4% intend to do so for 2015, and another 28% are considering it for 2016 or 2017)
• 76% are exploring the use of personalized digital technologies, including mobile health applications and fitness wearables

Towers Watson included a number of questions measuring the private health insurance exchange opportunity:

• 28% have extensively evaluated the viability of private exchanges
• 24% said private exchanges could provide a viable alternative for their active full-time employees in 2016.
• 64% said evidence private exchanges can deliver greater value than their current self-managed model would be a top decision factor
• 34% said adoption of private exchanges by other large companies in their industry would be a top decision factor
• 26% said an inability to stay below the excise tax ceiling as 2018 approaches would be a top decision factor
• 99.5% have no plan to exit health benefits for active employees and direct them and their families to public exchanges, with or without a financial subsidy.
• 77% are not at all confident public exchanges will provide a viable alternative for their active full-time employees in 2015 or 2016.

Of course it should be noted Towers Watson has their own private exchange product, OneExchange, that serves more than 1,100 employer clients with active employee and retiree options. Towers Watson just announced that during “the first half of 2014, 45 major U.S. employers launched OneExchange for full-time, part-time or retired employees. This is the largest number of employer implementations outside the typical fall enrollment period in the private exchange’s eight years of operation.” Major new clients they listed included GameStop; International Paper; Northrop Grumman; and the State of Rhode Island.

Ten Things to Know About Ebola Today:

Clive Riddle, August 15, 2014

While Ebola is only rampant in Africa, cases are now out-migrating, and Ebola is finally starting to get the increased  attention of the world it needs.  For those of us half a world away, we typically want to condense this information down to how it might ultimately indirectly or directly affect us. Unfortunately, some of that attention is overly shaped by fear, misinformation or even political agendas.

The CDC is a great resource site on Ebola Hemorrhagic Fever ,  including Ebola Virus Disease Information for Clinicians in U.S. Healthcare Settings.  NPR has a post today interviewing Jeanine Thomas, on why the Ebola decision has relevance for the U.S. health care system.  Much of the dilemma in West Africa is due to their lack of healthcare resources compared to more industrialized nations, as discussed in a Science Daily article posted yesterday, Ebola outbreak highlights global disparities in health-care resources, which pulls from NIH and New England Journal of Medicine content.

Perhaps a best first step for non-clinicians in the business of healthcare, is to become more conversant in the current state of affairs for Ebloa. As Lee Norman, MD, chief medical officer for The University of Kansas Hospital, reminds us, “the current Ebola Virus Disease is the deadliest on record but it is important to understand key elements of this virus. He and the University of Kansas Hospital have just released an excellent summary in the regard: 10 things to know about Ebola, we’ll repeat in its entirety:

1. Cases Are Out-Migrating From Africa: This is happening due to the fact that infected or ill people are traveling out of those countries in Africa with Ebola outbreaks. Cases found outside of Africa may likely go up as the number of people leaving outbreak areas increases when aid-workers and others return to their home countries.
2. No Cases of Human-to-Human Transmission Outside of Africa: There has been no human-to-human or other transmission to humans outside of Africa.
3. Ebola Is Not Transmitted By Air, Only Via Bodily Secretions: Ebola is not respiratory, so it is not transmitted through coughing or breathing. These infections are occurring because of people who are exposed to bodily fluids of infected individuals.
4. Ebola Is Not The Most Infectious Disease: As infectious diseases go, Ebola virus isn't inherently the most infectious nor is it the least infective from person-to-person. Measles and chickenpox, for example, are easier to spread. So are influenza and MERS.
5. High Mortality Rates Due to Geography: The mortality rate is quite high in Africa Ebola cases, partly because of the chaos, instability, and unrest of the governments there, and very directly related to the fact that their access to standard treatment supplies (IV solution, tubing, syringes, and protective equipment) is not universally available. Ebola cases identified and treated in westernized nations, and those with modern infection control practices, will have a much lower rate than those seen in most African regions.
6. Likelihood of Breakouts In Areas Outside of Africa: Meticulous infection control practices in modern hospitals will make it more unlikely that human-to-human transmission will occur in these settings. While expensive and advanced bio-containment units provide the highest level of infection control, it is unlikely that these units will be widespread throughout the world.
7. No Approved Immunizations and Treatments: There are no approved immunizations to prevent Ebola virus infection. There are no approved treatments for Ebola virus infection. There are experimental antibody treatments, as well as an antiviral medication not approved for Ebola. But whether either or both are safe or effective for widespread use is not known. "Compassionate use" or "experimental use" of the above treatments is tempting, because no targeted, specific "conventional treatment" exists. But widely adopting experimental, unproven medications as "the new conventional therapy" has its own difficulties: Is it safe? Is it effective? Is it costly? Are there unanticipated "down-sides" to using them? A WHO ethics panel has given the go-ahead for this, something it has never done before.
8. How Animals Play a Role: The non-human vectors that can harbor Ebola virus (fruit bats, non-human primates) are widespread in areas far removed from Africa. As such, it bears watching whether those vectors begin to harbor the virus. The WHO has an excellent map showing the parts of the world with these vectors.
9. Alert Levels: The WHO and CDC both recently increased their respective alert levels. State and local health departments throughout the U.S. and world will certainly seek guidance as to the adoption of best "local practices" to guide hospital and care providers. The guidance by the CDC as to how to manage exposed individuals and those who might be incubating the infection are quite specific and helpful. They will certainly change as time goes on.
10. What We Don't Know About Ebola: There are things unknown about Ebola. For example:

1. Can a person have had a low-level infection and not know they ever had it? Probably, based on serum testing.
2. Does a person who has had it and survived develop lifelong immunity? That is unknown at this point. The various strains of Ebola are enough different antigenically that there may not be cross-immunity.
3. Is there such a thing as a "chronic carrier state" in humans where a person can shed the virus and be infectious for a long period of time, even when they themselves have no illness or symptoms? That is also unknown at this point.

Healthcare Workers Are More Confident About Their Prospects and the Future

by Clive Riddle, August 8, 2014

Randstad Healthcare, the national healthcare staffing firm, issues a quarterly report on healthcare workers’ confidence, conducted by Harris Poll, based on a survey of physicians, nurses, healthcare administrators and other healthcare professionals. Their just released second quarter 2014 report, which tells us that confidence is up for the second quarter in a row, and that healthcare workers had the highest level of confidence compared to all industries they track.

