Grading the Emergency Care System

By Clive Riddle, January 17, 2014

For the first time since 2009, the American College of Emergency Physicians (ACEP) issued their report card on the emergency care system at the state and national levels. Our grades have slipped. Their 149-page report “America’s Emergency Care Environment: A State-by-State Report Card” — examines 136 different emergency system measures in five categories, as follows:

Category	% of Overall Grade	2009 National Score	2014 National Score
Access to Emergency Care	30%	D-	D-
Quality and Patient Safety	20%	C+	C
Medical Liability Environment	20%	C-	C-
Public Health and Injury Prevention	15%	C	C
Disaster Preparedness	15%	C+	C-
Overall	100%	C-	D+

The point ACEP wishes to illustrate through the report is that the current health care system, as well as the health reform environment rely heavily upon the nation’s emergency care delivery, and the state of emergency care is not necessarily up to the task going forward.

ACEP President Dr. Alex Rosenau, tells us “there were more than 130 million emergency visits in 2010, or 247 visits per minute. People are in need, but conditions in our nation have deteriorated since the 2009 Report Card due to lack of policymaker action at the state and national levels. With so much changing in health care, emergency care has never been more important to our communities. This Report Card is a call to action.”

In the report’s state-by-state rankings, these states stand out at the top and bottom five:

District of Columbia (1st, B-) Massachusetts (2nd, B-) Maine (3rd, B-) Nebraska (4th, B-) Colorado (5th , C+)

Kentucky (47th, D) Montana (48th, D) New Mexico (49th, D) Arkansas (50th, D-) Wyoming (51st, F)

What to do about these poor grades? Here are the recommendations made in the report:

1. Protect access to emergency care as health care reforms are implemented.
2. Support programs that recognize the pivotal role emergency medicine plays in care coordination and transitions of care.
3. Reduce the incidence of hospital crowding and boarding of admitted patients in the emergency department.
4. Enact federal and state medical liability reforms that enhance timely access to quality care, particularly those that provide appropriate liability protections for EMTALA-mandated care.
5. Increase coordination and regionalization of specialized emergency services and support funding of federally authorized regional pilot programs.
6. Devote consistent federal and state funding to ensure adequate and sustainable local and regional disaster preparedness.
7. Continue to increase the use of systems, standards, and information technologies to track and enhance the quality and patient safety environment.
8. Continue pursuit of state laws that help reduce the number of preventable deaths and injuries, particularly those that address traffic-related injuries and fatalities.
9. Expand access to standardized and user-friendly state and/or federal prescription drug monitoring programs to decrease unintentional deaths by drug overdose.
10. Fund graduate medical education programs that support emergency care, especially those related to addressing physician shortages in disadvantaged areas and in rural areas.
11. Support emergency medicine research, including basic, clinical, and translational research into improving the delivery of emergency care services.

The Locked-Up Potential of Healthcare Consumers

By Clive Riddle, January 10, 2014

It’s become a common theme in healthcare surveys – the consumer has all this potential in our era of health reform, and much is riding on the consumer in the healthcare reform equation, but to-date that potential remains largely locked up.

Altarum Institute’s Center for Consumer Choice in Health Care  has just released findings from their latest semi-annual Altarum Institute Survey of Consumer Health Care Opinions.  Let’s listen to what what Wendy Lynch, Director of Altarum’s Center author of their study has to say about that: “It’s a positive sign that people are open to asking their doctors about costs and involving themselves in their health care decisions. But overall, the study shows that people still have their head in the sand when it comes to what they think they can control. They have more power than they realize just by asking questions; now they just need to use it. Consumers still believe that problems in health care are the fault of insurance companies or government and underestimate what they can do themselves.”

Well said, Wendy Lynch.

Here’s some of Altarum’s findings from their eighteen-page report on the study:

“One-third would like to make a shared decision with their doctor, and 43% want to make the final decision with some professional input. Fewer than 10% of consumers prefer the doctor to have the final say in decision making… There appears to be a recent decline in the percent of consumers who want to be completely in charge of their decisions, from more than 30% in fall 2011 to 16% in fall 2013.”

“35% [of  consumers] sometimes forget to take their medicine, and 28% did not take their medication within the past 2 weeks. When examining rates by age, younger respondents were more likely to forget or skip medications.” [46% of ages 25-34 sometimes forget, and 35% of this group skipped in past two weeks]

“63% of consumers reported that a doctor has ever invited them to choose among different medications or treatments. A larger share (83%) reported that they have received a doctor’s recommendation for a specific course of action.”

“Four out of five consumers (79%) use input from friends and relatives to guide them in their health care provider choices. More consumers tapped into online sources compared to prior years, nearly one-third (32%) reported that they use online ratings of a doctor’s bedside manner or waiting time, and 27% use online quality ratings. Only 16% indicated that they look at cost information to assist them in selecting a doctor, and use of advertisements remains low at 7%.”

“The majority of consumers indicated that they would be comfortable approaching their doctor about the cost of health care services. Four out of five are either somewhat or very comfortable asking about price. Only 15% and 4% are somewhat and very uncomfortable, respectively. Despite these high comfort levels, fewer than half (46%) of all respondents reported that they have ever asked how much a visit would cost before going to the doctor.”

“Only 6% felt very confident and 29% were somewhat confident that they could take steps to find less expensive care. Nearly half (47%) were uncertain and 18% were not at all confident that they could reduce costs. They appeared to be slightly more convinced that they could shop for better doctors, if not better prices. Just a little more than half (52%) felt that they could compare information to select a more qualified health care provider, while 39% were uncertain and 9% were not at all confident.”

“20% of individuals who strongly agreed with the statement “There is nothing I can do to affect the cost of health care” also reported that they are overweight, they use tobacco, or they do not exercise. Only 13% of patients who reported none of those unhealthy behaviors agreed with the same statement.”

“Three out of five (44%) reported that they sometimes choose to go without health care due to financial concerns. Additionally, 27% respondents reported that the main reason why they are currently employed is to receive health insurance benefits. In general, cost seemed to be more prohibitive for younger respondents.”

“Only 5% of consumers are certain that they will have the recommended savings needed to cover health expenses after they retire. On the other hand, more than 80% are either unsure or unlikely to have enough money set aside for health care post-retirement.”

Can the Consumer Choose Wisely in 2014?

By Clive Riddle, January 3, 2014

The just released January 2014 issue of Medical Home News includes a profile of Paul Keckley, PhD, in which he is asked this question: “Looking back on your years as a health care analyst, what has been this country’s major achievement and what has been its greatest disappointment in terms of health care delivery?” His answer: “Greatest disappointment: the consumer is ignorant about the health system, even after all the fuss for and against health reform. Greatest positive: data-driven healthcare!!”