So what does that mean, that healthcare workers are increasing in confidence, are more confident than other workers, and what exactly is it that they are confident about?

The Randstad Healthcare Employee Confidence Index is a composite of various confidence measures via an online survey. The questions asked address their optimism regarding:

• Their current employers’ outlook
• Ability to find a new job
• Likelihood of retaining existing job
• Availability of other jobs
• Strength of the economy

Key survey findings for healthcare workers included:

• 71% have confidence in the future of their current employer, compared to 54% in the previous quarter.
• 61% have confidence in their ability to find a new job (same as previous quarter)
• 81% say it is not likely they will lose their jobs in the next 12 months, compared to 72 percent in Q1 of this year.
• 28% are likely to look for a new job, compared to 33% in Q1, and 46% in Q4 2013.
• 44% believe fewer jobs are available (compared to 48% previous quarter). 61% are confident they could find a job in the next 12 months.
• 31% say the economy is getting stronger (compared to 29% previous quarter). 33% believe the economy is staying the same, and 37% believe it is getting weaker

Given all the political hubbub about the health care reform, it’s interesting to see that the pivotal ACA implementation year of 2014 actually brought a rise in confidence about job prospects, sector economic strength sand overall economic outlook, for those working directly in the industry. Perhaps this means that insiders don’t view the ACA as all doom and gloom.

Everything Everyone Had To Say About Halbig and King

By Clive Riddle, July 25, 2014

Much has been written this week about the two conflicting circuit court decisions regarding Affordable Care Act Exchange subsidies - The Halbig v. Burwell decision that found against subsidies for FFE states was celebrated as a decisive blow against Obamacare by opponents; and hours later the King v. Burwell decision that came to an opposite conclusion and dampened, at least a tiny bit, such celebrations.

So is the net effect of the two decisions cause for Much Ado About Nothing, or Much Ado About Everything? Browsing the blogoshpere and articles from major organizations, here’s a sampling of what everyone had to see about the state of affairs in the aftermath – with some of the rhetoric a bit over-caffeinated and some seemingly more balanced:

• ACA Supporters Predict Ruling Against Subsidies Won't Go Into Effect
• Republicans Will Run On An Obamacare Replacement in 2016 – Will Democrats?
• Obamacare architect caught LYING about subsidy ‘typo’ on MSNBC
• Cheap solutions to Obamacare challenge could work: Experts
• Working around exchange subsidy ruling should be easy: experts
• If Obamacare subsidies go, states may have workarounds
• Rulings on Health Law Are Far From Last Word
• Obamacare Ruling: Congress’s Dysfunction Hands Power to the Courts
• Did Conservatives Just Win a Leninist Victory Over Obamacare?
• Wild day for Obamacare: Appeals court rulings conflict
• 4.683 million unanswered questions in Halbig
• A stinging defeat for the government
• NATIONAL JL: A Court Ruling Just Blew A Huge Hole In Obamacare

Given these were not SCOTUS decisions, the question is – what’s next? Margot Sanger-Katz of the New York Times answers that question in her article After Health Law Rulings, Here Are Possible Next Steps in which she spells out these scenarios and steps:

1. All the judges on the D.C. Circuit could decide the Halbig v. Burwell case.
2. The law’s challengers could ask the Fourth Circuit to reconsider King v. Burwell.
3. Decisions will be issued by other courts.
4. Either side — or both — could appeal the rulings to the Supreme Court. T
5. The Supreme Court could decide the case.
6. Congress could act.
7. States could act.

A Kaiser Health News article, New Health Law Court Decisions Could Have Limited Political Impact counsels that the decisions aren’t going to turn mid-term elections on their head: “Political analysts say this week’s court decisions on the legality of tax subsidies for those obtaining coverage under the Affordable Care Act may not have a broad impact on this fall’s midterm elections. The decisions sent a mixed legal message, complicating the political message as well. One appellate court panel ruled the subsidies cannot be provided in the 36 states relying on the federal insurance exchange; the other ruled in favor of the Obama administration, saying Congress intended that the subsidies be available regardless of whether states operated their own insurance marketplaces. Political candidates as well as voters will have to wait until the outcome of appeals of the cases to know their impact. But that didn’t stop some politicians from trying to immediately exploit the issue.”

If you are looking for a nice in-depth discussion of the situation – consider giving Timothy Jost’s Health Affairs Blog that provides such coverage: Implementing Health Reform: Appellate Decisions Split On Tax Credits In ACA Federal Exchange. He writes in part: “The issue in the cases is this: The ACA authorizes the IRS to provide premium tax credits to individuals with household incomes between 100 and 400 percent of the federal poverty level who are not eligible for other minimum essential coverage (such as affordable and adequate employer coverage, Medicaid, or Medicare). Premium tax credits are, however, only available to individuals who purchase coverage through the exchanges. The ACA requests that the states establish exchanges, and sixteen states and the District of Columbia have done so. The ACA also, however, authorizes the federal government to establish exchanges in states that fail to set up their own exchanges. The federal government has done so in 34 states and is operating the individual exchange for two more. The IRS regulation allows premium tax credits to be awarded to eligible individuals in both states with state-operated exchanges and states with federal exchanges. Two subsections of the ACA, which describe how the amount of tax credits are to be computed and what months can be covered by tax credits, however, provide that tax credits are available for months in which an individual is enrolled in a qualified health plan “through an Exchange established by the State under 1311” of the ACA. The plaintiffs in the King and Halbig cases argue that this provision bars the IRS from issuing premium tax credits to individuals who enroll in qualified health plans through federal, as opposed to state-operated, exchanges.”

What are the stakes? Tim tells us “these cases, as well as two other cases pending in the federal district courts in Oklahoma and Indiana brought by the attorneys general of those states, have clearly been brought for a political purpose — to bring down the ACA.”

But the last word on this for today perhaps should belong to John Stewart, who Adrianna McIntyre notes in her Vox Healthcare Blog: Still confused about the latest Obamacare lawsuits? Let Jon Stewart explain (which includes the video clip) “Stewart commended the judges on getting past stop signs the morning of the decision. ‘Until the law expressly provides a 'go' sign, we can in no way ascertain the intent of the framers of the sign. Surely the people honking behind me appreciate the rigor of my judicial acumen.’