In August 2013, Kaiser Family Foundation released new survey results that the Wall Street Journal summarized as:  Consumers Remain Baffled By Health Law, Poll Shows. At the end of the year, things got no better. Consider findings from a December 2013 Consumer Reports survey of consumers regarding the Affordable Care Act which found:

• 38% of respondents indicated they felt LESS informed over the course of the past month.
• 48% thought the ACA established a government-run health plan
• 36% thought the new law allowed the government to control their selection of doctors
• 30% believed the law set up government panels that would dictate decisions about end-of-life care
• One-quarter or less of respondents correctly identified the above as false statements.

But Paul Keckley’s point wasn’t just that consumers are confused about reform – rather that they are confused about the entire system, in spite of reform. And there a plethora of survey results previously cited in mcolblog postings to back that up.

George Van Antwerp, in blogging his 2014 healthcare predictions, posts that “consumer engagement in healthcare will continue to be the elusive Holy Grail.”

It is difficult to engage someone who is confused, and ignorant about the system. The consumer might feel as if they are in the scene at the end of Indiana Jones and the Last Crusade, confronted with a hundred different goblets, with only one being the true Holy Grail, as they try to navigate their health choices, and fear that the Guardian of the Holy Grail won’t be telling them that they “have chosen wisely.”

Ten Trends to Ponder for 2014

By Clive Riddle, December 20, 2013

These aren’t necessarily the top ten trends for the coming year, because the ranking of trends depends on the position of the stakeholder – in other words – in the eye of the beholder.  But below are ten trends worth pondering as one positions oneself for the year ahead:

Private sector co-opting of public healthcare policy.  Consider a number of the trends discussed below. What they have in common – an overarching theme – is that the private sector has co-opted public healthcare policy, and may have achieved a greater impact than the public sector in doing so. The ACA begat Medicare ACOs – but the commercial ACO arrangements are generating a groundswell of activity. The ACA’s centerpiece is the public exchange launch of 2014, but the private sector is paying an awful lot of attention to private exchanges. Ten years ago, HSAs and High Deductible Plans were policy driven – now they are market driven. The Stimulus drove Meaningful Use, but now that it’s become meaningful, the private sector is leveraging what to do with this new framework.

Commercial ACO Collaborations become commonplace. Soon health plans and provider networks may stop issuing press releases with each new collaboration because they are so commonplace, they just aren’t news anymore. Unlike their Medicare counterparts that are standardized arrangements, the commercial collaborations are customized, any one might argue about how many of them meet the definition of a true Accountable Care arrangement. Or perhaps they will simply erode the definition to the point where we end up calling them something else.

Private Exchanges Exceed Expectations While Public Exchanges Fall Short.  While public exchanges can drive much bigger numbers due to sheer numbers of the uninsured and underinsured, and the availability of subsidies, 2014 will find the level of impact and implications falling short of expectations as not as many of these population opt-in as expected, at least for now. This will also mean the dire predictions of ongoing glitches and budget shortfalls may not be as bad as predicted, because there will be fewer numbers for now compared to initial rosy projections. Meanwhile, private exchanges may very well exceed initial expectations for enrollment and levels of interest as 2014 takes shape.

Defined Contribution Drives Private Exchanges.  Defined contribution health plan arrangements were the buzzwords at the dawn of this millennium, but got left aside in the rush to account based and high deductible health plans in the consumerism movement. But now the stars are aligning for the return of the prodigal defined contribution son, as the driver of how most private exchanges are designed, and the driver of private sector interest in 2014 and beyond.

Is Everyone in a High Deductible Plan? There a lots a surveys with varying reported levels of HDHP penetration in the commercial sector – but this much can be agreed upon – all the percentages keep trending up… and up. Unfortunately, the account based plans that were supposed to accompany the HDHPs are missing in many employer sponsored plans, or at least the employer contribution is. Never the less, the trend for HDHP growth will continue.

Innovation, Transformation and Integration are the Words of the Year.  Like the old 80’s episodes of Pee-Wee’s Playhouse, with the word of the day that set off buzzers, Innovation, Transformation and Integration are the words for 2014… although they will in many cases, be words but not action at this point in time. But if your organization doesn’t yet have a Chief Innovation, Chief Innovation or Chief Integration Officer, look for them in 2014.

EHR Tipping Point Drives Innovation. Of course lots of physician practices still don’t have EHR. And a number who do aren’t all that interoperable. But still, the point has been reached where there’s gobs of stuff you can do with the level of electronic data and transmission that is now being generated – and this is going to continue to stimulate a plethora of new applications and solutions in a range of environments.

Analytics Extends Its Reach.  Analytics has become huge for so many sectors – healthcare may actually be a laggard. But make no mistake – analytics is where the action is in healthcare for 2014 if there is any hope in taming the beast of operational inefficiencies, resource management, and explosive costs.

The Further Evolution of Population Health.  Ten years ago the definition of Population Health was commonly held to be “the health outcomes of a group of individuals, including the distribution of such outcomes within the group” and was more prevalent in policy and academic circles. 2014 finds the scope and role of population health expanding and evolving, with strong involvement from the private sector.

Consumer Engagement Just Needs More Consumers to Get Engaged. In 2014, we will see the tools are there – apps, websites, outreach programs, incentive programs, plan design, you-name-it. The challenge we find ourselves in for 2014, is a number of surveys continue to demonstrate that large blocks of consumers remain unengaged, uninformed and fairly clueless about the delivery or the business of healthcare.

Humana’s Vipin Gopal on Advancing the Frontiers in Predictive Modeling

By Clive Riddle, December 10, 2013

Vipin Gopal, PhD, Vice President of Clinical Analytics for Humana gave the opening plenary presentation last week during the Seventh National Predictive Modeling Summit in Washington, DC, providing an excellent overview of the current and future state of predictive modeling in healthcare.