State Health Care Prison Spending by the Numbers

by Clive Riddle, July 10, 2014

The State Health Care Spending Project, an initiative of The Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation, has been monitoring and analyzing prison healthcare costs for some time, and Pew has just released a new 32-page report: State Prison Health Care Spending: An Examination.

This is on the heels of their report Managing Prison Health Care Spending first released last October, which covered the period of 2001 – 2008, and found that spending sharply increased in most states during that time period. The new report analyzes spending from 2007 – 2011 and found “state spending on prisoner health care increased from fiscal years 2007 to 2011, but it is trending downward from its peak in 2009.”

The new report concludes: “Correctional health care spending poses a fiscal challenge to state lawmakers, though evidence indicates that spending peaked at the end of the last decade. The situation posed by these expenses may be particularly acute in states where older inmates represent a relatively large proportion of the prison population. Corrections officials will be better positioned to manage their systems effectively with access to rigorous, disaggregated spending and health outcomes data that can be used to identify cost drivers and to evaluate the value and impact of cost-containment initiatives.”

Here’s a compilation of various analysis and findings from the new report, by the numbers:

4 key variable characteristics that affect delivery of health care and increase costs include: (A) Prison population trend; (B)  Older inmates, greater expense; (C) Prevalence of disease and mental illness. And (D) Location and inmate transportation.

4 strategies being used to manage costs are: (A) use of telehealth technologies; (B) outsourcing of prison health care, (C) enrollment of prisoners in Medicaid, and (D) appropriately paroling older and/or ill inmates.

37% of health care spending was on general medical care (20% was on hospitalizations; 14% on pharmaceuticals; 14% on mental health; 5% on substance abuse)

39 States saw per-inmate health care spending rise from fiscal 2007-2011, with a median growth of 10%.

41 States experienced growth in their correctional health care spending from fiscal 2007-2011, with a median increase of 13%.

34 States saw their total correctional health care spending peak before fiscal 2011

40 Of 42 states surveyed experienced a rise in the share of older inmates from fiscal 2007-2011

204% increase in the number of state and federal prisoners age 55 and older

from 1999–2012

$441 million - The amount of California’s decrease in spending from fiscal 2009 to 2011 accounting for most of the national decline of half a billion dollars during that time

$7.7 billion total prison health care spending in fiscal 2011

$8.2 billion total prison health care spending in fiscal 2009

athenahealth Annual PayerView Report Ranks Human Top Plan Again For Providersa

by Clive Riddle, June 6, 2014

athenahealth recently released their 2014 PayerView Report, which ranks “commercial and government health insurers according to specific measures of financial, administrative, and transactional performance. These measures provide an objective, comparative benchmark for assessing how easy or difficult it is for providers to work with payers.” For the second year in a row, athenahealth found Humana the top performing plan out of 148 plans analyzed.

Here are their rankings for local and national Commercial plans:

1. Humana
2. HealthPartners
3. BCBS of MA
4. Cigna
5. Group Health Cooperative
6. Capital Blue Cross - PA
7. Care First BCBS - DC
8. Unicare
9. BCBS of NC
10. Neighborhood Health Plan

Four major insights were provided by athenahealth regarding the report:

(1) “ Medicaid's Lackluster Performance Continues - For the 9th straight year, Medicaid performed worse than commercial plans and Medicare on key metrics such as Days in Accounts Receivable (DAR), Denial Rates, and Electronic Remittance Advice (ERA) transparency. “

(2)  “Providers' Burden to Collect on Claims Varies Widely - PayerView data indicates that provider collection burden (PCB), measured as the percent of charges transferred from the primary insurer to the next responsible party after the time of service, is increasing slightly. ..PayerView results reveal that Medicare and many Blue Cross Blue Shield plans require providers to collect large percentages of payments from patients, while Medicaids require minimal collection. “

(3) ”Blue Cross Blue Shield Plans Pay Providers the Fastest - As a category, Blue Cross Blue Shield plans reimburse providers most quickly, with an average of three fewer Days in Accounts Receivable compared to all other payers. On this measure, Blue Cross Blue Shield plans represent 20 of the top 25 performers.”

(4) “Commercial Payers Offer the Most Efficient Enrollments - While Medicaid enrollment proves particularly burdensome, national commercial payers' enrollment proves simplest. “

athenahealth notes that rankings from their report “are derived from athenahealth's athenaNet® database, which to date includes more than 52,000 providers across 50 states. The 2014 PayerView data set analyzes 108 million charge lines and $20 billion in health care services billed in 2013.”

RWJF Examines Current and Future Coverage Eligibility For the Uninsured – It’s a State by State Issue

By Clive Riddle, May 30, 2014

The Robert Wood Johnson Foundation, in conjunction with the Urban Institute, has just issued a nine-page Issue Brief: Eligibility for Assistance and Projected Changes in Coverage Under the ACA: Variation Across States.

The Urban Institute authors, Matthew Buettgens, Genevieve M. Kenney, and Hannah Recht found that:

• This year, under the ACA, 56% of the uninsured became eligible for financial assistance with health insurance coverage through Medicaid, CHIP or subsidized private coverage through the new marketplaces.
• In states that expanded Medicaid eligibility under the ACA, 68% of the uninsured became eligible for assistance, compared with 44% in states that have not expanded Medicaid.
• If states that have not expanded Medicaid eligibility were to do so, 71% of their uninsured would be eligible for assistance.
• Among states expanding Medicaid, the ACA is projected to reduce the number of uninsured people by 56%, compared with a 34% reduction among states not expanding Medicaid.
• If the states that have not expanded eligibility were to do so, the number of uninsured in those states would decrease by 59% 

The authors note that the “Medicaid expansion states with the lowest share of uninsured eligible for assistance tend to be those in which Medicaid eligibility for adults had already been expanded above minimum required levels before the ACA.”