Vipin summarizes the state of predictive modeling from his and Humana’s perspective as follows:

• They have seen rapid evolution as a discipline over the past decade
• There is newer and better software, data sources, hardware
• There are a lot more applications
• They have a deeper understanding of their members
• There are now more efficient and effective delivery mechanisms for model output
• Predictive Modelers will make a broader and deeper impact for in the coming years

Vipin offers as advice, these guiding principles for organizations deploying predictive modeling functions:

1. Establish a set of "quick wins" to drive early results and build momentum
2. Show results to bolster the business case behind making further investments
3. Focus on the issues that have the most direct impact on the business
4. Ensure that effort is placed on key strategic issues and pressing challenges
5. Address challenges with underlying data
6. Clean and streamlined data is an enabler for the creation of more effective and comprehensive analytical models

Vipin advocates that leading-edge analytics should encompass these themes:

• Focus: Are we solving the right problems?
• Nimble: Rapid analytics to respond to business needs
• Cutting-edge Methods: State-of-the-art problem solving
• Tools: Leverage advancements in the analytics marketplace
• Optimize: Maximize output of analytic resources
• Integrate: Systems approach to data, analytics and action
• Real-time: Closing the feedback loop with the most recent data

What are the key components of predictive modeling in healthcare, according to Vipin? Three things that should all work towards improved outcomes, high engagement and reduced costs: (1) Integration of Data,

Action, and Analytics; (2) Infrastructure incorporating Consistent, comprehensive datasets, Cutting edge analytic tools, and Deployment to action; and (3) Talent (predictive modeling staff and outsourced vendors.)

Vipin notes that past modeling work primarily relied on claims data, while current work aggregates multiple data sources to create an integrated view of the member for consistent and rapid analytics.

So where are we headed with data sources? Vipin reviewed these Next-Gen sources:

• Text Based (EMR; Nurses’ Notes; Call Center Transcripts)
• Devices (Remote monitoring, Smart Phones)
• Online Data (Social Media Data, Web Footprint)

And where are we headed overall? Vipin sees a broad range of applications, including Clinical, Marketing, 

Financial, and Fraud Detection. He sees us mining deeper data sources, driven by a need to know our consumers better, while deploying more efficient delivery mechanisms that incorporate real-time alerts and mobile devices.  The “Holy Grail” in all of this? Vipin says it is predicting and influencing consumer behavior; and we need to do this in an environment in which there is a proliferation of models and we hopefully will simultaneously see efforts to have them work in unison!

Physicians: Unhappy Campers in Affordable Care Act Land

By Clive Riddle, November 22, 2013

Jackson & Coker, the healthcare staffing company, has just released survey results on current physician views of the ACA, in their 33-page report- Survey: Physicians on the Affordable Care Act. The results shouldn’t be that surprising – physicians aren’t happy campers in this brave new world.

Jackson & Coker highlighted these findings from their survey, which yielded 3,072 self-selected practicing physician respondents from a survey were emailed to subsets of a database totaling 277,778 physicians, which included physicians who have been placed by Jackson and those who have not:

• 80 % believe those patients with current coverage will wind up paying higher healthcare costs
• 765 said overall healthcare costs would go up due to the new health reform law
• 73% said patients would have less choice in picking their doctor
• 66% said they would have to spend more time on administrative duties
• 61% said their opinion of the law has changed for the worse
• 60% said the quality of patient care would be negatively impacted
• 57% said the law would have a negative impact their treatment decisions for patients
• 56% support repealing or defunding the law
• 44% said they would not participate in the Exchange

The general population’s view of the Act often boils down to political perspectives. Physicians would not seem to be immune from red and blue polarization. Indeed, a Mayo Clinic study published in the Journal of General Internal Medicine June 25, 2013 issue: Specialty, Political Affiliation, and Perceived Social Responsibility Are Associated with U.S. Physician Reactions to Health Care Reform Legislation, addressed this issue, and concluded “significant subsets of U.S. physicians express concerns about the direction of U.S. health care under recent health care reform legislation. Those opinions appear intertwined with political affiliation, type of medical specialty, as well as perceived social responsibility.”

The Mayo Clinic authors reported that “(41 %) believed that the ACA will turn U.S. health care in the right direction and make physician reimbursement less fair (44 %). Seventy-two percent of physicians endorsed a general professional obligation to address societal health policy issues, 65 % agreed that every physician is professionally obligated to care for the uninsured or underinsured, and half (55 %) were willing to accept limits on coverage for expensive drugs and procedures for the sake of expanding access to basic health care. In multivariable analyses, liberals and independents were both substantially more likely to endorse the ACA …respectively), as were physicians reporting a salary …or salary plus bonus … compensation type…..Those who agreed that addressing societal health policy issues are within the scope of their professional obligations …, who believe physicians are professionally obligated to care for the uninsured / under-insured …, and who agreed with limiting coverage for expensive drugs and procedures to expand insurance coverage …., were all significantly more likely to endorse the ACA. Surgeons and procedural specialists were less likely to endorse it.”

But beyond the impact of political persuasions and social viewpoints raised in the Mayo Clinic study, it would seem some fundamental business interests are driving the Jackson & Coker results, that boil down to these three things:

1. Concerns about impact on reimbursement levels
2. Issues regarding access to participation in applicable plans
3. Concerns about “hassle factor” of administrative requirements

MedPage Today this week published an article that seems to support these points: Docs Unhappy With ACA Exchange Plans resulting from their press coverage of the AMA’s Interim Meeting Conference. They cite Steven Larson, MD, board chairman of the California Medical Association: “the patients nor the physicians know if they're in network or not," and state “it has been a common complaint thus far, as plans have been slow to report or update provider networks for exchange plans.” With respect to reimbursement, they note “some providers have reported rates as much as 70% below what commercial plans pay, with negotiations starting at Medicaid payment levels.”

The MedPage Today article cites another survey from last month with similar results: “the Medical Group Management Association reported 55.5% held an ‘unfavorable’ or ‘very unfavorable’ view of the impact the ACA's health insurance exchanges on them,” and concludes “with these stories starting to mount, the fear is that patients -- with their insurance card in hand -- either won't be able to find a doctor who is seeing patients with that plan, or will have to travel great distances to find someone who does.”

Certainly, as with the Exchange website enrollment, much needs to still get sorted out with respect to the status of provider networks with participating Exchange plans across the country.

Checking out 16,275 Patient Health Apps

By Clive Riddle, November 1, 2013

The IMS Institute for Healthcare Informatics, part of IMS Health, this week released  their report: Patient Apps for Improved Healthcare: From Novelty to Mainstream, which examined all 16,275 apps directly related to consumer patient health and treatment (out of a total 43,689 health care apps,  of which 7,407 are for health care professionals) available from the Apple ITunes store.

Murray Aitken, executive director of the IMS Institute for Healthcare Informatics had this to say after releasing the report: “The movement toward digital therapeutics is clear. Mobile health apps have the potential to drive a disruptive shift in patient engagement and healthcare delivery. Harnessing the power of apps has become a focal point of innovation, yet barriers remain to their broad and systematic use by providers and patients. Development of clear evidence on the benefits of driving positive behavioral changes and improving health outcomes will be key to breaking through the barriers.”