Given the state decisions are the determining factor, what is the range of eligible uninsureds in the non-Medicaid expansion states, and where is the low end based? Look South. The Authors state that “with the exception of Wisconsin, the share of the uninsured in nonexpanding states eligible for assistance ranges from 40 percent in Texas to 58 percent in Alaska and Maine. The states with the lowest shares eligible for assistance (Texas, Mississippi, Louisiana, and Georgia) have particularly large shares of residents below 100 percent of FPL. [What’s up with Wisconsin? The authors note that Wisconsin changed its Medicaid Waiver in 2014 and “therefore, Wisconsin resembles a Medicaid expansion state.”]

The top five states (all expansion states) by percentage eligible for any assistance, along with the projected percentage decrease in uninsured under the ACA:

1. West Virginia – 83% Eligible / 76% decrease in uninsureds

2. Kentucky – 82% Eligible / 63% decrease in uninsureds

3. Michigan – 81% Eligible /64% decrease in uninsureds

4. Ohio – 81% Eligible / 65% decrease in uninsureds

5. North Dakota – 80% Eligible / 64% decrease in uninsureds

Conversely, here’s the bottom five states (all non expansion states):

50. Texas – 40% Eligible / 31% decrease in uninsureds

49. Mississippi – 42% Eligible / 31% decrease in uninsureds

48. Louisiana -– 42% Eligible / 32% decrease in uninsureds

47. Georgia – 42% Eligible / 30% decrease in uninsureds

46. Alabama -– 43% Eligible / 28% decrease in uninsureds

Practice Profitability Index: Physicians Bearish on the Year Ahead

By Clive Riddle, May 9, 2014

CareCloud, in partnership with QuantiaMD, has just released their second annual Practice Profitability Index report. The ten-page 2014 report, “intended to serve as an annual barometer for the operational wellbeing of U.S. medical groups in the year ahead,” finds that “U.S. physicians are now more than twice as likely to foresee eroding, not increasing, profits in 2014,” as they illustrate with survey results in this portion of an infographic provided in conjunction with the report.

Of course, as the healthcare landscape evolves and trends for integration continues to gradually gather steam, those remaining in private practice may view themselves in an increasingly embattled or even endangered species. Albert Santalo, CareCloud Chairman and CEO  tells us, “physicians are experiencing increasing strain on their practice operations as a result of healthcare reform and government mandates. This strain, in turn, affects patients – including the millions of new ones entering the system as a result of the Affordable Care Act.  Nearly half of physicians say they cannot take on these patients, foreshadowing an access to care issue. Meanwhile, despite the hype about emerging reimbursement models, physicians are most likely to seek improvements through programs that help them engage with their sickest and most vulnerable patients.”

The Practice Profitability Index involves gathering insights via an interactive online questionnaire and related discussion groups. This year, 5,064 physicians participated during March, 2014. Here’s highlights of findings presented in the report: 

• Physicians with a negative outlook increased from 36% to 39% during the past year
• Physician optimists declined from 22% to 19%.
• The detailed breakdown of responses for profitability trending was 5% very positive; 14% somewhat positive; 30% about the same; 29% somewhat negative; 10% very negative; and 12% not sure.
• Their top financial concerns are: declining reimbursements (60%); rising costs (50%); requirements from the Affordable Care Act (49%); and the transition to ICD-10 (43%).
• The percentage of doctors spending more than one day a week on paperwork rose sharply between 2013 and 2014, from 58% to 70%.
• 23% spend more than 40% of their time on administration, up from 15% last year.
• 40% of physicians indicated patient engagement programs hold the greatest promise for improving their practice performance in 2014.
• Other responses for improving performance including new alliances with other providers (21%), ACO participation (11%) and mobile technologies (11%)
• The survey was taken before the minimum one-year delay to the ICD-10 code transition, originally scheduled for October 2014, but at that time 44% did not know whether they would be ready. Another 25% were certain they would not be prepared and faced high transition and upgrade costs.
• Of the 48% of respondents that own their practice, 24% of these physicians are considering selling the practice, up from 21% in 2013. 53% are not looking to sell at all, down from 50% in 20

Humana Study Measures Claims Costs and Absence Rate by level of Wellness Program Engagement

By Clive Riddle, May 2, 2014

Humana has released findings from their HumanaVitality Health Claims and Productivity Impact Study of Humana employees. HumanaVitality is a joint venture between Humana Inc. and Discovery Holdings, Ltd. That serves 3.5+ million members and “is a data-driven wellness and rewards program that motivates members to make healthier life choices.”

Humana touts that “the two-year study found improved health, as shown through lower health care costs and fewer unscheduled absences, among employees who actively participated in the HumanaVitality program.”

Here’s their specific findings:

• Unengaged members in both years averaged $53 more per month spent on health care claims than members who were engaged in HumanaVitality both years.
• The largest impact on health care costs was on members with lifestyle-related chronic conditions like high blood pressure or diabetes. Engaged members with these conditions had 60 percent lower health claims costs than unengaged members with these conditions.
• Another way of stating this: Unengaged members with lifestyle-related chronic conditions had 101% higher claims costs than the total population, while engaged members with these chronic conditions had 41% higher claims costs than the total population
• Unscheduled absences were 56.3 percent higher among unengaged members in both years than engaged members
• Members who were unengaged the first year but engaged the second year had 29% higher unscheduled absence and an average of $28 per month in claims costs than members who engaged both years

Humana shared this about the study methodology: “This study was performed on a cohort of Humana associates that were on a Humana employee medical health plan for a full 12 months in at least two consecutive plan years over the study period. The study was conducted by Humana actuaries for the following time period: Baseline Year (July 2010 – June 2011), Year 1 of the HumanaVitality program (July 2011 – June 2012) and Year 2 of the HumanaVitality program (July 2012 – June 2013). Only Humana employees were included in the study; individuals with high cost claims (>= $ 150,000 in the Baseline Year, Year 1 or Year 2) were removed from the sample. The final sample size was 13,046 members in the Year 1 analysis and 16,296 members in the Year 2 analysis.”

The Colossal Ship - The SS Rx Costs – makes a Course Correction

by Clive Riddle, April 17, 2014

Course corrections on mammoth shipping lines don’t happen in an instant – you watch them develop over a period of time. The same can be said for pharmaceutical costs as well as the entire healthcare sector, and the IMS Institute for Healthcare Informatics tells us we’re witnessing a slow correction right now.

Costs that have been stabilized this decade are gradually starting to tick upwards. The IMS Institute has just released a study: Medicine Use and Shifting Costs of Healthcare: A Review of the Use of Medicines in the United States in 2013 which found that “total dollars spent on medications in the U.S. reached $329.2 billion last year, up 3.2 percent on a nominal basis and a rebound from the 1.0 percent decline in 2012…  Total spending on U.S. medicines increased 1.0 percent on a real per capita basis in 2013, while the use of healthcare services overall rose for the first time in three years.”

This doesn’t mean that costs are about to go crazy in an upward spiral just yet – remember that this is a big ship. Instead, Murray Aitken, executive director of the IMS Institute for Healthcare Informatics, tell us  “following several years of decline, 2013 was striking for the increased use by patients of all parts of the U.S. healthcare system – even in advance of full implementation of the Affordable Care Act.  Growth in medicine spending remains at historically low levels despite a significant uptick last year, and continues to contribute to the bending of the healthcare cost curve.”

So what is driving this gradual correction? The IMS Institute identifies these factors:

1. The reduced impact of patent expiries (“Patent expiries in 2013 contributed $19 billion to lower medicine spending, compared with $29 billion the previous year.”)
2. Price increases for branded products added $4 billion more in spending growth last year compared to 2012
3. Higher spending on innovative new medicines (“while 36 New Molecular Entities launched in 2013, the largest number in a decade”)
4. Greater use by patients of the healthcare system  (“Overall utilization of healthcare services grew slightly as consumers returned to the healthcare system – primarily through more office visits to specialist physicians as well as outpatient treatments – following several years of self-rationing. “)

The IMS Institute shared these other key findings from their report:

• The number of patient office visits to primary care physicians fell by 0.7 percent in 2013.
• Visits to specialists increased by 4.9 percent overall and by 9.5 percent for seniors.
• Patients filled an average of more than 12 retail prescriptions last year, up nearly 2 percent year over year.
• Those aged 65 and over filled an average of 28 prescriptions annually, down slightly from 2012.
• Overall spending on medicines remained concentrated in traditional small-molecule pills dispensed through retail pharmacies.
• But higher spending growth was seen in biologics and specialty drugs – particularly in retail and mail-order settings.
• A total of 27 new oncology drugs have launched in the past three years.
•  Additionally, clusters of innovation are transforming patient care in hepatitis C, multiple sclerosis and diabetes, as well as stroke and acute coronary syndrome.
• Seventeen orphan drugs – developed for patient populations of fewer than 200,000 individuals – launched in 2013, the most in any year since the passage of the Orphan Drug Act in 1983.
• Patients with insurance are incurring higher out-of-pocket costs for healthcare services despite lower co-pays for many prescriptions and additional discounts for preventive medicines.
• Prescription drug costs paid by most patients are declining, with average out-of-pocket costs falling below $5 for 57 percent of all retail prescriptions filled.
• At the same time, 30 percent of total patient out-of-pocket costs relate to just 2.3 percent of prescriptions, often high-cost specialty medicines.
• Twenty-three percent of prescriptions now carry no out-of-pocket costs, a dramatic rise in 2013 driven by common preventive medicines that include oral contraceptives.

Want to get more detail? The report can be downloaded as an app via iTunes.

April Fool’s Day Brings Some Humor to Healthcare

By Clive Riddle, April 4, 2014

The first of April marked the annual issuance of satirical lists from healthsprocket, zinging a range of current topics in the business of healthcare, which I can’t resist repeating.

First, let’s visit a list of predictions of future major news items, in a list entitled -  Top Healthcare Headlines from Tomorrow's News

1. Healthcare.gov server achieves singularity, assumes control of planet
2. Obesity Problem eliminated in United States thanks to Congressional Act to expand BMI ranges
3. Exchange enrollment count after March 31st deadline exceeds 400 million, last minute inclusion of uncovered domestic pets credited with enrollment surge
4. Influenza eradicated after development of oral vaccine distributed in Starbucks Coffee
5. National consulting lobby urges Congress and states to adopt new, confusing and conflicting healthcare legislation - say lack of new laws since Affordable Care Act is stifling consultant job creation
6. Medicare officially re-named "Johnsoncare" in keeping with Obamacare precedent
7. Health Plan of San Mateo declared second largest plan in nation after Kaiser-BlueCrossBlueShield-UnitedHealthcare-Human-Aetna-Cigna-HealthNet-Molina-Centene merger

Here’s another list looking into the future, this time predicting what big problems lie ahead a year from now, with the Top Five Healthcare Crises Predicted for 2015:

1. Acute Shortage of available new healthcare acronyms
2. Global climate change causes the Cloud holding all healthcare big data to disappear
3. Demand for health coaches exceeds supply, causing raid on NFL, NBA and MLB staffs
4. Healthcare exchanges finally end up working smoothly, causing a wide-scale chain reaction of pundits and politicians heads to explode on national television
5. Lack of funding causes medical homes to downsize to medical apartments

And one more list about upcoming events, this time narrowing the focus to upcoming month, as we consider Healthcare scandals that will surface later this year:

1. The "two ferns" in the Obama -Zach Galifianakis healthcare.gov interview were secretly switched out with alternative plants provided by medical marijuana lobby
2. Major healthcare analytics platform discovered to be vintage Magic 8-Ball
3. Move by major Health Savings Account (HSA) administrators to convert all accounts to bitcoins proves disastrous
4. Jointly funded XBox, Wii and Playstation study finding health benefits of exercise and fresh air to be vastly overrated, revealed to be based on SimCity and not actual data
5. High speed disclaimers at end of prescription television ads discovered to be spoken in Klingon language

Speaking of the “Two Ferns” video, next we look at a list that addresses the White House media blitz to promote signing up in the health insurance marketplaces, with New Television Shows Created to Attract the Young Invincibles to Obamacare:

1. How I Met Your Health Plan - A previously uninsured guy spends nine seasons explaining to his kids how he finally got coverage after years of searching
2. CSI: Covered Singles Insurance - Each week, investigators track down an uninsured single twentysomething, and bring their health coverage to justice
3. The Amazing Race - Young uninsured individuals hurry to sign up in a plan before the open enrollment deadline, despite obstacles placed in their path
4. Modern Family - Different dependent coverage scenarios are explored in each episode
5. Once Upon a Time - Evil witches try and convince the population to hold out for their fairy tale past of fee for service medicine, house calls, low costs, and happy doctors and patients