The IMS analysis involved categorizing apps based on providing one or more of these functionalities:

• Inform:  Provide information in a variety of formats (text, photo, video)
• Instruct:  Provide instructions to the user
• Record: Capture user entered data
• Display: Graphically display user entered data/output user entered data
• Guide:  Provide guidance based on user entered information, and may further offer a diagnosis,  or recommend a consultation with a physician/a course of treatment
• Remind/Alert: Provide reminders to the user
• Communicate: Provide communication with HCP/patients and/or provide links to social networks

Here’s some key points from their 65 page report:

• More than 90% of healthcare apps reviewed by the IMS Institute scored less than 40 out of a possible 100 for functionality, based on 25 screening factors.
• While 10,840 of the 16,275 apps reviewed can provide and display information, less than half of those can also provide instructions and approximately 20% can also capture user-entered data.
• More than 50% of available healthcare apps have been downloaded fewer than 500 times.
• Five apps account for 15% of all downloads in the healthcare category
• Patients over the age of 65 are among the top users of healthcare resources, yet  only 18% of the elderly U.S. population use smartphones, compared with 55% of consumers age 45-54

The report identifies these four issues that must be address, ”in order for apps to move from novelty to mainstream”:

1. There must be recognition of the role apps can play in healthcare by payers and providers, as well as regulators and policymakers.
2. Security and privacy guidelines and assurances established among providers, patients and app developers.
3. A systematic evaluation of apps to inform their appropriate use.
4. The effective integration of apps with other aspects of patient care.

Survey on Consumer Engagement and Health Tracking

By Clive Riddle, October 25, 2013

Partners Healthcare’s Center for Connected Health, commissioned Harris Interactive to survey 2,000+ consumers on health engagement and tech driven tools to monitor health and wellness, in conjunction with the launch of the Center’s new Wellocracy program.  They found that almost half of respondents (48%) say they have trouble staying motivated to live a healthy life, and less than a fourth (22%) are very confident that they can keep track of their own health.

Joseph C. Kvedar, MD, the founder and director of the Center for Connected Health tells us, "there are dozens of activity and health trackers on the market today, and literally thousands of health apps available for consumers. Yet, instead of getting people moving towards a healthy lifestyle, most feel paralyzed by all these choices and the technology can be dizzying. "We know that if we give people -- young and old -- insights into their health and help them understand how lifestyle choices impact quality of life, they feel more accountable, engaged and live a healthier, more active life. Integrating 'self-health' tools like activity and nutrition trackers and sleep monitors into our daily lives, we can learn from our own behaviors and make positive changes to take charge of our health. We're taking these devices and apps, personalizing the experience and helping people figure out the right health technologies, the right strategy and the right inspiration to get on the right track to health and wellness."

Here’s finding the Center has shared from the survey results:

• 68% of consumers agree that encouragement from friends and family is important for them to achieve health goals
• 65% of consumers believe that using a health tracking device, website or app would be beneficial,
• 32% felt these tools would help them stay motivated to meet health and fitness goals
• 31% believe the tools would provide accountability
• 27% felt the tools would help them stay in control of their health

• 86% believe that feeling informed about their own health is empowering
• 59% of women and 56% of men aged 35-44 reported that it is hard to stay motivated to live a healthy life
• 52% and 51%, respectively of women and men aged 35-44 wished they could make better use of technology to keep track of their health
• 55% of women and 49% of men aged 18-44 believe that easy tracking  is essential to achieving health-related goals
• 48% of women and 42% of men aged 18-34 reported that encouragement from family and friends is essential
• 42% of women and only 20% of men aged 45-54 reported that support and tools from their healthcare provider is essential
• 19% of women and 17% of men aged 35-44 are very confident in their ability to keep track of their own health
• 25% of women and 21% of men aged 55 and over are very confident in their ability to keep track of their own health

• 56% of all consumers  have never used any type of health tracking device, app or website
• Adults aged 18-34, were most likely to use diet (23%) or fitness apps (26%) on their phones
• 7% of adults aged 55 and over reported ever using a diet app and only 3% have used a fitness app on their phone
• 35-44 year olds were the age group reporting the highest use of digital activity pedometers (19%)
• 5% of adults aged 18 and over reported ever using a sleep tracker

While these results are encouraging for engagement initiatives, we need to remember that they survey indicates more than half of consumers have never used any such tool – even a website.

Health Insurance Marketplace Opening Week Enrollment

By Clive Riddle, October 11, 2013

The opening bell sounded, and public exchanges were open for business on October 1st amidst much noise about startup glitches. Health Insurance Marketplace News, in its current issue, provided the following infographic providing opening week enrollment and volume statistics for selected exchanges:

The newsletter also provided these links to releases from these exchanges with further details about their opening week activity, and the length of time the infographic data represented for each exchange:

Press Release, Covered California

Data through October 5, 2013

Press Release, Connect for Health Colorado

Data for October 1st and 2nd 2013

Press Release, Access Health CT-stats 10/8

Data through October 8, 2013

Press Release, Hawai'i Health Connector 10/2

Data through October 2, 2013

Press Release, New York Health Benefit Exchange 10/8

Data Through October 8, 2013

Press Release, Washington Healthplanfinder 10/7

Data through October 7, 2013

Taking a deeper  look at Covered California for example, we compiled the following additional statistics from their release:

• Average wait time: 15:08 *
• Average handling time: 16:48
• % Applications only partially completed: 62.6%
• Number of Californians determined eligible for coverage: 28,699
• Small Business Health Options Program businesses registered as of 10/8/2013: 430
• *Average wait time was reduced to less than four minutes by Friday, 10/4/2013

It will be quite interesting to see what data becomes available for the full month of October, after month end.

Consumer Surveys: Finding a Doctor, and Finding Out About Electronic Medical Records

By Clive Riddle, October 4, 2013

Two studies released this week examine aspects of consumer-physician relationships.  The American Osteopathic Association conducted a survey on consumer physician selection. AOA found that “word of mouth” is still the reigning tool for physician selection even in this digital age. Once consumers have selected a doctor, their physician’s may not be doing all that much to communicate with them or educate them about digital health records, Xerox concluded in their fourth annual study on electronic medical records.

The AOA survey found the top five resources adults utilize when selecting a physician for themselves or a loved one  to be:

• Word of mouth, i.e. family, friends, coworkers (65.9%)
• Insurance provider directory (51.9%)
• Physician rating websites, i.e. Vitals, Healthgrades (22.8%)
• Hospital website (10.8%)
• Consumer review websites, i.e. Yelp (10.5%)

Here’s an interesting finding  about younger adults that embrace the digital age more than they order counterparts:  “when selecting a physician for themselves, younger adults are much more likely to use “word of mouth” than older adults (77.1% among 18-29 year olds, 64.6% among 30-49 year olds and 59.8% among 50-79 year olds).”

Regardless of the tools used, the AOA survey found the most important factors in the selection decision to be:

• Acceptance of insurance plan (83.3%)
• Bedside manner/empathy (60.5%)
• Proximity of office to home, work or school (57.4%) 
• Convenient office hours (42.9%)
• Medical specialty (37.5%)

The AOA survey also addressed de-selection, with the top reasons for leaving a doctor being:

• moved out of the area (34.7%)
• didn’t feel physician was a good fit (33.9%) 
• changed insurance provider (21.2%)
• physician retired or moved (19%)

Meanwhile, Xerox found that “only 29 percent of those who have a doctor have been informed their medical records will be converted to digital format. While this shows a 13-point improvement from four years ago, the survey results continued to show that the majority of Americans (83 percent) have concerns, such as security, about EHRs and less than one-third (32 percent) want their medical records to be digital (compared to 82 percent and 26 percent in 2010, respectively).”

Here’s the infographic Xerox released with the survey results:

Annual Census Report on Health Insurance Coverage: What Will this Report Look Like After 2014?

By Clive Riddle, September 19, 2013

The U.S. Census Bureau has just released their annual report: Income, Poverty, and Health Insurance Coverage in the United States: 2012. This year’s 88-page report was “compiled from information collected in the 2013 Current Population Survey (CPS) Annual Social and Economic Supplement (ASEC). The CPS-ASEC was conducted between February-April 2013 and collected information about income and health insurance coverage during the 2012 calendar year.”

The key takeaway? “The percentage of people without health insurance coverage declined to 15.4 percent in 2012 ─ from 15.7 percent in 2011. However, the 48.0 million people without coverage in 2012 was not statistically different from the 48.6 million in 2011.”

Here’s some summary figures compiled from the report:

	2011%	2012%	2011#(mil)	2012#(mil)
Uninsured	15.7%	15.4%	48.0	48.0
Private Coverage	63.9%	63.9%	197.3	198.8
Public Coverage	32.2%	32.6%	99.5	101.5

Here’s the respective demographic from each category with the greatest improvement in percentage change in uninsured from 2012 over 2011, compiled from the report:

• Family Status: unrelated subfamilies -5.3%
• Race: Asia -1.7%
• Age: under age 25 -0.5%
• Nativity: foreign born naturalized citizen -0.9%
• Region: Midwest -0.8%
• Work Experience: Did not work at least one week -0.9%

Finally, here’s a breakdown of the percentage of the total population covered by more specific coverage categories for 2011 and 2012; the totals add up to more than 100% due to dual coverage:

	2011%	2012%
Employment based	55.1%	54.9%
Direct-purchase	9.8%	9.8%
Medicare	15.2%	15.7%
Medicaid	11.5%	11.3%
Military	4.4%	4.4%
Uninsured	15.7%	15.4%

The big question is, what will this report look like two years from now, when the 2014 data is compiled?

NBGH Annual Survey: Consumer Driven Plans, Private Exchanges and Seven-Percent

By Clive Riddle, September 6, 2013

The National Business Group on Health recently released findings from their annual benefits survey addressing plan design and cost issues for 2014. What did they conclude after getting results from 108 large employer organizations? The cost of providing health benefits will rise 7% (third consecutive year projected at that  rate); employers continue to further embrace consumer driven plans; and there is potential interest in exchanges – particularly private exchanges.

Regarding consumer driven care:

• 36% of respondents said consumer driven plans were the most effective tactic to control rising costs
• 72% offer at least one CDHP
• 22% planning to implement a total replacement CDHP next year, up from 19% this year

Meanwhile, NBGH President Helen Darling tells us “Private exchanges are another option some employers are considering. In the last year, there has been an increase in the number of private exchanges that are being launched. And while some employers are considering private exchanges for active employees sometime in the future, very few (3%) are considering eliminating health care coverage entirely,” said Darling.

41% responded that COBRA participants might find public exchanges to be the most cost effective option. 26% felt some pre-65 retirees might opt to join exchanges, while 20% believe that some part-time employees will do so.

The survey also covered these topics:

• 44% currently have an on-site clinic in at least one of their locations, with 9% are expecting to build a clinic next year
• 66% will cover surgical interventions for the treatment of severe obesity in 2014
• 36% will cover FDA-approved medications and intensive, multi-component behavioral interventions for participants with a BMI of more than 30
• 89% offer a tobacco cessation program
• 77% offer telephonic or on-site health coaching
• 55% offer on-site weight management programs
• 88% conduct health assessments
• 83% do biometric screenings

The Context of Y2K for Healthcare: 1999 vs. 2013

By Clive Riddle, August 22, 2013

I was surprised to see this headline pop up in my email – Will health insurance exchange launches be the 'next Y2K'? from an article in the August 12, 2013 issue of FierceHealthIT.  Intrigued, I clicked to find the article subheader warning that “Some computer experts warn of possibility of system overload.”

Further intrigued, I started googling Y2K and Health Insurance Exchanges.  On the same day, Benefitspro ran this article: IT threatens exchange enrollment which reported that “at this summer’s Colorado State Association of Health Underwriters’ annual symposium in Denver, one speaker warned the exchange launch could be the “next Y2K” — millions of Americans logging on in October might overwhelm the exchanges.”

Just below that, my search results displayed:  Y2K All Over Again. Can the Insurance Marketplaces Handle Opening Day? from the  Navix Blog (an on-line insurance brokerage company ) posted on August 5^th.

My bemusement connected with these analogies? Their references to Y2K were in the 1999 context – warning us of all the monumental problems that would unfold after the event.  The correct post-Y2K context of using the term Y2K would seem to be, referring  all the preparation that is involved for such an undertaking, not the aftermath (which by the way didn’t bring about a zombie apocalypse or the crash of modern society as we know it.)

So I googled on – there wasn’t a preponderance of current health insurance exchange references, but there were a number of references to the ICD-10 conversion and Y2K, such as Deadline ICD-10: Y2K all over again? from Health Management Technology in December 2010 and more recently - Schools beef up medical coder ranks before ‘Y2K of health care’ from the South Florida Business Journal, on February 15, 2013. All in all there were 8,120 google search results for ICD-10 combined with Y2K. But in this case, the articles mostly seemed to get the context right – the emphasis was on preparation.