And finally, no discussion of the Affordable Care Act is complete without a few zombies thrown in the mix, as demonstrated by the healthsprocket list Upsides for the Affordable Care Act after a Zombie Apocalypse:

1. Web traffic will not overwhelm healthcare.gov
2. Annual ACA expenditures will come in under budget
3. That stubborn "young invincibles" demographic won't be so important
4. Consumer engagement strategies can be significantly simplified
5. More of the population will be walking and less sedentary

March Brings Three Different Slices of Health Plan Consumer Experience Ratings

by Clive Riddle, March 28, 2014

This month, three annual proprietary consumer experience studies have yielded separate slices of the health plan consumer experience. J.D. Power, Temkin Group and Saatmetrix have all weighed in, and each shed favorable light on Kaiser Permanente, among other plans.

J.D. Power released results from their eighth annual Member Health Plan Study, in which they provide member satisfaction index rankings by region. Their 2014 Member Health Plan Study is based on responses from more than 34,000 members of 136 commercial health plans across 18 regions in the United States. The study was fielded in December 2013 and January 2014.  

J.D. Power ranks satisfaction on a 1,000 point scale. Satisfaction is highest among health plan members in the California and Michigan regions (in a tie); the Indiana-Illinois and Mid-Atlantic regions (in a tie); and the East South Central and South Atlantic regions (in a tie). Satisfaction is lowest in the New England, New York-New Jersey and Southwest regions. 

Top ranked plans by region, according to the J.D. Power study, were compiled in healthsprocket, in these regional lists:

J.D. Power 2014 Member Health Plan Study: Top Plan Scores - Southern United Stated

• Kaiser Foundation Health Plan (784) ranks highest among health plan members in the South Atlantic region (which includes Georgia, North Carolina and South Carolina) for a fifth consecutive year
• AvMed Health Plans and Humana (in a tie at 690 each) rank highest among health plan members in the Florida region, AvMed ranks highest in the Florida region for a third consecutive year
• Cigna (689) ranks highest among health plan members in the East South Central region (which includes Alabama, Kentucky, Louisiana, Mississippi and Tennessee)
• Aetna (677) ranks highest among health plan members in the Texas region

J.D. Power 2014 Member Health Plan Study: Top Plan Scores - Eastern US

• Kaiser Foundation Health Plan (732) ranks highest among health plan members in the Mid-Atlantic region (which includes Maryland, Virginia and Washington, D.C.)
• Capital District Physicians Health Plan (727) ranks highest among health plan members in the New York-New Jersey region
• Geisinger Health Plan (705) ranks highest among health plan members in the Pennsylvania region for a third consecutive year
• Tufts Associated Health Plans (681) ranks highest among health plan members in the New England region (which includes Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont)

J.D. Power 2014 Member Health Plan Study: Top Plan Scores - Midwestern US

• Health Alliance Plan of Michigan (711) ranks highest among health plan members in the Michigan region for a seventh consecutive year
• Dean Health Plan (703) ranks highest among health plan members in the Minnesota-Wisconsin region
• Medical Mutual of Ohio (697) ranks highest among health plan members in the Ohio region
• Health Alliance Medical Plans (692) ranks highest among health plan members in the Indiana-Illinois region
• Wellmark Blue Cross Blue Shield of Iowa (680) ranks highest among health plan members in the Heartland region (which includes Arkansas, Iowa, Kansas, Missouri, Nebraska and Oklahoma)

J.D. Power 2014 Member Health Plan Study: Top Plan Scores - Western US

• Kaiser Foundation Health Plan ranks highest among health plan members in the California region for a seventh consecutive year, with a score of 756
• Kaiser Foundation Health Plan (732) ranks highest among health plan members in the Northwest region region (which includes Oregon and Washington)
• Kaiser Foundation Health Plan (703) ranks highest among health plan members in the Colorado region for a seventh consecutive year
• SelectHealth (698) ranks highest among health plan members in the Mountain region (which includes Idaho, Montana, Utah and Wyoming) for a fifth consecutive year
• Blue Cross Blue Shield of Arizona (675) ranks highest among health plan members in the Southwest region (which includes Arizona, New Mexico and Nevada

Temkin Group pronounced the health plan industry “mediocre” and bestowed the highest customer experience rankings to Kaiser Permanente and Humana respectively, in releasing results from their fourth annual ranking of companies based on a study of 10,000 U.S. consumers that “examines the quality of the customer experience delivered by 268 organizations across 19 industries: airlines, appliance makers, auto dealers, banks, car rental agencies, computer makers, credit card issuers, fast food chains, grocery chains, health plans, hotel chains, insurance carriers, Internet service providers, investment firms, parcel delivery services, retailers, software firms, TV service providers, and wireless carriers.”

Bruce Temkin, managing partner of Temkin Group, tells us "consumers give pretty bad ratings to most health plans, as this entire industry needs a customer experience makeover.  Overall, the health plan industry averaged a 56% rating in their study and tied for 17th place out of 19 industries.

Temkin ratings by plans included in the survey were:

1. Kaiser Permanente (68%)
2. Humana (63%)
3. Medicare (62%)
4. TriCare (62%)
5. United Healthcare (59%)
6. Blue Shield of California (58%)
7. Aetna (57%)
8. Health Net (55%)
9. CIGNA (54%)
10. Anthem (BCBS) (53%)
11. CareFirst (BCBS) (48%)
12. Medicaid (45%)
13. Highmark (BCBS) (44%)
14. Empire (BCBS) (42%)
15. Coventry Health Care (41%).

Temkin noted that Humana (+12 points), Blue Shield of California (+7 points), and United Healthcare (+5 points) improved the most between 2013 and 2014. Coventry Healthcare (BCBS) (-18 points), TriCare (-9 points), Empire (BCBS) (-7 points), and Highmark (BCBS) (-6 points) declined the most since 2013. Kaiser Permanente with their 68% rating, was in 109th place overall out of 268 organizations across 19 industries. Humana, with a rating of 63% placed 160th overall. Coventry Health Care (BCBS) was in last place across all 268 companies in the ratings with their score of 41%.