Then I found where the references started crawling out of the woodwork: with the more broad-brush of Obamacare.  A whopping 1,110,000 google search results were yielded with Obamacare combined with Y2K. The specifics of these articles were all over the map: Obamacare's Y2K: Coverage for pre-existing conditions and Y2K was a Breeze Compared to State IT Prep for ObamaCare for example. The context for use of Y2K (maybe for Obamacare we could call it YOb) was a mixed bag. But the 1999 context was way too prevalent in the limited click-thrus I browsed – with a common denominator being that the political oriented rants seemed to get it wrong the most. 

Ten things to know about 2013 Health Savings Account Data

By Clive Riddle, August 9, 2013

Devenir has just released their 2013 HSA Research report. The survey data was collected in July 2013 and primarily consisted of the top 50 HSA providers in the health savings account market, with all data being collected for the June 30th, 2013 period.  The six page executive summary provides some great, concise data, which includes these ten takeaways:

1. The total number of HSA accounts rose to more than 9.1 million with assets totaling nearly $18.1 billion.
2. This represents a year over year increase of 29% for both accounts and assets for the period of June 30th, 2012 to June 30th, 2013.
3. The average account balance halfway through 2013 grew to $1,981 from $1,879 at the end 2012, over a 5% increase.
4. When you eliminate identified zero balance accounts that average rises to $2,228, an almost 3% year over year increase.
5. Current average account balances by the year the account was opened range from $5,117 for accounts opened in 2005 to $1,192 for accounts opened in 2012 (and $775 for accounts opened this year to date).
6. Total contributions to HSA accounts from June 2012 to June 2013 are estimated to have reached $16.7 billion, with accountholders retaining about 23% of those contributions.
7. Debit cards represent 74% of all withdrawal transactions, with an average of 5.1 annual debit card withdrawals per account for an average $124.48 per transaction.
8. Currently 14% of HSA assets are comprised of investments .
9. HSA investment assets reached an estimated $2 billion in June, up 14% from the end of 2012 and 26% year over year. The average investment account holder has a $10,484 average total balance (deposit and investment account).
10. Devenir projects that year-end 2013 assets will total $20 billion, and 2015 HSA assets will reach $29.3 B, comprised of $4.2B in investments, and $25.2B in deposits.

I only wish our family’s HSA account balance was followed by a capital “B” as well.

PhRMA’s Consumer Health Survey: Honest Answers Indicate a Long Ways to Go

By Clive Riddle, August 2, 2013

The Pharmaceutical Research and Manufacturers of America (PhRMA) – just released findings from their new annual “From Hope to Cures” survey, which “explores Americans’ attitudes on personal health and medical concerns.”  What did PhRMA have to say about their new report?  President John J. Castellani, tells us "a patient-centric dialogue is crucial to improving health outcomes. The Health Survey findings will help also inform efforts to address major health challenges such as chronic disease, improved prevention and wellness activities and enhanced patient adherence to prescribed therapies.”

What do I get out of the report? The respondents were surprisingly honest (in many surveys consumers tend to rate themselves more on top of their health behaviors.) Large percentages don’t seem to be as engaged as some other studies have led us to believe.

58% say there are paying more attention to their health compared to a few years ago. This means 42% of consumers are not stepping up their game.  Here’s the depressing part – consider these percentage who said they are paying more attention to these health behaviors:

• 57% - eating a healthy diet
• 54% - maintaining a healthy weight
• 48% - reducing stress
• 41% - exercising regularly
• 37% - taking medicine as prescribed
• 37% - getting plenty of sleep
• 35% - seeing doctor regularly
• 33% - monitoring blood pressure
• 23% - moderating alcohol

Okay – so if over 40% are NOT paying more attention to their diet or weight, and well over 50% are NOT paying more attention to the other above listed behaviors, the must be because they are in pretty good shape already, so they don’t need to pay even more attention – right?

So, when asked to describe their health for the year, these percentages responded good or great:

• age 18-34 - 71%
• age 35-49 - 61%
• age 50-64 - 53%
• age 65+    - 56%
• overall       - 61%

So almost 30% in the prime of their life say their health isn’t good, and almost half above age 50 say the same. Wouldn’t that be cause for large numbers to be paying more attention to some of these health issues?

The survey covered a number of other topics, which were probably of bigger concern to PhRMA in tying consumer perceptions to their mission, but the above disconnect with consumer engagement is what engaged me.

CMS Pronouncements on Pioneer ACO Results and 2014 HIX Premiums

By Clive Riddle, July 18, 2013

This week CMS announced results from the first performance year of the Pioneer Accountable Care Organization (ACO) Model, along with a new report that finds premiums in the Health Insurance Marketplace will be nearly 20 percent lower in 2014 than previously expected.

Here are the Pioneer ACO results that CMS is touting:

• Costs for the more than 669,000 beneficiaries aligned to Pioneer ACOs grew by only 0.3 percent in 2012 where as costs for similar beneficiaries grew by 0.8 percent in the same period.
• 13 out of 32 pioneer ACOs produced shared savings with CMS, generating a gross savings of $87.6 million in 2012 and saving nearly $33 million for Medicare
•  Pioneer ACOs earned over $76 million in compensation.
• Only 2 Pioneer ACOs had shared losses totaling approximately $4.0 million.
• All 32 Pioneer ACOs successfully reported quality measures and achieved the maximum reporting rate for the first performance year, with all earning incentive payments. 
• Overall, Pioneer ACOs performed better than published rates in fee-for-service Medicare for all 15 clinical quality measures for which comparable data are available.
• 25 of 32 Pioneer ACOs generated lower risk-adjusted readmission rates for their aligned beneficiaries than the benchmark rate for all Medicare fee-for-service beneficiaries.
• The median rate among Pioneer ACOs on blood pressure control among beneficiaries with diabetes was 68 percent compared to the comparison value of 55 percent as measured in adult diabetic population in 10 managed care plans across 7 states from 2000 to 2001. 
•  Pioneer ACOs performed better on clinical quality measures that assess low density lipoprotein (LDL) control for patients with diabetes. The median rate among Pioneer ACOs for LDO control among beneficiaries with diabetes was 57 percent compared to 48 percent in an adult diabetic population in 10 managed care plans across 7 states from 2000 to 2001.
• Pioneer ACOs were rated higher by ACO beneficiaries on all four patient experience measures relative to the 2011 Medicare fee-for-service results.

CMS did disclose that seven Pioneer ACOs that did not produce savings intend to switch to the Medicare Shared Savings Program, and two Pioneer ACOs have indicated their intent to leave the program. 

The Wall Street Journal  didn’t interpret these results as rosily as did CMS. Here is the WSJ take, from their July 16^th article Mixed Results in Health Pilot Plan: “All of the 32 health systems in the so-called Pioneer Accountable Care Organization program improved patient care on quality measures such as cancer screenings and controlling blood pressure, according to data to be released Tuesday by the Centers for Medicare and Medicaid Services. But only 18 of the 32 managed to lower costs for the Medicare patients they treated—a major goal of the effort. Two hospitals lost money on the program in the first year. Seven have notified CMS that they intend to move to another program where they will face less financial risk. Two others have indicated they intend to leave the program,”

On the Health Insurance Marketplace front, CMS touted findings from a just released twelve-page ASPE Issue Brief: Market Competition Works: Proposed Silver Premiums in the 2014 Individual and Small

Group Markets Are Nearly 20% Lower than Expected. CMS notes the report found that:

• In the 11 states (including the District of Columbia) that have made information available for the individual market, proposed premiums for 2014 are on average 18 percent lower than HHS’ estimate of 2014 individual market premiums derived from CBO publications.
• In the six states that have made information available in the small group market, proposed premiums are estimated to be on average 18 percent lower than the premium a small employer would pay for similar coverage without the Affordable Care Act.
• Preliminary premiums appear to be affordable even for young men. For example, in Los Angeles - the county with the largest number of uninsured Americans in the nation - the lowest cost silver plan in 2014 for a 25-year-old individual costs $174 per month without a tax credit, $34 per month for an individual whose income is $17,235, and a catastrophic plan can be purchased for $117 per month for an individual.

Here a chart provided in the ASPE report, comparing the ASPE premium estimate for Individual Silver premiums compared to actual premiums for applicable states:

Consumer More Generous This Year with Expressing Health Plan Satisfaction

By Clive Riddle, June 28, 2013

J.D. Power has just released their excellent annual Health Plan Study of Satisfaction.  I got a different major takeaway from the study than did the folk at J.D. Power, although I also agree with their conclusions. Their take is in the context of the impending health exchange environment: “With such alternative healthcare purchasing choices as public and private exchanges--or cutting coverage altogether--taking shape among employers, health plans risk losing group business unless they improve employer satisfaction.” 

The J.D. Power study “is based on responses from 5,857 employers, with quotas to assure an adequate distribution of small, medium and large companies. The study was fielded in April and May 2013. …The study, now in its fourth year, measures six key factors that affect employer satisfaction with health plans: employee plan service experience; account servicing; program offerings; benefit design; problem resolution; and cost. Health plans are ranked in two employer segments: fully insured employers (health plan assumes the risk of providing health coverage for insured events); and self-funded employers (employers bear the risk associated with offering health benefits).”

Richard Millard, J.D. Power’s senior director of the healthcare practice  tells us “health plans need to understand the importance of satisfaction in order to limit the erosion of their business from employer-sponsored coverage to alternative channels where employees have more choices. Those health plans that focus on closing the satisfaction gap across key performance factors are more likely to retain employer-sponsored group contracts."

J.D. Power notes that “nearly one-fifth (15%) of employers say they "definitely will not" or "probably will not" continue sponsoring coverage in five years. Among employers in both segments, there is a 90-point gap in overall satisfaction scores between employers that intend to offer coverage in the future and those that intend to discontinue coverage.”

They go on to point out that “in both the fully insured and self-funded segments, employer satisfaction with program offerings, such as preventive health programs, disease management or wellness initiatives, is a key area of differentiation between employers that intend to offer coverage in the future and those that intend to drop coverage.  In the program offerings factor, the gap in satisfaction scores between fully insured employers that intend to offer coverage in the future and those that intend to drop coverage is 104 points--705 among employers that intend to offer coverage, compared with 601 among those that intend to drop coverage. Among self-funded employers, the gap in satisfaction scores between those that intend to offer coverage in the future and those that intend to drop coverage is also 105 points--689 among employers that intend to offer coverage, compared with 584 among those that intend to drop coverage.”

All good point as 2014 hovers over health plans. But what I found interesting was that health plan satisfaction scores improved significantly almost across the board for plans, compared to their 2012 study. I compiled their 2012 results with the current results J.D Power made available:

Overall Customer Satisfaction Index Scores
(Based on a 1,000-point scale)

Fully Insured Employer Segment	2013	2012
HCSC	741	697
Cigna	737	689
Kaiser	737	718
Aetna	724	670
Fully Insured Segment Average	709	675
WellPoint/Anthem	707	658
UnitedHealthcare	703	663
Humana	693	691
Self-Funded Employer Segment
Cigna	707	643
Self-Funded Segment Average	696	665
Aetna	694	682
WellPoint/Anthem	692	631
UnitedHealthcare	669	662

What is the cause of the rise in satisfaction? The 2011 overall rate full insured was 696, so the rate dropped in 2012, and rebounded even higher in 2013. What are the implications of this improvement in satisfaction as the health exchange landscape takes shape?

Here’s a graphic J.D. Power provided on fully insured satisfaction results:

It Depends on the Outcome: Payments for Providers – Benefits for Consumers

By Clive Riddle, May 10, 2013

Two separate studies released this week took the pulse of the outcomes-based financial landscape in healthcare at different ends of the spectrum: Availity released a sixteen-page white paper: Health Plan Readiness to Operationalize New Payment Models for providers, while the Midwest Business Group on Health released a twenty-page report: Employer Survey on Incentives, Disincentives & Outcomes-Based Incentives for employees.

The Availity study was conducted by Porter Research in the fourth quarter of 2012, involving interviews of 39 health plans. 82% of the plans consider payment reform a ‘major priority. 90% expect value-based payment models to impact their top three business objectives ( 46% expect a ‘major’ impact, while 44% anticipate ‘some’ impact.)

That doesn’t mean value based payments are mainstream today.  Just 20% say value-based models

support more than half of their businesses today.  But 40% predict that in three years, value-based models will support more than half of their businesses; and nearly 60% forecast that more than half of their business will be supported by value-based payment models in the next five years. And, of those, 60% are at least mid-way through implementation.

While the ACA uses Medicare as a primary tool to promote provider payment reform, the marketplace seems to be focusing health plans even more on the commercial side. More than 75% say they are focusing value-based payment efforts on their Employer Group plans, compared to 54%  for Medicare plans  and 46% and 44% citing Medicaid plans and Individual plans..

Availity noted that “transitioning to payment models that base compensation on outcomes requires physicians and health plans to exchange new kinds of information – different than what is required under today’s predominant fee-for-service arrangements. 90% of health plans agree that automating the exchange of ‘new’ information required under value-based payments is critical to success, with 85% saying the highest value will come from real-time exchange, though less than half have real-time capabilities.”

Meanwhile, the Midwest Business Group on Health employee incentive study was conducted during April 2013, with responses from 94 self-funded employers that represented multiple industries and locations around the US.  They found that “80% of responding employers are utilizing some form of incentives, with 41% using or planning to use outcomes-based incentives to increase engagement and participation as well as motivate healthy behaviors in employer-sponsored programs.”