Satmetrix Systems released results for their 2014 Satmetrix® Net Promoter® Benchmarks which measure and rank customer loyalty more than 219 brands across 22 U.S. industry sectors, including financial services, insurance, technology, online services, retail stores, electronics, travel and hospitality, and telecommunications. The Satmetrix Net Promoter Benchmark rankings are based on survey responses from more than 24,000 U.S. consumers nationwide who indicated they had significant experience with a company's products or services in the previous 12 months. A company's Net Promoter Score is based on customers' likelihood to recommend the company's product or service. The score is the percentage of customers who are promoters, rating the company 9 or 10 on a 0 to 10 point scale, minus the percentage who are detractors, rating 6 or lower.

The Satmetrix study for the health insurance sector followed these nine companies:

• Aetna
• Anthem
• BlueCross BlueShield of Florida
• BlueCross BlueShield of California
• Cigna
• Humana
• Kaiser
• Medicare
• United Healthcare

Like J.D. Power and Temkin, Satmetrix found Kaiser Permanente to be a dominant force, leading the health insurance category for the fourth consecutive year  and “improving to an all-time high [Net Promoter Score] score of 40 points. The provider rated highest on a number of important key loyalty drivers, as patients appreciated its service features, company reputation and the feeling that Kaiser Permanente acts in their personal best interest.” Kaiser’s score was 23 points higher than the industry average. Like Temkin, Satmetrix ranked Human in second place: “with a score of 32 points, Humana saw significant improvement from 2013, moving up 14 points to beat out last year's second place finisher, Medicare (27 points).”

Seated Behind a Health Plan Dashboard

By Clive Riddle, March 21, 2014

Spring has sprung, and if your fancy lightly turns to thoughts of health plans, and in fact you are driven towards such thoughts, a dashboard can be useful. You may be in luck, as Sherlock Company provides a summary from their health plan dashboard as part of their complementary publication, Plan Management Navigator.

Here’s what Sherlock Company reports in their just released March 2014 issue of the Navigator, about the trailing three months ended December 31, 2013, for health plans participating in their dashboard program. Health plans in their Dashboard universe are comprised of Blue Cross Blue Shield and Independent/ Provider-Sponsored Plans.

Health Plan reported “an increase in health revenues of 8.7%. Revenues for Medicaid grew most rapidly, increasing by 17.2%. Medicare Advantage revenue growth followed at 4.7%, while Indemnity product revenues increased 2.7%. ASO/ASC and Managed Care revenues fell by 6.2% and 4.3%, respectively. Overall, membership increased 1.1% for all health lines. Enrollment in Managed Care fell 1.1%, while increasing 1.6% for Indemnity. ASO/ASC membership declined 0.4%.”

“Membership grew in both Medicaid and Medicare by 4.6% and 4.2%, respectively. Both Managed Care and  Medicaid experienced the largest price increases, both at 3.5%. Indemnity followed with a price increase of 1.1%. Medicare Advantage products had a price decrease of 2.3%, while ASO/ASC posted a decline of 5.3%.”

“Health benefit ratios for health lines deteriorated by 2.0 percentage points to 90.0%. Managed Care and Indemnity had the largest increases of 5.4 percentage points and 4.5 percentage points, respectively. The number of scripts per person increased by 0.4 to 9.5 on an annualized basis. E/R visits per thousand members fell 13.4 to an annual rate of 241.8 per thousand, while hospital days also increased by 21.2 days to 335.1 days per thousand. The administrative expense to premium ratio increased 0.6 percentage points to 11.8%, while the administrative costs per member per month increased 2.3% to $34.76. Claims volumes increased 0.87 to 17.7 per member per year, while inquiries per member grew 0.34 to 1.9 per member per year. Staffing ratios fell 0.32 FTEs per 10,000 members to 21.1.”

You can click here if you’d like to subscribe to Sherlock Company’s complementary Plan Management Navigator, which includes additional articles full of great health plan data, benchmarks, and insights like those provided in the Dashboard Summary.

How do you Define Population Health?

By Clive Riddle, March 7, 2014

This week, the inaugural issue of Population Health News was published. In their Thought Leaders Corner, a number of members of their national advisory board answered the question – how do you define population health? Here’s what the experts had to say:

Fred Goldstein, M.S., Founder and President of Accountable Health, LLC; and Executive Director of Population Health Alliance says “A population health management program is one that strives to address health needs at all points along the continuum of health and well-being through the participation of, engagement with and targeted interventions for the population. The goal of a population health management program is to maintain or improve the physical and psychosocial well-being of individuals through cost-effective and tailored health solutions.” (Fred cites this description is from Population Health Alliance, formerly the Care Continuum Alliance)

Thomas Graf, M.D., Chief Medical Officer, Population Health and Longitudinal Care Service Lines at Geisinger Health System offers this definition:  “Population health is the ability to define and understand the health status of every individual patient and proactively deploy medical resources to support those patients, whether it is to push resource to them where they are, or effectively connect them to the optimal resource in a patient specific manner, accelerated by technology.”

Paul Grundy, M.D., MPH, FACOEM, FACPM, the Global Director of Healthcare Transformation for IBM and President of the Patient-Centered Primary Care Collaborative (PCPCC) elaborates that  “population Health is ‘the health outcomes of a group of individuals, including the distribution of such outcomes within the group.’ For me, the ability to deliver population health requires a place in the delivery system that acts as the system integrator where the data flow about the population and is held accountable. We ask the house of primary care to give us a set of principles for this system integrator that is known as the patient-centered medical home (PCMH).  The medical home is defined as a ‘healthcare setting that facilitates partnerships between individual patients and their personal providers and when appropriate, a patient’s family. It lies at the center of the effort to address population health through the provision of integrated and coordinated, team-based care. It is a delivery organization that fosters clinician-led primary care with comprehensive, accessible, holistic and evidence-based coordination and management. PCMH builds the infrastructure through which data flow and is held accountable as the system integrator for POPULATION HEALTH.”

David Nash M.D., MBA, Founding Dean of the Jefferson School of Population Health at Thomas Jefferson University observes that "population health recognizes that the social determinants of healthcare, like poverty and education, are the key drivers of a society's well-being. Medical care is responsible for 15% of a society's quality of life.”

Vince Kuraitis, J.D., MBA, Principal and Founder of Better Health Technologies, LLC explains that “definitions of population health usually focus on improving the health and health outcomes of a population. That said, the understanding and point of view of population health managers will vary greatly. Consider three highly variable factors in populations: 1. What's the COMPOSITION of YOUR POPULATION? The answer will vary depending upon whether you are a health plan, a physician practice, an employer or the government. 2. How STABLE is your population? How long do you expect it to remain with you? If you are a health plan, you will expect 18% to 20% annual churn in membership and an average tenure of around three years. If you are Medicare, your members will be with you for the rest of their lives. 3. Are you at FINANCIAL RISK for the health of your population? Upside risk? Downside risk? What are the details?   These factors will affect the economics of a population and in turn, the type and timing of potential interventions. Population managers will consider ROI as a primary metric for evaluating success. While this might seem narrow, it's very real. For example, if you are a health plan, you are more likely to invest in a congestive heart failure disease management program that has potential to identify patients and interventions that will keep patients from being admitted to a hospital within the next one to three years. If you are Medicare, you might consider a diabetes prevention that promises to reduce eye or foot problems over the course of 15 years.”

Finally, Al Lewis, Founder and President of the Disease Management Purchasing Consortium International, Inc. informs us that “population health is the provision of free (or financially incentivized) health-related tests, education and support services to groups who are (rightly or wrongly) believed—due to demographics, claims history or even company/health plan policy—to be at risk for chronic disease or chronic disease exacerbations absent those interventions, whether or not such interventions are requested by the employee or member.”

The second issue of Population Health News will include additional responses from Population Health Thought Leaders. Stay tuned.

mHealth on my Mind

by Clive Riddle, February 28, 2014

With the HIMSS14 gargantuan annual conference being held this week in Orlando, the spotlight has been shining bright on mHealth and other health information technology as of late.  In conjunction with the conference HIMSS Analytics released results from their 3rd Annual HIMSS Analytics Mobile Survey.

Here’s some highlights shared in their report:

• 59% of respondent stakeholders have a mobile technology plan; another 29% are developing a plan.
• Of those with a policy in place, here’s what the policies addressed: (1) 82% listed Means of securing devices (i.e. storing information on device); (2) 78% listed Use of personal devices for clinical/work use; (3) 71% listed Management of lost/stolen devices; (4) 71% listed Ability to access data from remote locations 71.43%; (5) 63% listed Types of apps approved for use ; (6) 45% listed Brand/version of device 44.90%
• Respondents scored HIPAA highest as the federal legislation with the most nHealth impact; Meaningful Use was second
• 95% use at least one security tool to secure data on mobile devices;  Of those with security tools, 94% used Passwords; 71% used encryption measures; and 69% used remote wipe capability
• 83% indicate their physicians use mobile technology to facilitate at least some patient care.
• 71% indicated their nurses used mobile technology to facilitate at least some patient care
• Clinicians are most likely to use technology to support patient care by either: Looking up patient information (69%); or Looking up non personal health information (65%). Rounding out the top five responses were  Use for education/training purposes (49%);  Clinical notifications (42%) and Secure communications regarding patients (39%)
• The top five tools used to engage patients/consumers in their healthcare were (1) App-Enabled Patient Portals (56%);  (2) Telehealth Services (52%);  (3) Provide Remote Monitoring Devices (36%);  (4) Prescribing Apps (23%); and (5) Discharge Kit with Mobile Technology (13%)

On another front, moving to specific, Citrix released ranking of the Top 10 Mobile Health Apps By Number of Network-Connected Subscribers, which was posted in Healthsprocket as follows:

1. Runtastic
2. My Fitness Pal
3. RunKeeper
4. Weight Watchers
5. Nike+
6. Map My Run
7. Pregnancy
8. Period Diary
9. Lose It!
10. Baby Bump

Stakeholder Views on Trends, Winners and Losers for 2014

By Clive Riddle, February, 14, 2014

MCOL recently conducted its annual Future Care e-Poll, asking stakeholders their perspective of trends, winners and losers for the coming year and beyond. Here’s a sneak peek at some of the results from the soon to be released report on this year’s findings. The full report still being compiled addresses additional e-poll questions, breaks down responses by stakeholder category and compares results to previous years.

Here’s a table of how respondents view the business trend that will have the greatest overall impact in 2014. The Affordable Care Act of course dominates all other issues, and even more so than last year, when exactly half of respondents list it as the trend with the greatest impact.

Affordable Care Act Implementation	61.1%
Government Spending Cuts	9.7%
Consumerism Initiatives	6.9%
Effects of the Economy	6.9%
Increased Consumer Cost Sharing	5.6%
Compliance Issues	4.2%
Other	2.8%
Advances in Health Care Technology	1.4%
Population Health and Wellness Initiatives	1.4%

Below is an infoGraphoid MCOL published earlier this week illustrating the e-poll results on this question. The designer of this graph informed me it looked like a green Pac-Man (the ACA respondents) vomiting a rainbow (of all the other respondents.)

Regarding winners and losers, here’s what stakeholders thought 2014’s fortunes would bring to other stakeholders:

Losers:

Hospitals – 56% say Hospitals are the big losers (only 18% said better off; 26% the same)

Physicians – 53% view Physicians as worse off (only 8% said better off; 38% the same)

Employers  - 52% think Employers are worse off (only 15% said better off; 33% the same)

Consumers  - 51% placed them in the losers column (34% said better off; 15% the same)

Status Quo:

Pharmaceutical – 60% see Pharmaceutical organizations as staying the same (29% said better off; only 11% said worse off)

Winners:

Health Plans – 47% say Health Plans as the big winners (29% said they will stay the same; 24% said they will be worse off)

It’s interesting that the stakeholder that the ACA was designed to benefit – the Consumer – is not viewed by stakeholders as the biggest beneficiary. It’s also interesting that last year respondents didn’t view health plans fortunes near as positive – at the start of 2013, 27% replied health plans would be better off;  34% said the same; and 39% said worse off.