Here MBGH findings from the study regarding outcomes-based Incentives:

• Employers responded that 13% are already offering outcomes-based incentives and 28% are planning to launch programs over the next one to two years, while 40% indicated interest, but need more information.
• Of those currently offering outcomes-based programs, 54% tie incentives to both outcomes-based measures (i.e. meeting specific targets such as BMI of 25) and improvements in outcomes (i.e. percentage decrease in BMI), versus one or the other.
• Onsite clinical screening programs are used by 94% of employers as the way to capture biometrics with the top measurements being: 86% blood pressure, 81% BMI, 73% cholesterol, 68% glucose, and A1c and waist circumference tied at 59% each.
• Employers said that 18% are experiencing participation levels of over 90% for outcomes-based programs; while the majority (60%) is experiencing participating levels of 40 to 80 percent.
• Employers indicate that 98% of employee feedback is “somewhat positive” to “very positive.”
• Degree of difficulty is notable with 95% of employers finding some level of difficulty in implementing an outcomes-based program.

Also, MBGH shared this data regarding the overall offering of incentives/disincentives:

• Of the 18% of employers who reported not offering incentives or disincentives, 53% indicated the reason was that it was not part of their corporate culture and 47% are not sure it works.
• For those employers offering incentives, 62% reduce premiums, 38% use gift cards and 35% offer merchandise.
• Of those employers that use disincentives, 43% increase employee share of premiums for non-compliance and 14% have higher plan deductibles or out of pocket fees.
• Activities that most employers’ incented included biometric screenings (70%) and health risk assessments (78%), with the greatest disincentive (78%) being used for tobacco use.
• The monetary value of incentives programs varies widely, with $250-500 for 27% of those offering programs, $100-250 for 22% of employers and $500-1,000 for another 22% of companies.
• Employers indicated that 71% found their incentive strategy was “very successful” or “successful” and 45% viewed their disincentive strategy as “very successful” or “successful.”
• With the Affordable Care Act (ACA) in 2014 allowing employers to increase their incentives from 20 to 30 percent of total coverage, almost 67% said they are “very likely” or “likely” to do so and almost 36% are “not very likely” or “not likely.” For tobacco users, the ACA allows employers to increase the value from 20 to 50 percent, with employers indicating 48% “very likely” to “likely” and 52% “not very likely” to “likely.”

Anchors Aweigh!

By Clive Riddle, May2, 2013

In MCOL’s current issue of ThoughtLeaders, the question was asked “Which provision of the Affordable Care Act do you feel has had the greatest degree of success thus far with regard to implementation and achieving its objectives?”

The sage, and always insightful Peter Kongstvedt, MD, provided a response with an intro that demands repeating in part here, because it is that good:

Peter opens his reply with: “The answer to this or any other question must always be preceded with a question: Who’s asking? In other words, how successful or effective something is depends on who is defining success or effectiveness. The following table illustrates this:”

Person	Thing	Effectiveness
Drunk Don, drowning after diving into a pool	Inflated inner tube	Life-saving, thank God
	Gallon of water	No thanks, I take mine neat
	200 pound anchor	Is this a case of Murder?
Desert Pete, far from civilization without his mule or canteen	Inflated inner tube	In the desert? Useless
	Gallon of water	Life-saving, thank God
	200 pound anchor	In the desert? Worse than useless
Yachtsman Biff on his unmoored sloop, foundering off the lee shore of a rocky isle	Inflated inner tube	May need it if can’t anchor yacht
	Gallon of water	May need if need to abandon ship
	200 pound anchor	Life-saving, thank God

The wisdom of Peter’s anchor analogy is not only humorous, it is quite profound.  We all need to keep Drunk Don, Desert Pete and Yachtsman Biff in mind as we tackle the spectrum of healthcare issues stretching out from here to the horizon, with the understanding that whether we’re talking about reform policy issues, readmissions management, health plan marketing segmentation, performance analytics, wellness incentives, and on and on…. the needs, solutions, outcomes and metrics are not one size fits all. Populations, geography, situational scenarios..they all matter.

Peter expanded on his ThoughtLeaders response in his own blog, which is highly recommended reading. I urge you to click now and check out the KvedtBlog from PR Kongstvedt Company!

Health Sector Economic Indicators – Altarum Institute

By Clive Riddle, April 12, 2013

Altarum Institute each month issues Health Sector Economic Indicators Briefs through its Center for Sustainable Health Spending. The brief cover health care spending, utilization, prices, and employment, and are worth perusing each time. 

Altarum’s Charles Roehrig, Director of the Center, had this to say about their current assessment of health care in the economy:  “Health spending has remained at about 18 percent of gross domestic product since mid-2009, but health employment continues to slowly increase as a share of total employment.  Expanded coverage under the Affordable Care Act should push these figures upward, but an improving economy will push in the other direction as non-health spending and jobs accelerate. We look forward to tracking how these forces play out.”

Here’s the current pulse of the health care economic sector from Altarum’s just issued April briefs, which incorporate February and March 2013 data:

• National health care spending in February 2013 grew 3.9% relative to February 2012
• Health care price growth rose to 1.7% in February 2013 compared to February 2012, two-tenths above January 2013 reading
• This was still the second lowest rate of price increase since 1.3% growth recorded in December 1997.
• The 12-month moving average price growth at 1.9% in February 2013 is the lowest since the same figure recorded in November 1998.
• In February 2013, health spending increased to a seasonally adjusted annual rate of $2.89 trillion, slightly higher than its value of $2.88 trillion in January.
• The health spending share of the gross domestic product was steady at 18.0% in January 2013, up from 16.4% at the start of the recession in December 2007.
• Health spending by category in February 2013: Hospital – 32%; Physician & Clinical – 19%;  Prescriptions – 10%; Nursing Home – 5%; Dental – 4%; Home Health – 3%; Other personal healthcare – 11%; Other health spending – 16%
• Year-over-year, hospital prices rose to 2.6% in February (from 2.0% in January). Physician and clinical services rose 0.8%, barely above the low 0.6% January print.  Prescription drugs saw price growth tumble to 0.8%, from 4.0% as recently as August 2012, and the lowest since 0.7% in June 2007.
• Implicit per capita health care utilization averaged 1.3% growth over the last 12 months.
• Health care employment rose by 23,000 jobs in March 2013, somewhat below the 24-month average increase of 24,000
• Health care represented 10.74% of total employment in March 2013, compared to 10.67% a year ago and 9.49% in December 2007.